Men's health in Ayurveda

Regardless of your age, gender, or general health, it is important to take a proactive approach to health. Many men avoid the doctor until they become sick, injure themselves, or are faced with a serious health problem. However, it is important for men to have regular visits with their doctor to promote good health and to prevent and/or manage health issues early. Although several health conditions, such as heart disease and diabetes, affect both men and women, there are a few health conditions that are specific to men.

Low Testosterone

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, bone density, and red blood cell production. In the normal developing male, testosterone peaks during early adulthood.

After the age of 30, testosterone levels slowly decline by approximately 1% a year. Although this is a normal part of aging, for some men the decline occurs more rapidly. According to the American Urological Association, about 2 out of 10 men older than 60 years have low testosterone. That increases slightly to 3 out of 10 men in their 70s and 80s. Overall, low testosterone (Low-T) affects approximately 4 to 5 million men in the US.

In general, the normal range for testosterone in males is about 270-1070 ng/dL with an average level of 679 ng/dL. The diagnosis of Low-T in men is based upon the presence of both clinical symptoms and low serum testosterone levels (<300 ng/dL).

Men can experience a range of symptoms and medical conditions when testosterone levels decrease. These include:

• Low sex drive
• Fatigue
• Reduced lean muscle mass
• Loss of body hair
• Irritability
• Depression
• Increased body fat (obesity)
• Erectile dysfunction
• Decreased bone mass (osteoporosis)
• Diabetes
• Heart disease

Some medical conditions, such as diabetes and obesity, not only result from testosterone deficiency but may also cause Low-T. An excess amount of body fat can cause a man’s testosterone levels to drop as much as 10 years of aging. Excess intra-abdominal fat (also known as visceral fat) is particularly detrimental. In one research study, overweight men had 30 % lower total testosterone (TT) levels compared to lean men, and 40 % had levels lower than 12 nmol/L.[1] Low levels of both total testosterone and free testosterone are consistent features of men with metabolic syndrome. In fact, men with lower baseline total testosterone levels have a 1.7-fold higher risk for developing metabolic syndrome. Additionally, a recent meta-analysis including four prospective studies demonstrated that Low-T is associated with a three- to four-fold increased risk of diabetes mellitus, which is a known predictor of cardiovascular morbidity and mortality.[2]

Low levels of total, bioavailable, and free testosterone are associated with increased risk of development of cardiovascular disease, atherosclerosis, and mortality.[3] As testosterone declines, the arteries and veins lose plasticity, the heart muscle starts to weaken, and there is a higher risk of hypertension. This may partly explain why heart disease is the leading cause of death among American men.

Prostate Problems

The prostate is a walnut-sized gland located below the bladder and wraps around the upper part of the urethra, the tube that carries urine from the bladder out of the body.  The prostate plays a significant role in men’s health, and if prostate function is disrupted, men may have trouble urinating, develop pain with urination, notice blood in the urine, or have trouble with their reproductive and sexual health.

There are three main conditions that may affect the prostate. 1) Benign prostatic hypertrophy (BPH) is an enlargement of the prostate gland related to the aging process. BPH affects about three-quarters of men over age 60, and by age 80, more than 80 percent of men have this condition. 2) Prostatitis is inflammation of the prostate gland or the area surrounding the gland and is characterized by painful urination, painful ejaculation, and/or pain in the area between the scrotum and rectum (known as the perineum). Common triggers of prostatitis may include infection, injury, stress, nerve damage, and immune disorders. 3) Prostate cancer begins when abnormal cells continue to grow and divide more rapidly than normal cells. Usually, prostate cancer develops slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, some types are aggressive and can spread quickly. Approximately 1 out of 7 men in the United States will be diagnosed with prostate cancer during his lifetime.

Many of the major health risks that men face can be prevented with healthy lifestyle modifications. These include:

• Choosing a healthy diet. Eating a diet that is low in fat, cholesterol, and salt, and increasing the number of fresh fruits and vegetables, whole grains, and fiber can help improve overall health while decreasing the risk of heart disease, diabetes, and certain cancers. Eating cooked vegetables and incorporating spices such as cumin, coriander, and turmeric may improve digestion and absorption. Certain foods such as eggs, organic lean meat, oysters, pomegranates, avocado, leafy green vegetables, and healthy oils (e.g., olive oil) may enhance testosterone levels.
• Avoiding alcohol and smoking.
• Exercising 3-5 days per week. Exercise is an essential way to stimulate vitality, strength, and natural healing mechanisms of the human body. Exercising regularly is important for developing exercise tolerance, as well as improving stamina and endurance. As little as 20 minutes of exercise can stimulate the immune system, reduce stress, provide cardiovascular benefits, and produce anti-inflammatory effects.
• Reducing stress. Over time, stress can adversely impact emotional and physical health. Incorporating stress-relieving activities such as yoga, meditation, deep breathing, and massage improves overall health, lowers the risk of cardiovascular disease, reduces inflammation, and changes the body’s physiological responses to stimuli.

In addition to diet and lifestyle changes, incorporating Ayurvedic herbs may help promote male sexual vitality while supporting overall health and longevity. A member of the Solanaceae family, Withania somnifera (Ashwagandha) has been used for over 4,000 years in India. More commonly known as “Indian ginseng” due to its stimulating effects, it has been used to also calm the mind, relieves weakness and nervous exhaustion, builds sexual energy, and promote healthy sleep. In particular, the root of Ashwagandha is regarded as a tonic and aphrodisiac.

The ability of ashwagandha to stimulate and regulate testosterone production in the body is one of the key benefits for men. Numerous human and animal studies have validated the aphrodisiac and testosterone-enhancing effects of Ashwagandha.[4] [5] [6] In addition, studies have shown that the components found in ashwagandha can be helpful in improving physical performance including cardiac endurance, muscle strength, and exercise-induced muscle damage.[7]

Mucuna pruriens (often referred to as “velvet bean”) is a creeping vine that can be found growing in India, the Caribbean, and tropical areas of Africa. The seeds of the Mucuna pruriens plant naturally contain levodopa (L-dopa), a precursor to the neurotransmitter dopamine. In Ayurvedic tradition, velvet bean is considered a diuretic, nerve tonic, and aphrodisiac. In a study of 75 infertile men, treatment with Mucuna pruriens significantly improved testosterone, luteinizing hormone, dopamine, adrenaline and noradrenaline levels, reduced the levels of follicle stimulating hormone and prolactin, and significantly recovered sperm count and sperm motility in infertile men.[8]

For centuries, Tribulus terrestris has been used as an aphrodisiac, for erectile dysfunction, and to improve overall sexual health. Tribulus elevates testosterone levels by increasing gonadotropin-releasing hormone and may be useful in mild to moderate cases of erectile dysfunction.[9]

It is important for men to take charge of their health. Establishing care and visiting a primary care doctor at least once a year for a routine checkup is a good first step. Regular prevention screenings and incorporating simple diet and lifestyle changes are keys to maintaining good physical wellness and long-term health.

References :

[1] Tajar, A., Forti, G., O'Neill, T.W., Lee, D.M., Silman, A.J., Finn, J.D., Bartfai, G., Boonen, S., Casanueva, F.F., Giwercman, A., Han, T.S., Kula, K., Labrie, F., Lean, M.E., Pendleton, N., Punab, M., Vanderschueren, D., Huhtaniemi, I.T., Wu, F.C., EMAS Group. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010 Apr; 95(4):1810-8.

[2] Brand, J.S., Rovers, M.M., Yeap, B.B., Schneider, H.J., Tuomainen, T.P., Haring, R., Corona, G., Onat, A., Maggio, M., Bouchard, C., Tong, P.C., Chen, R.Y., Akishita, M., Gietema, J.A., Gannagé-Yared, M.H., Undén, A.L., Hautanen, A., Goncharov, N.P., Kumanov, P., Chubb, S.A., Almeida, O.P., Wittchen, H.U., Klotsche, J., Wallaschofski, H., Völzke, H., Kauhanen, J., Salonen, J.T., Ferrucci, L., & van der Schouw, Y.T. Testosterone, sex hormone-binding globulin and the metabolic syndrome in men: an individual participant data meta-analysis of observational studies. PLoS One. 2014;9(7):e100409.

[3] Morgentaler, A., Miner, M.M., Caliber, M., Guay, A.T., Khera, M., & Traish, A.M.Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin. Proc. 2015;90(2):224-25.

[4] Ambiye, V. R., Langade, D., Dongre, S., Aptikar, P., Kulkarni, M., & Dongre, A. (2013). Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot Study. Evidence-based complementary and alternative medicine : eCAM, 2013, 571420.

[5] Ahmad, M.K., Mahdi, A.A., Shukla, K.K., et al. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertility and Sterility. 2010;94(3):989–996.

[6] Subramanian S. Ashwagandha-an ancient Ayurvedic drug. Arogya-Journal Health Sciences. 1982;8:135–139.

[7] Sandhu, J.S., Shah, B., Shenoy, S., Chauhan, S., Lavekar, G.S., Padhi, M.M. Effects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) on physical performance and cardiorespiratory endurance in healthy young adults. Int J Ayurveda Res. 2010 Jul;1(3):144-9.

[8] Shukla, K.K., Mahdi, A.A., Ahmad, M.K., Shankhwar, S.N., Rajender, S., &  Jaiswar, S.P. Mucuna pruriens improves male fertility by its action on the hypothalamus-pituitary-gonadal axis. Fertil Steril. 2009 Dec;92(6):1934-40.

[9] Gauthaman, K., & Ganesan, A.P. The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction – an evaluation using primates, rabbit and rat. Phytomedicine, 2008 Jan;15(1-2):44-54.

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