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Optimizing Men’s Health: Exploring the Science Behind Supplements

Men's health is a field that focuses on health issues that are most relevant to men, including testosterone levels, testicular health, sperm quality and production, and prostate health. Some of the major conditions that fall under the umbrella of men's health include low testosterone (hypogonadism), sexual dysfunction, infertility, and benign prostatic hyperplasia (BPH).

Low testosterone can have a range of negative effects, including reduced energy levels, depressed mood, difficulty concentrating, and decreased seks drive. BPH and prostate cancer can cause bothersome urinary symptoms, and prostate cancer is the second most common cancer in men worldwide and a leading cause of cancer-related death in men. As such, maintaining healthy testosterone levels and managing men’s health conditions is important for both quality of life and longevity.

The prevalence of these conditions increases with age. For example, studies have shown that about 40% of men experience erectile dysfunction at age 40, increasing to about 70% by age 70. About half of men over 50 have evidence of BPH, which increases to over 80% in men over 70. Testosterone levels decrease by up to 2% per year after age 40. These statistics highlight the importance of addressing men’s health concerns as men age.

 

BPH and nutraceuticals

Benign prostatic hyperplasia (BPH) is a condition where the prostate gland, which is part of the male reproductive system and located below the bladder, becomes enlarged but not cancerous. This condition is very common in men over 50 years old, with about 50% of men in this age group showing evidence of BPH. The prevalence of BPH increases with age. As the prostate enlarges, the bladder wall thickens and may eventually weaken, leading to lower urinary tract symptoms. However, the correlation between prostate size and symptom severity is inconsistent, and some men with substantially enlarged prostates may experience few symptoms. It is important to note that the symptoms of BPH largely overlap with those of early prostate cancer: a frequent and urgent need to urinate, especially at night, trouble starting a urine stream, a weak or interrupted (i.e., stops and starts several times) urine stream, dribbling at the end of urination, incomplete urination Patients using food supplements represent a patient population with a keen potential interest and/or adherence to healthy lifestyle changes. Some food supplements and active ingredients have been studied in order to prove their efficacy and safety.

Regardless, more attention should be directed toward heart-healthy lifestyle changes for most urologic men’s health conditions, whether they are used in a preventive or synergistic setting with other acceptable clinical treatment options1.

During the last decade, phytotherapeutic drugs have gained a more central role in BPH and LUTS management. In particular, clinical usage of the extract of the dried ripe fruit of Serenoa repens with a dosage of 320 mg per day, has shown its clinical efficacy and its superiority. The purpose of the following multicentric observational retrospective study was to evaluate all the urological aspects (clinical, biochemical, instrumental and pathological) of patients affected by BPH and LUTS, with a PSA < 10 ng/ml, a previous negative prostatic biopsy and in therapy with a daily dose of 320/640 mg of Serenoa repens.

The study2 was conducted in 8 different centres. Data and information of 298 men with an average of 63 years (mean PSA of 5.4 ng/ml and mean prostate gland volume of 57 cc), affected by non-acute urinary symptoms caused by BPH, a dosed PSA level inferior to 10 ng/ml, a previous negative prostate biopsy and in therapy with Serenoa repens alone or associated to an alpha-blocker, were retrospectively inserted in an extensive on-line SIUrO Database (Societa Italiana di Urologia Oncologica; Italian Society of Oncological Urology).

Results were: PSA levels weren’t subjected to an increase, revealing a stabilizing or downward trend.The percentage of patients with PSA below the level of 4 ng/mL was lower at the end of the study. The overall changes in the uroflowmetry were similar and parallel both in the group with only Serenoa repens intake and in the group with Serenoa repens plus alpha-blocker. The mean medium flow and the mean maximum flow had a slight increase during the observation time. There was a substantial decrease in the number of patients presenting severe prostatic symptoms. Patients reported through the IIEF-5 score a sexual activity substantially unchanged after 6 months of follow-up. The Serenoa repens intake resulted in an improvement of the “inflammatory-like reports”, in terms of ultrasound patterns, DRE and bioptical features.

Conclusion of the study was: Serenoa repens demonstrated its efficacy in reducing dysuria with minimal side effects. Further prospective studies might confirm its stabilization or lowering role on PSA levels in this cohort of patients and its possible clinical anti-inflammatory action2.

 

Pygeum (Prunus africana)

Pygeum is an herbal supplement derived from the bark of the Prunus africana tree. Pygeum is often sold as a prostate health supplement, specifically to alleviate benign prostatic hyperplasia (BPH).

Further research is needed to determine if pygeum does exert this protective effect. Though one meta-analysis showed pygeum supplementation provides overall benefits for BPH, subsequent studies suffered from poor design and did not provide strong evidence.

Pygeum has been shown to reduce BPH proliferation in vitro (in a test tube) by interfering with growth factors. It also has an anti-androgenic effect on its receptor. Additional studies are needed to determine if this effect takes place inside the human body after oral supplementation.

A meta-analysis3 assessing 18 trials with a sample of 1562 (although only being able to quantify a minimal amount; 5 with a sample of 430) was able to find a reduction in reported symptoms associated with benign prostatic hyperplasia associated with variable doses of pygeum bark extract in the range of 19-23%. 

Erectile dysfunction (ED)

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain an appropriate penile erection that is sufficient for sexual intercourse and is clinically classified as psychogenic (such as relationship dissatisfaction, societal pressures, anxiety or depression) or organic (underlying causes or comorbidities). This is a common and increasing male sexual health concern, with a prevalence of up to 31% and projected to affect up to 322 million men by 2025. The prevalence of ED is reported as 1–10% of males aged <40 years (mostly psychogenic), >40% of men aged >40 years, and 50–100% of men aged >70 years (mostly organic).

Complementary and alternative medicines, including dietary supplements and herbal remedies, are increasingly being used for the treatment of ED, particularly through over-the-counter and Internet sources4-7.

The increased use of alternative medicines and herbal remedies for ED with limited scientific investigations on extractions, efficacy, safety and dosage is a challenge to clinicians, whereas a comprehensive overview of clinically relevant research in these disciplines is currently lacking. Therefore, the present study aimed to systematically review and discuss the current evidence from placebo-controlled clinical trials that investigated the use of traditional medicine and herbal remedies in the management of ED as assessed by the IIEF (The International Indeks of Erectile Function).

The conclusion of the study was that the reported use of alternative medicines and herbal remedies for ED is extensive, particularly through dietary supplements available on the market. However, there is limited research into specific treatments for the improvement of erectile function. There is also a significant amount of heterogeneity in the interventions investigated and the dosage and duration. Based on the present results, Panax ginseng, and pycnogenol have some promising evidence as herbal products, alongside L-arginine as a nutritional supplement.

The mechanisms of action remain unclear, but each of these appears to increase NO synthesis and NO production to induce erection. Importantly, improved diet and exercise should be considered, particularly in patients with obesity or diabetes mellitus8.

 L-carnitine

L-carnitine is a compound that is synthesized in the body from the amino acids lysine and methionine. It is also found in food, particularly in meat products. Acetyl-L-carnitine (ALCAR) is an acetylated form of L-carnitine that can cross the bloodbrain barrier more efficiently. L-carnitine is known for its role in the mitochondrial oxidation of longchain fatty acids.

L-carnitine has been shown to be useful in the treatment of liver diseases. It can reduce ammonia levels and improve symptoms of hepatic encephalopathy, as well as improve various markers of liver function. High doses of L-carnitine supplementation have also been found to improve sperm quality, and a small number of studies have reported improvements in male fertility.

Several studies have found an improvement in the case of erectile dysfunction, but more research is needed to confirm its effects9,10,11.

L-arginine

Arginine, also called L-arginine, is an amino acid used by the body as a protein building block. It’s also an intermediate metabolite in the urea cycle and the nitric oxide cycle.

In men with erectile dysfunction, daily supplementation with arginine can alleviate symptoms12.

Many supplements promoted for ED and sexual enhancement have been found to be tainted with drug ingredients or related substances. Some products include combinations of multiple ingredients or excessively high doses, both of which can be dangerous. It is important to exercise caution when considering the use of supplements for ED.  

Low testosterone levels

Testosterone is a well-known androgen, or male sex hormone, that is produced by the testicles. It plays a crucial role in the development and maintenance of secondary male characteristics, such as increased body and facial hair, a deepened voice, and increased muscle mass. When testosterone levels are low, due to a problem within the hypothalamic-pituitary-testicular (HPT) axis, it can result in a condition known as hypogonadism.

Some common signs and symptoms of low testosterone include a decreased sex drive, erectile dysfunction, low sperm count, reduced muscle mass and strength, increased fat mass, low bone density, loss of body hair, enlargement of breast tissue (gynecomastia), sleep disturbances, reduced energy levels, depressed mood, and difficulty concentrating.

While many supplements are marketed as testosterone boosters, there is little evidence to suggest that they have any significant impact on testosterone levels. However, supplementing with certain nutrients such as vitamin D, zinc, and magnesium may slightly increase testosterone levels if dietary intake and serum levels are inadequate.

 DHEA

DHEA is a precursor to testosterone. As assigned males get older, their levels of testosterone gradually decline by 10% per decade after age 30. Through the use of DHEA supplements, many individuals aim to counter the effects of declining testosterone levels. Some evidence shows that DHEA increases libido and helps treat erectile dysfunction in men. DHEA can lead to improved libido as it may increase your free testosterone levels.

There appears to be an increase in testosterone following DHEA supplementation, but the vast majority of literature is in menopausal women (where testosterone contributes to libido). There is limited evidence of DHEA increasing testosterone in all studies including youthful athletes, which are less studied.

 Conclusion

In summary, while there is evidence to suggest that specific supplements can contribute positively to men’s health, a cautious approach is essential. Prior to initiating any supplementation regimen, consultation with a qualified healthcare provider is strongly advised. Individual health status, dietary habits, and potential interactions with medications need to be taken into account. Moreover, supplements should not be viewed as standalone solutions but rather as part of a holistic strategy that incorporates a balanced diet, regular exercise, stress management, and adequate sleep for optimizing men’s health and well-being.

Although it’s important to present more scientific evidence to support the positive results, supplementing with various ingredients can bring numerous benefits to men’s health on multiple levels.

 

References:

1 Moyad MA. Nutraceuticals and Phytotherapy in Men’s Health: Antioxidants, Pro-oxidants, and a Novel Opportunity for Lifestyle Changes. Urol Clin North Am. 2022;49(2):239-248.doi:10.1016/j.ucl.2021.12.006

2 Bertaccini A, Giampaoli M, Cividini R, et al. Observational database serenoa repens (DOSSER): overview, analysis and results. A multicentric SIUrO (Italian Society of Oncological Urology) project.Arch Ital Urol Androl. 2012;84(3):117-122.

3 Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev.2002;1998(1):CD001044. doi:10.1002/14651858.CD001044

4 Cui T, Kovell RC, Brooks DC, et al. guide to ingredients found in top-selling nutraceuticals for men’s sexual health. J Sex Med. 2015;12(11):2105–2117.

5 Sin VJ, Anand GS, Koh HL. Botanical medicine and natural products used for erectile dysfunction. Sex Med Rev. 2020. Online ahead of print. DOI: 10.1016/j.sxmr.2020.10.005

6 Corazza O, Martinotti G, Santacroce R, et al. Sexual enhancement products for sale online: raising awareness of the psychoactive effects of yohimbine, Maca, horny goat weed, and ginkgo biloba.Biomed Res Int. 2014;2014:841798.

7 Srivatsav A, Balasubramanian A, Pathak UI, et al. Efficacy and safety of common ingredients in aphrodisiacs used for erectile dysfunction: a review. Sex Med Rev. 2020;8(3):431–442.

8 Leisegang K, Finelli R. Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review. Arab J Urol. 2021;19(3):323-339. Published 2021 Jun 11.doi:10.1080/2090598X.2021.1926753

9 Cavallini G, Modenini F, Vitali G, Koverech A. Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology. 2005;66(5):1080-1085. doi:10.1016/j.urology.2005.05.014

10 Cavallini G, Caracciolo S, Vitali G, Modenini F, Biagiotti G. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging.

Urology. 2004;63(4):641-646. doi:10.1016/j.urology.2003.11.009

11 Gentile V, Vicini P, Prigiotti G, Koverech A, Di Silverio F. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes.Curr Med Res Opin. 2004;20(9):1377-1384. doi:10.1185/030079904X2394

12 Rhim HC, Kim MS, Park YJ, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis [published correction appears in J Sex Med. 2020Mar;17(3):560]. J Sex Med. 2019;16(2):223-234. doi:10.1016/j.jsxm.2018.12.002

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