Posts Tagged ‘male pill’

One Child China

Sunday, June 13th, 2010
China: 5000 years old and on the move.

China: 5000 years old and on the move.

Just got back from China, from Beijing and Hong Kong to be exact. I lectured to several medical and academic institutions on where I believe men’s health is headed in the future. What I found was an audience eager to push the research frontiers in this field, however I also a sensed a lack of sufficient infrastructure to do this at the highest level. I paused for a moment to think about what was possible, since a monumental tidal wave of increased industrial productivity and change is occurring in China. For example, there are 1000 new cars being put on the road daily in Beijing alone! I sensed that when the might of China’s intellectual potential directs its energy toward medical research and innovation, the world will stand in utter awe at the prodigious output that will result.

Despite the fact that China’s culture is endowed with 5000 years of evolution and is responsible for helping to define human civilization, one thing really surprised me: its decision in 1979 to control its population by mandating a “One Child Only” policy. In the rest of the world, human reproduction is a basic right and for the most part, entirely unregulated. Under China law, families are allowed to have one child. After that, a vasectomy is performed on the male partner. Like it or not.

In addition to great control of population growth, the “One Child Only” policy has also led to the development of the wildly successful “No Scalpel Vasectomy” procedure. Now relatively common in the U.S., the “No Scalpel Vasectomy” is a quicker (10 minute), cleaner, less invasive and more comfortable innovation on a 100-year old American procedure.

But the curse of the “No Scalpel Vasectomy” is now being felt in China. Currently, it is difficult to find enough youth to fill jobs in urban areas within the massive and burgeoning Chinese economy. As a consequence, there has been a softening of the law such that couples that are both products of “one child” parents can now have two children. So can farmers, handicapped couples, and couples who work in “high risk” occupations like coal mining, heavy equipment operations and the like.

Even more fascinating is that infertile couples have a real reproductive edge over fertile couples under this law. How? Well, if they need assisted reproduction to help them conceive and they happen to have twins or triplets as a result (a 30-40% chance), they are not penalized for bearing “extra” children. Can’t help but think that this little known fact may partly contribute to the size of the massive, bustling IVF clinics that I visited in China last week. many of which are 4-10 times the size of U.S. clinics.

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The Curse of Women’s Urine

Sunday, April 25th, 2010
Estrogens and the manly man.

Estrogens and the manly man.

There must be something in the air… or water. The Bolivian President Evo Morales recently asserted publicly that hormones found in mass-produced foods are “feminizing” men. Speaking about chicken in Bolivia, which he believes are “loaded with feminine hormones,” he suggested that when men eat chicken “they are diverted from their nature as men.” So, is this how metrosexuals came to be?

But wait, the Vatican commented on this issue a year earlier, although they blamed female hormones from birth control pills for the increased estrogens in ground water. Pedro Castellvi, writing in the Vatican newspaper L’Osservatore Romano in 2009, stated: “we have sufficient data to affirm that one of the reasons for the not insignificant rise in male infertility in the west, is the environmental contamination caused by the pill.” Actually, it’s not the birth control pill itself but the urine from women taking the pill.

In fact, to date, the urine of women taking birth control pills has been blamed for worsening sperm counts in men, the growth of female sex organs in male fish, breast growth in young men and the early onset of puberty in young girls. What next?

Can I add a little balance to this discussion? First of all, exactly what is happening to men in Bolivia such that the President is not happy with them? Are they more civilized and less disruptive? Second, male infertility is not necessarily increasing in the western world; it may even be true that men have lower sperm counts now than a generation ago not because they are less fertile but because women are more fertile. Third, estrogens are found everywhere in the environment including in many plants (phytoestrogens) such as soy and legumes, and are not produced exclusively from the urine of women. Fourth, the intersex conditions that have been reported in many animal species tend to be caused by a very specific exposure at a very specific time point during fetal development and have been linked to pesticides, bisphenol A, dioxins and other environmental contaminants (xenoestrogens). Fifth, did we somehow forget about the worldwide obesity epidemic in humans and the fact that fat converts male hormones to female hormones? Lastly, there is little evidence that substantially increasing a man’s estrogen levels as an adult will dramatically alter anything, except maybe waist size and color preferences. Where the truth lies in all of this is currently unknown, but it is hard for me as a urologist to see how women’s urine could be blamed for so much.

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Are We Replacing Ourselves?

Tuesday, September 8th, 2009
Where are you? Green means high and red means low.

Where are you? Green means high and red means low.

When a couple decides to have children, they rarely, if ever, contemplate the effect this has on the nation. But population scientists do. The effect that birth rates have on society is critical—as basic as knowing whether a nation is sustaining their population or not. But, trying to figure out if birth rates are going up or down is also complex, not unlike taking our temperature by feeling our foreheads.

A good barometer of birth rate assesses the average number of births per woman, and is generally noted by country. For a country to sustain its population in the future, the replacement rate is 2.1, or 2.1 births to every woman. What has occupied the minds of population scientists over the past 20 years is the fact that birth rates have dropped around the world, especially in Europe, but also in China and Japan. Interestingly, many countries in Africa do not have this problem, with birth rates well above 4. 

Also notable is the fact that in the past 20 years, the population of the world has dropped, falling an average of 1% per year. You can imagine how much this issue has occupied the minds of population scientists who seek to explain the phenomenon. Contributing factors include changing attitudes about family size, the cost of raising a child and the wider availability of contraceptives. The birth rate may also be dropping because child mortality on the whole has dropped. Or, because women who choose to have children later create a temporary lull in the birth rate. One concern with population drops is that countries whose populations become too small may not be able to afford to support its infrastructure, causing economic decline. So, on the one hand, it’s expensive to raise a child. On the other, it’s also expensive not to.

A recent study however, does show a change in these trends. Fertility rates now show a recent increase in developed nations. For years it has been thought that for some reason, developed nations, including most of Europe, have steadily dwindling populations. But this may not actually be the case. For example, in the 1970s, the US fertility rate was at a low of 1.74; lately it’s been relatively stable at 2.05. It appears that children are still wanted in a modernized world.

It’s quite hard to see these trends in my daily medical practice, as I perform as many vasectomies as I do vasectomy reversals. It’s even harder to render an opinion when the information is so diffuse and generational. So, to population scientist, I am a professionally “neutral contributor” to fertility rates. Like to think I do more good than that though…

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The Agents of Erection

Monday, August 24th, 2009
The biochemistry is complex; the result is simple.

The biochemistry is complex; the result is simple.

Subtle, efficient, and powerful, Viagra is a first-line agent of erection, along with its accomplices, Cialis and Levitra. True, there are other agents out there, such as penile implants and injections, but these three, the triumvirate of pills, are the go-to agents, because they work so well for so many people.

Viagra wasn’t so much invented as happened upon. Its ability to restore erections was discovered as a side effect of a clinical trial targeted towards treating heart disease. Viagra was supposed to reduce anginal chest pain by increasing blood flow to the heart. It turned out that Viagra did increase blood flow, but to a different organ. After the trial, when the company asked the test subjects to return the extra pills, the patients refused because their erections were so much better. And so the agents of erection were born.

Viagra, Cialis, and Levitra all work the same way–sort of like coffee for the penis. Similar to coffee, which works by preventing the breakdown of the energy molecule ATP, thus increasing metabolic energy, these agents inhibit an enzyme that breaks down a different energy molecule (cGMP) that is found in the penis. This energy molecule causes the arteries of the penis to dilate which is how erections begin. Because cGMP is not being broken down, more cGMP is available, and for a longer period of time. More cGMP equals more blood to the penis. Cue the Love Boat theme.

These medications, as a class called PDE5 inhibitors, are not aphrodisiacs and are no replacement for sexual stimulation. In other words, the traditional rules of engagement still apply. They can take up to one hour to start working, during which time foreplay and intimacy is important for a good experience. All three medications work equally well, with Cialis having the longest effect. Aside from the usual side effects from most pills that include headaches and upset stomach, the major concern with these medications is that they can have dire consequences if one is also taking certain heart or blood pressure medications, namely nitrate-containing medications and alpha-blockers. Dangerously low drops in blood pressure can result, leading to strokes and heart attacks.

These first-line agents of erection are intended for mild to moderate cases of erectile dysfunction. Because this disease is frequently a harbinger of other medical problems such as diabetes and heart disease that you should really know about, a thorough evaluation by a doctor should be performed before it is prescribed. So for health’s sake, please resist the temptation to purchase them from your email spam folder and see a doctor; although embarrassing at first, you’ll be happier in the long run.

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The Ailing Male Pill

Thursday, August 6th, 2009
What shape will the male pill take?

What shape will the male pill take?

A male birth control pill certainly sounds like a good idea. But after 25 years and millions of dollars of research, there’s still no pill. We put a man on the moon faster than we’ve invented a male pill.

The question isn’t really whether it can be done, because it can. The production of sperm is linked to testosterone levels in the body. When testosterone levels are too high, the body stops producing sperm. Witness the testis shrinking (atrophy) that occurs with anabolic steroid use. Such pills have been tested, and are successful. One problem, though, is that the ability of hormone-based male pills to work perfectly (which they really need to do) varies with a man’s ethnicity. Works for some, but not all. This issue alone may prove fatal for the male hormone pill.

Besides this, there is a litany of concerns regarding the physical side effects of a hormone-based male pill. Immediate concerns have been a big issue in past trials- adult acne, weight gain, moodiness and the like. But what about possible long term effects? The female contraceptive pill has been linked with higher rates of heart disease and breast and liver cancer in women. Although not completely comforting, at least we know these issues in women. But little to no research has addressed similar issues with long term “pill” use in men.

Despite all of this, there is still a healthy interest in a male birth control pill. Studies have shown that men in committed relationships are more interested than single men in a pill– no surprise here. Single men are interested in using condoms for the added bonus of protection against STDs. A male birth control pill might also be a better contraceptive alternative for men who want more control over family planning than that offered by vasectomy. That said, there is still the eternal question of whether or not a pill would sell successfully– would women, in the end, trust their partners to be consistent and compliant in taking the pill? The answer to this question varies from couple to couple, but to get a sense of things, ask yourself how often you fail to take something as simple and uneventful as a daily multivitamin to get an idea of the magnitude of this problem.

There simply aren’t enough options for male contraception on the market today. The main ones are abstinence, rhythm method, withdrawal, condoms, and vasectomy. Given this lineup, there is certainly room for more, and more reliable, contraceptives for men. One thing seems reasonable clear: given the safety and effectiveness of vasectomy, and fact that daily compliance is not needed to keep it effective, anything new has to be this good or better. How about a truly reversible vasectomy? Or a long term, implantable hormonal device? In the end, these are likely to become tasty alternatives to a male pill.

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