Men Are Not Always Thinking About Sex. Study Says: There Are At Least 4 "Good" Reasons They Don't - Stress Is #1! Plus: A Proven De-Stress Protocol to Restore Your Libido

If either of these individuals remind you of yourself, you should reduce his stress levels.

Recent research suggest: The good old saying that "Men always think about sex!" is essentially untrue (The "!" indicates that I used the feminist version of this common "wisdom").

If we put faith in the results of a recent European study from the Department of Clinical Psychology at the Instituto Universitário in Lisbon, Portugal, the Department of Psychology at the University of Tromsø in Tromsø, Norway, and the Sexology Unit at the Faculty of Humanities and Social Sciences, University of Zagreb, Croatia, stress is the common denominator that distracts men from their original duty to do what has to be done for the survival of the human race ;-)

Homo coitum quaerens aut evitarens?

It may sound surprising, but unlike sexual function, the sexual desire of the male members of the human race has not been examined as extensively as the one of their female counterparts. When you think about the initially quoted "wisdom", it is actually not that surprising.  Men are are after all believed to be always looking for the next "catch".

The problem cannot be that prevalent, can it? Yes it can! According to recent data from the The National Health and Social Life Survey (NHSLS), the average American's prevalence of “lacking desire for sex” ranged from 14% (for those 18–29 years old) to 17% (for those 50–59 years old). In spite of the fact that the exact figures are debatable, the currently available literature supports the notion that 15-20% of the US men 'don't think about sex at all'. If we take a look at international data the figures don't look better: Depending on the geographic region 13% to 28% of the ~14,000 men aged 40–80 years from 29 countries in the Global Study of Sexual Attitudes and Behaviours said that their sexual desire had been low for at least 2 months Laumann. 2005).

After focusing more or less exclusively on functional aspects of male sexuality for decades, research does now start to draw and embrace a more versatile image of male and general human sexuality. According to studies by Hyde and Janssen, the black-and-white gender differences which is also at the heard of the saying "men think about sex all day" is in fact non-existent. On the contrary, gender theorists have recently suggested that greater diversity exists within gender than between gender (Hyde. 2005+2007; Janssen. 2008).

Sexual disinterest is stressful!

Faced with the surprisingly high rates of sexual disinterest in men, scientists like Mccarthy et al. have already identified several major relationship problems as potential culprits. In view of what you've learned already, it should be obvious that these problems are not necessarily related to the 'classic' mismatch in sexual interests between a hyperactive male and an (under-)active female partner. On the contrary, the data in Figure 1 makes it plain obvious that for men in their thirties, it would not be unlikely that they are disinterested and their wives or girlfriends dissatisfied.

It goes without saying that problems like these and the mismatch between the perceived and the expected level of sexual desire are stressing - very stressing, according to the data Ana Carvalheira's, Bente Træen's and Aleksandar Štulhofer gathered in inteviews with heterosexual men from Portugal, Croatia, and Norway (Carcalheira. 2013):

Figure 1:Lack of desire and professional stress, two sides of the same coin? Data based on Carcalheira (2013)

In the worst case scenario a man will get caught in a vicious circle of professional stress ⇆ lack of sexual desire ⇆ private stress that is hard to break. Against that background it's only logical that the essence of the recommendations in the bottom line of this article is to get rid of the stress that's keeping you from thinking about sex.

"Stress ⇆ Sexual Disinterest" - it's that easy!

A 2013 study by Talbott et al. suggests that Tongkat Ali, a traditional testosterone and libido booster works mainly be reducing stress levels (learn more)

If you don't believe in the deeper truth of this 'equation', I suggest you go back to an article I wrote earlier this year (see Beyond Testosterone: 200mg/day of Tongkat Ali (Eurycoma Longifolia) for Stress Management & Improved Mood!?" | read more). It deals with a traditional "testosterone booster" and its effects on stressed individuals... you will see: Stress is not only a libido-, it's also a testosterone -killer (no surprise, right?).

It is thus not really surprising that the data from the Carcalheira study tells us that men who feel distressed about their own lack of libido were 2.5x more likely to suffer from anxiety right before sex  and/or have trouble maintaining an erection.

To be stressed or not to be stressed - that's the question!

Just as the cliche would have it, the highly reserved Norwegians were 3x more likely than the red-blooded self-proclaimed Latin lovers from Portugal to suffer from a lack of sexual desire. With a 50% higher risk of losing interest in the other sex, the participants from Croatia end up somewhere in between the 'Latin lovers' and the 'prudish Vikings'.

Table 1: Sociodemographic characteristics, individual variables, and relationship-related characteristics as correlates of a distressing lack of sexual interest among healthy heterosexual men who are not using antidepressants (Carcalheira. 2013)

Aside from their origin there were other sociodemographic characteristics, individual variables, and relationship-related characteristics which were found to be associated with the an increased risk of suffering from a lack of sexual desire. As the data in Table 1 goes to show you, having children, even young ones, was, contrary to what you may have expected, not among these characteristics. In contrast to the self-confidence on erectile function, of course.

What's I personally find quite telling is the high rate of a distressing lack of sexual desire in long-term (5years +) relationships and as a consequence of an indifferent attitude towards the attractiveness of the sexual partner. Interestingly, finding your wife or girlfriend "neither attractive, nor unattractive" is an even greater turn down than thinking of her as a "very unattractive" (see Table 1).

"And that's all stress?"

No, that's not all stress... In the previous paragraph we have already learned about a libido killer that cannot be traced back to stress: The lack of 'adventure', 'novelty' or whatever you may call it - a phenomenon which is probably also the reason that people start looking at their partner as "neither attractive nor unattractive" is another important contributor to sexual disinterested in men. One out of 22 if you will - 22 items on the scientists list of potential causes of a reduced sexual interest:

Table 2: Self-assessed causes of a reduced sexual interest during the past 6 months among heterosexual Portuguese, Croatian, and Norwegian men in percent (Carvalheira. 2013)

I know, not all of them appear logical. Why would masturbating too often be associated with a reduced interest in sex? ⇦ That does not sound right - right? Something similar can be said for the Croatian porn fans (22.5%). In the end, though, it does not change the overall picture: It is stress that's gnawing at our sexual desire, guys.

The Dimou protocol: Diaphragmatic breathing is performed by taking deep diaphragmatic inspirations followed by slow prolonged expirations.  In the second phase of PMR relaxation, patients were guided through successive contractions and relaxations of different large muscle groups in a down-top orientation. The process was complemented by guided imagery involving mental exercises, designed to allow the mind to influence the health and well-being of the body (GI is used with standard medical treatment in people with cancer and other diseases, such as fibromyalgia, as it can help to reduce stress, depression and manage pain). In each step, the patients were encouraged to focus on the difference between tension and relaxation, thus gradually sharpening the perception of the relaxation response.

What So what can be done? By now the question "what can be done" should - at least on the surface level - already have a rhetorical character. It's obvious that you have to de-stress. The only question is: How do you do that? Luckily (for us), P.A. Dimou et al. have just successfully tested an anti-stress program that consisted of progressive muscular relaxation (PMR), diaphragmatic breathing and guided imagery and was topped off with a handful of tips to achieve better time management. The program was designed to optimize sexual health in young men and it worked! It worked like a charm: Over the course of the 8-week stress management program practicing the PMR + diaphragmatic breathing + guided imagery regime twice a day effectively reduced the number of men who were totally or somehow dissatisfied with their sex life decreased from 9 to 4 (-55%; cf. Dimou. 2013). Aside from the intended benefits in sexual satisfaction, the young 60 young men in the active arm of the Dimou study also lost weight (-3% BMI), felt less overall less stressed (-23%; social stress subscale -11%) and achieved +6% higher scores in the general health evaluation.

PMR and guided imagery does not sound like you? Well, I guess simply limiting your mobile phone, email, Facebook and SMS use, making room for the occasional time out with a cup of tea during the working hours, a rigorous 7h+ sleeping regimen and letting go of the 'more is more principle' will work wonders even in the absence of 'meditative' interventions....ah, and don't forget: Don't stress about de-stressing that would ruin all your efforts to find inner peace ;-)

Reference:

• Carvalheira A, Træen B, Štulhofer A. Correlates of Men’s Sexual Interest: A Cross-Cultural Study. J Sex Med. 2013 [accepted manuscript]
• Dimou PA, Bacopoulou F, Darviri C, Chrousos GP. Stress management and sexual health of young adults: a pilot randomised controlled trial. Andrologia2013,xx, 1–10 [accepted manuscript]
• Hyde JS. The gender similarities hypothesis. Am Psychol 2005;60:581–92.
• Hyde JS. New directions in the study of gender similarities and differences. Curr Dir Psychol Sci 2007;16:259–63.
• Janssen E, McBride K, Yarber W, Hill B, Butler S. Factors that influence sexual arousal in men: A focus group study. Arch Sex Behav 2008;37:252–65.
• Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T; GSSAB Investigators’ Group. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005;17:39–57
• Mccarthy B, McDonald D. Sex therapy failures: A crucial, yet ignored, issue. J Sex Marital Ther 2009;35:320–9.

40% Increase in Total + 50% Increase in Free Testosterone - Two Not Necessarily Undesirable Side Effects of Sildenafil. Human Study Confirms Direct Effect of PDE-5 Inhibition

Either you buy one of the bazillion OTC test-boosters that will not do anything for your testosterone levels, but may have minimal effects on your libido; or, you get a script for the blue pills and accept that one of the side-effects of these proven libido-boosters is an increase in testicular testosterone production.

If you were all Germans, I would probably be cracking a joke about the lead author's name "Spitzer", but in view of the fact that you aren't and that it would be a saucy one I will stick to the news-piece alone - it's saucy enough, anyways ;-)

Actually you've heard Carl and me talk about the purported testosterone boosting effects of sildenafil aka Viagra on the Science Round Up in the past, but Mr. Spitzer and his colleagues from the Greenfield Health Center are the first to prove the potency of the testosterone response in male subjects who received "an optimized dose" (more on that later) of sildenafil, as well as its "direct action on the testes" in a controlled larger-scale trial (Spitzer. 2013).

More than just "spitz" (engl. "horny")

The data Matthew Spitzer et al. analyzed came from the Testosterone and Erectile Dysfunction Trial in the course of which 140 men, aged 40–70 years with erectile dysfunction, low serum total testosterone (<11.4 nmol/L; 330 ng/dL) and/or free testosterone (<173 pmol/L; 50 pg/mL) over received starting doses of

• 25mg sildenafil, if they were on an alpha-blocker
• 50mg sildenafil, if they never used sildenafil before, and
• 100mg sildenafil, if they were viagra veterans

for  3–7 weeks. The men in the 25mg and 50mg groups had the chance to increase the dosage to up to 100mg "on occasion"; or, in other words, when their sexual desire did not match their physical function.

Figure 1: Changes of testosterone and other hormones rel. to baseline level (Spitzer. 2013)

As you can see in Figure 1 the ingestion of a handful of the infamous blue pills lead to significant increases of in total (+3.6 nmol/L = 103 ng/dL; p<0.001) and free (+110 pmol/L = 31.7 pg/mL; p<0.001) testosterone levels and were accompanied by parallel increases in serum DHT (0.17 nmol/L = 4.9 ng/dL; p<0.001) and oestradiol (14 pmol/L = 3.7 pg/mL; p<0.001) and significant suppression of luteinizing hormone (change 1.3 units/L; p=0.003) levels.

The latter, i.e. the reduced luteinizing hormone levels are what actually suggests that we are dealing with a direct effect at the testicular level and not some weird hyptohalamic feedback. A centrally mediated in crease in testosterone production would after all have gone hand in hand with in- not decreases in luteinizing hormone concentration.

Minimal changes in adrenal hormones

With small, but noticeable increases in androstenedione and oestrone increased by 1.3 nmol/L (38 ng/dL; p=0.011) and 10.7 pmol/L (2.9 pg/mL; p=0.012), Spitzer et al. cannot exclude that the sildenafil induced phosphodiesterase-5 inhibition did also affect the adrenal glands - or, to be precise, "late adrenal androgen synthesis" (Spitzer. 2013):

Gingko = Brain Viagra?

"The adrenal glands are the major site for production of androstenedione, which is converted to oestrone by aromatase. Enzyme 17,20 lyase, which converts 17a-hydroxyprogesterone to androstenedione, is upregulated with sildenafil treatment in rats.

This could explain the increase in serum androstenedione levels in our participants. However, an increase in 17,20-lyase activity should also result in an increase in DHEAS levels, which was not observed. Further investigation is needed to study the effect of sildenafil on adrenal androgens." (Spitzer. 2013)

While the exact mechanism that's responsible for the androstenedione increases must still be determined, it is, as previously mentioned, almost certain that the increase in testosterone levels was mediated by direct effects on the steroidigenic leydig cells in the testes. They are the ones that respond to the luteinizing hormone signalling from the brain have been reported to respond directly to PDE-5 inhibitors in previous studies by Andric et al. from 2007 & 2010, as well as Janjic et al. from 2012.

More sex = more testosterone?

Whether and to which extend the increase in testosterone has also been indirectly promoted by increases in sexual activity, which have been previously reported to lead to increases in testsosterone levels after successful treatment of erectile dysfunction (Aversa. 2013) remains to be seen. The data from the study at hand does at least not support this notion, because a "greater sexual activity did not predict greater change in serum total testosterone" (Spitzer. 2013).

Other studies have associated greater sexual arousal with acute increases in LH and subsequent increases in testosterone production (LaFerla. 1978; Rowland.1987). With decreasing not increasing LH levels being one of the main findings of the study at hand, it is however more or less impossible that the increased sexual desire was the horse, not the cart in the sildenafil-related increases in testosterone levels Spitzer et al. observed in their 140 borderline to full-blown hypogonadal man.

SuppVersity Suggested Read: "Will Sex Before a Competition Hamper Your Performance? Plus: How Can Estrogen, Cortisol, Quail and Muhammad Ali Help Us Answer This Important Question" | read more

Bottom line: It appears to be settled that it is the direct effect of PDE-5 inhibition on testicular testosterone production that's responsible for the Viagra induced increases in testosterone production. What is not settled, though and I guess that is something people tend to forget about, when they hear promising study results like  these is that the benefits were observed in a men whose testosterone production was already impaired.

In fact, the researchers' acknowledgment that "some portion of the observed increases in testosterone occurring during sildenafil administration is almost certainly attributable to regression to the mean" (Spitzer. 2013) would suggest that similarly pronounced effects cannot necessarily be expected in men with normal testosterone levels... but hey, the same goes for 99.9% of the OTC "test boosters" and people still buy them despite the fact that they do not even have produce those "nasty" boners as a side effect ;o)

References:

• Andric SA, Janjic MM, Stojkov NJ, Kostic TS. Sildenafil treatment in vivo stimulates Leydig cell steroidogenesis via the cAMP/cGMP signaling pathway. Am J Physiol Endocrinol Metab. 2010 Oct;299(4):E544-50.
• Aversa A, Jannini EA, Maggi M, Lenzi A. Effects of testosterone replacement on response to sildenafil citrate. Ann Intern Med. 2013 Apr 2;158(7):569-70.
• Janjic MM, Stojkov NJ, Bjelic MM, Mihajlovic AI, Andric SA, Kostic TS. Transient rise of serum testosterone level after single sildenafil treatment of adult male rats. J Sex Med. 2012 Oct;9(10):2534-43.
• LaFerla JJ, Anderson DL, Schalch DS. Psychoendocrine response to sexual arousal in human males. Psychosom Med. 1978 Mar;40(2):166-72.
• Rowland DL, Heiman JR, Gladue BA, Hatch JP, Doering CH, Weiler SJ. Endocrine, psychological and genital response to sexual arousal in men. Psychoneuroendocrinology. 1987;12(2):149-58.
• Spitzer M, Bhasin S, Travison TG, Davda MN, Stroh H, Basaria S. Sildenafil increases serum testosterone levels by a direct action on the testes. Andrology. 2013 Nov;1(6):913-8.