A rather difficult audience to reach at one point is now embracing their gender-induced issues. Here’s how to welcome more men to support their health.
Compared to just 20 years ago, open discussion about genital health and function in product marketing was still considered somewhat verboten. Now, of course, anything goes—“down there” is out in the open, figuratively of course.
This bodes extremely well for retailers, as men are no longer reticent about questioning what supplements they can take to maintain or improve their virility.
“In the past, anything involving a discussion of sex or sex hormones was considered taboo,” underscored Jay Wilkins, founder and formulator of Bionox, North Carolina. Today there is more of an open line of communication regarding sexual health, and men generally now understand the effects of testosterone.
Practitioner Jorge Reveron, ND, of Oasis Integrative Health in Arizona, related that among the male patients he works with, the most prominent concerns are erectile dysfunction (ED) or low testosterone. Most of the men are in their 40s to 60s and these conditions tends to take priority over the rest of their health, typically because ED and low T are affecting their relationships or sex life. “Though due to COVID, within the past few months, I have seen more men, young and old, come in to have a full health checkup wanting to know more about their cholesterol levels, diabetes and heart health,” he said.
He added that increased media and social media coverage have encouraged more men to be more interested therapy for low testosterone, which has led to increased discussions about testosterone replacement therapy within the past few years.
Similarly, practitioner Rosia Parrish, ND at Boulder Natural Health, Colorado, said the primary issue in her male patients is a trend toward low T. She tests male patients’ levels of free and total testosterone, as well as sex hormone binding globulin (SHBG) that can bind to testosterone, inactivating it, “so some patients might have a robust amount of testosterone, but they still exhibit signs of low testosterone—SHBG might be the reason.”
Dr. Parrish also tests for DHEA-S, a precursor to testosterone and other hormones. She explained, “If DHEA-S is low, then testosterone downstream can also be low. For my fertility patients, I work up numerous other hormones and biomarkers including pituitary hormones, stress hormones, metabolic biomarkers including electrolytes, liver and kidney function, glucose levels, and I also test men for estrogens since that can play a role with male hormonal imbalance.”
Men today are affected by higher inflammation and xenoestrogens from environmental exposure, high chronic stress and unhealthy diets—all of which impact their testosterone and related hormones, she added.
Brian Keenan, ND, lead medical writer for Ayush Herbs Inc. in Washington likewise observed that the most prominent issues men are concerned about involve vitality—desire to maintain a healthy sex drive, energy levels, physical stamina and to have a thick and full head of hair and beard. “This makes sense, as those are the main things that wane under stress, with age and genetically,” he commented.
Dr. Keenan noted that a concern that is much more prominent among men today as opposed to 20 years ago is male fertility; a 2017 study has indeed shown that sperm counts have dropped as much as 50 percent from the 1970s to the 2000s. Research has implicated environmental toxins as a contributing cause, which, he stated, is a key distinction. “This is important because many men’s health supplements are geared to boost testosterone and libido; however, the solution isn’t going to come from the libido, it’s going to come from detoxification and healthy living, which require a different supplement protocol.”
According to the Council for Responsible Nutrition (CRN) Consumer Survey 2020, most men (68 percent) take supplements, primarily to achieve overall health and wellness benefits, pointed out Joe Brunner, president, Endurance Products Company (EPC), Oregon. This year, immune support edged out energy as the second most popular reason to take supplements and among younger men, immune health was the top reason for taking supplements.
“This is surprising,” he commented. “After all, young men typically perceive themselves as invincible to health issues, including issues like COVID-19. Yet the survey tells another story: These ‘young invincibles’ are anxious enough to take action to protect their health.”
That stated, some things remain constant, age-wise. According to Cheryl Myers, chief of scientific affairs and education, Wisconsin-based EuroMedica Inc., a 20-year-old may prioritize better skin, or to lift heavier weights, while a 60-year-old may want better sleep at night and a healthier prostate. “I think men want to feel vital, energetic and remain as youthful as possible for as long as possible,” she opined. “Like everyone, they want to preserve vigor and function well into their later decades.”
“An interesting trend we are seeing regarding testosterone is lower levels in younger men. This could be due to increases in comorbidities, like diabetes and elevated BMI (body mass index),” mused Wilkins.
In agreement is Zoraida Aguilar, vice president for research services, Bio-Tech Pharmacal, Arkansas, who said that the prevalence of erectile dysfunction (ED) in men as young as 40 years old has led to newer research that expanded understanding of the etiology of ED. In the past five years, she stated, “it has become more apparent that ED is not caused by low testosterone alone. ED is the result of low blood flow that may be due to other health conditions such as high blood pressure, hardening of the arteries and psychological conditions such as depression and anxiety. ED may also come from back injuries and other neurological conditions.”
Other newer research is demonstrating that testosterone level is not a key cause of prostate cancer, pointed out John Hall PhD, director of research, The Beljanski Foundation, New York. In fact, he declared, “risk of prostate cancer does not correlate with testosterone level. A consensus now exists that prostate cancer risk is unrelated to serum testosterone concentration; men with higher testosterone are at no greater risk than men with lower testosterone.”
Testosterone-replacement drugs, however, are on the rise among men, especially middle-aged men, according to Brunner. He believes that this suggests men perceive testosterone replacement therapy as safer than it may be. “This is because the popularity of these drugs stems more from intense marketing tactics such as direct-to-consumer ads and clinics that cater to low-testosterone anxiety rather than from solid science,” he asserted. “Importantly, the cardiovascular risks associated with testosterone replacement drugs—atherosclerosis, lipoprotein function, heart failure and beyond—continue to concern researchers and clinicians alike.”
Dr. Keenan added that supplemental testosterone has its own side effects, including decreasing sperm count, which has been shown to already be steadily declining.
Well-being More Important
A quickly disappearing way of thinking is that men couldn’t quite grasp the idea of well-being, as it seemed more of a concept rather than something more tangible that they could feel, such as sore muscles or erectile issues. “Overall men view the concept of well-being as tied with masculinity,” said Wilkins. The older stereotype of don’t talk about your feelings, be the family provider, be admired by peers and colleagues, and be physically fit and strong is starting to, well, get old. “We are beginning to see a shift in emotional well-being as a priority,” he said.
In Brunner’s viewpoint, Millennials and Generation Z men are typically more likely to view “well-being” as the fuel they need to maintain peak performance, both mentally and physically. This, he stated, makes sense as in their 20s and 30s is a time when men are desirous of being in top form at work, home and play. “Baby Boomer men, on the other hand, are more likely to view well-being as freedom, a super power of sorts so they can remain active enough to enjoy life to the fullest.”
Dr. Keenan agreed that the concept of well-being is frequently quite different between Baby Boomers and Millennials. Whereas Boomers entered into an era of financial prosperity and as such making money was a huge focus and source of pride, Millennials are reacting to a more unstable financial reality, and as such, have placed much more emphasis on work-life balance, even if it means not maximizing income. Additionally, Millennials have adopted holistic health care at a much younger age than Boomer men. “This is due to a variety of factors including improved access to holistic health services, better research into supplements and what works, and the rise of internet making new ideas and approaches to wellness available to the everyday man,” he explained.
Supplements for Male-specific Health
There are numerous dietary supplements that can help your male patients of all ages to begin to achieve their health goals. Urogenital health is a key concern at which several supplements are targeted.
New from Euromedica USA is Male Sexual Health, which features the company’s exclusive HRG80 Red Ginseng blended with apple polyphenols, flavonoids from grape seed and saffron extract. According to Myers, it delivers an herbal ingredient that is well-known, but markedly improved in its cultivation, and as a result, its effects. In a pilot clinical study, men between the ages of 45 and 65 who consumed this combination experienced 74 percent improvement in their hardness score and 72 percent improvement in their IIEF-5 (International Index of Erectile Function) score.
Myers explained that through a unique cultivation process, HRG80 Red Ginseng delivers seven times the rare noble ginsenosides than conventionally grown and processed ginseng supplements. These noble ginsenosides in HRG80 Red Ginseng have been shown in an in-vitro scientific (Caco-2) study to be up to 17 times better absorbed than classic ginsenosides.
Euromedica USA’s Bladder Manager targets bladder health and urinary urgency. “The conventional approach for bladder issues and urinary frequency or urgency is to prescribe anticholinergics like Ditropan, Vesicare and Detrol,” Myers explained. However, she noted, because they are anticholinergic drugs, they can cause cognitive impairment after only two months of use. The potential for development of dementia worsens if the man also uses diphenhydramine, also an anticholinergic) for allergies, or Advil PM, Tylenol PM or other analgesic combinations for sleep.
Bladder Manager features an Angelica archangelica leaf extract that shows remarkable potential for men dealing with the sensation of urinary urgency or nocturia. In an eight-week, randomized, double-blind, placebo-controlled study, men with nocturia supplemented with Angelica archangelica or a placebo.
Myers reported that men in the angelica group with the lowest bladder capacity saw a reduction in nocturia by up to 50 percent. It also extended the time three-fold that men slept before first awakening for urination, thereby also achieving markedly improved sleep. The most significant results were in the men with the lowest bladder capacity.
She explained that A. archangelica’s isoquercitrin content may be at least partly responsible for its effectiveness, as isoquercitrin appears to inhibit the activity of leukotrienes (LTD4) in the bladder and urethra that stimulate receptors triggering overactive bladder contractions.
New York-based Patient One MediNutritionals Prostate FA Plus is, according to company Vice President Kathy McIntee, a comprehensive nutritional protocol for promoting prostate health, urinary tract health and reproductive wellness. Prostate FA Plus supplies evidence-backed fatty acids, phytosterols and carotenoid antioxidants in a liquid vegetable capsule. Prostate FA Plus features multiple natural compounds shown to regulate the high 5-alpha-reductase enzyme activity that has been associated with prostate issues. In addition, the formula modulates prostate inflammation, inhibits growth factors and optimizes cell-signaling pathways. Prostate FA Plus is an ideal all-in-one formula for supporting prostate, urinary and sexual health—promoting peak quality of life for your male patients.
Bionox’ M3 Ultimate Nitric Oxide Nutrition, according to Wilkins, is formulated for supporting healthy circulation, energy, fitness, libido and sexual performance. It features L-arginine and L-citrulline to support nitric oxide production as well as vitamins D3 and K2 for optimal calcium metabolism, to protect cardiovascular structure.
Bionox’s “recently rejuvenated, Nox3 Greens Ultimate Nitric Oxide Superfood contains nutrient-rich superfoods to provide healthy circulation, vitality, digestion and energy,” Wilkins explained. Nox3 Greens blends 26 different superfoods with probiotics. Arugula extract, beetroot, spinach and other greens provide naturally occurring nitrates that facilitate conversion into nitric oxide. Each canister of Nox3 Greens includes two MyFitStrips to check nitric oxide potential, which can be a useful tool when working with the patient.
Research shows that Beljanski Foundation’s Pao pereira and Rauwolfia vomitoria extracts are strong botanicals for supporting prostate structure and function, according to Dr. Hall.
Botanical solutions also include ayurvedic herbs. For example, Ayush Herbs’ Ayu-Test contains ashwagandha, shilajeet and tribulus which all support performance, enhance strength and improve virility. “We’ve balanced it with herbs like amla, saffron and licorice to support sustaining healthy energy levels, and supporting our body’s ability to heal and recover,” described Dr. Keenan.
A companion product for men is Ayu-Dep, which Dr. Keenan stated “supports the male mind and spirit. After the year we’ve all collectively faced, and with the shift to remote online work, men are feeling burnt out. With that burn out we’re seeing hopelessness, apathy and lack of interest in things that were formerly enjoyable. Ayu-Dep addresses this with saffron, an herb that readily supports healthy mood, along with shilajeet. Bacopa and ashwagandha support healthy focus and cognition.”
New Jersey-based Herbalist & Alchemist’s Men’s Midlife Tonic was formulated by founder and president David Winston, RH (AHG) to provide support including mood balancing, for older men experiencing the symptoms of andropause. Men’s Midlife Tonic addresses changes in hormone levels that cause sleep impairment, decreased sexual functioning, BPH, weight gain, depression, moodiness or irritability—collectively known as andropause.
The formula features milky oat, ashwagandha, black cohosh, mimosa bark, saw palmetto and pulsatilla. “Milky oat is one of the great nerve trophorestoratives; it gently helps to restore emotional balance and is useful for anxiety, depression or irritability. Animal studies show that milky oat can improve stress response, enhance learning and decrease social avoidance behaviors,” Winston explained.
Ashwagandha is a calming adaptogen that also enhances testosterone levels and libido, while also reducing the effects of chronic stress and alleviating depression and anxiety. Black cohosh, known to be a women’s herb, is also effective for supporting hormonal (andropausal) depression in men. “Mimosa bark or He Huan Pi (Collective Happiness Bark) is one of the most effective mood elevators known,” Winston asserted. “And, saw palmetto not only reduces symptoms of BPH, it also helps relieve ‘Grumpy Old Man Syndrome,’ which is exacerbated by increasing levels of dihydrotestosterone (DHT). Pulsatilla is used in very small amounts for hormonal depression, anxiety, irritability, moodiness and ‘fly off the handle’ anger.”
And of course, your male patients will likely ask about and/or need recommendations for the basics of good health – multis, letter vitamins and other nutraceuticals for cardio support, weight management, blood sugar health and joint/muscle/bone support.
According to Aguilar, Bio-Tech Pharmacal (BTP) “offers the supplements that are most needed by men.” These include Vitamin D3 at 50,000 IUs as cholecalciferol in water soluble form, C-Max which contains vitamin C (1,000 mg), magnesium (80 mg as magnesium ascorbate), zinc (10 mg as zinc ascorbate), potassium (20 mg as potassium ascorbate), and manganese (2 mg as manganese ascorbate).
The Endurance Products (EP) brand likewise features a variety of products that support the nutritional needs of men, according to Brunner. “Cardiovascular and metabolic health is our wheelhouse,” he emphasized. “We offer a full range of products to support heart health, lipid metabolism, glucose balance, vascular health and related functions. We also offer products that support other health concerns important to men such as healthy digestion and liver support, healthy joints and mobility, energy and cognition, and healthy aging. The EP brand includes chewable tablets and immediate-release tablets, but our key differentiator is our controlled-release tablet technology. “
Your practice is likely seeing more male patients discussing and presenting health concerns mentioned here. The great news for men today is that because they are becoming less shy and more candid about their gender-specific health concerns, manufacturers are listening, researching and creating products that help you to help them.
Healthy Take Aways
• A 2017 study has shown that sperm counts have dropped as much as 50 percent from the 1970s to the 2000s.
• Isoquercitrin appears to inhibit the activity of leukotrienes (LTD4) in the bladder and urethra that stimulate receptors triggering overactive bladder contractions.
• Pao pereira and Rauwolfia vomitoria extracts are strong botanicals for supporting prostate structure and function.
• Black cohosh, known to be a women’s herb, is also effective for supporting hormonal (andropausal) depression in men.
For More Information:
Ayush Herbs Inc., www.ayush.com
Bio-Tech Pharmacal, www.biotechpharmacal.com
Endurance Products Company, www.endur.com
EuroMedica Inc., www.euromedicausa.com
Herbalist & Alchemist, www.herbalist-alchemist.com
Patient One MediNutritionals, www.patientoneformulas.com
The Beljanski Foundation, www.beljanski.org; www.maisonbeljanski.com