We all have male and female qualities within us, but men and women do have physical differences that mean differences in how their health plays out over a lifetime. The days of men refusing to talk about their health are, hopefully, behind us but some men can still be less than enthusiastic about supporting their own health. It’s worthwhile bringing together in one spot all that we know about male health and how that health can be supported with natural measures. It all begins, of course, with the fundamental nature of the male anatomy.

Male Basics

Anatomically, the male reproductive system comprises the testes and the penis with a system of ducts and glands, including the prostate. The testes are a pair of egg-shaped glands that sit in the scrotum on the outside of the body next to the penis and it’s these (stimulated by the action of pituitary hormones) that produce both sperm and the male hormone, testosterone. The brain, through hormone regulation by the pituitary and hypothalamus, plays a critical role in the control of the male reproductive system.

In young men, the prostate is about 20g (the size of a walnut) but it becomes enlarged as men age. The prostate doubles in size between the ages of 21 and 50, then doubles again from 50 to 80 years old, although it’s not fully understood why this happens. The growth of the prostate relies on testosterone and, if it grows too large, it can slow or stop the flow of urine.

Testosterone

Testosterone is the primary male sex hormone (androgen) synthesised from cholesterol. Its synthesis and secretion occur mainly in the testes; its production is stimulated by the hormone from the pituitary gland, in turn stimulated by the hypothalamus. Once it’s released into the general circulation, about 7 per cent is tightly bound to the storage form — sex-hormone-binding-globulin (SHBG) — and unavailable for biological activity. Forty-eight per cent is bound to albumin, serving as a buffer to protect it from rapid metabolism, and about 2 per cent is free testosterone — the bioavailable and active form.

Testosterone’s metabolism is regulated by feedback mechanisms and by the liver, which breaks down the hormone to its inactive metabolites after use. Testosterone is also secreted by the adrenal glands, which is why stress can impact on its levels.

In the Massachusetts Male Aging Study it was shown that the levels of testosterone fell by 2 per cent per year and the levels of DHT (its metabolite, dihydrotestosterone) rose from the ages of 40 to 70. This was much less marked in men who had a good diet and healthy lifestyle, which reduced this age-related decline by 10–15 per cent.

Men with higher body fat have higher levels of oestrogen as testosterone is converted to oestrogen in body fat.

Testosterone and oestrogen interact in complex ways and liver congestion can seriously affect the balance. The pathways in the liver that detoxify environmental chemicals also break down hormones such as oestrogen so, with the high chemical exposure of today, these pathways are overloaded and hormone breakdown and secretion are reduced. This is particularly a problem with oestrogen. Over-oestrogenisation plays a large role in adverse health conditions today, including those associated with deficiencies of testosterone.

Testosterone regulation determines male health. It plays a key role in the development and function of the male reproductive system. Testosterone has major anabolic effects, is responsible for muscle growth and strength and plays a role in the normal inflammatory response.

Testosterone & male development

During foetal development, testosterone promotes maturation of the sex organs, particularly the penis and the scrotum. This process is initiated in the first 4–6 weeks of conception when the male characteristics start to develop. The second trimester of pregnancy is then the crucial time for the masculinisation of the foetus and is a major predictor of behaviour of the future adult.

Once the male baby is born, testosterone levels rise, triggering the masculinisation of the brain where it crosses the blood–brain barrier into the male brain, a pathway that’s blocked in females.

During puberty, androgen levels rise (in both boys and girls), causing adult-type body odour, increased oiliness of the skin (sebaceous glands enlarge), acne, the appearance of pubic, facial, body and armpit hair and, in males, the deepening of the voice. In the boys, androgens stimulate male sexual differentiation and development, a heightened level of free testosterone in the blood, triggering sperm production, increasing male fertility and libido, penis enlargement and the frequency of erections. In conjunction with human growth hormone, facial bones are remodelled and overall body growth and completion of bone maturation occur.

Testosterone & adult males

In adult males, testosterone is essential for healthy sperm development, regulating the hypothalamic-pituitary-adrenal axis (the stress pathway) and increasing competitive and challenging behaviour.

In terms of sexual arousal, testosterone levels peak early in the day, regardless of sexual activity. Research shows that the degree of sexual arousal is exquisitely sensitive to levels of testosterone and there’s a marked increase in male testosterone levels when meeting a new female. Males are also very sensitive to female body odour and testosterone levels rise when exposed to an ovulating female — sexual arousal in men is heightened when women are most fertile. The prostate secretes a slightly alkaline fluid that transports the sperm into the female vagina for conception. This alkalinity counters the acidity of the vaginal tract and prolongs the life of the sperm.

The ‘Mediterranean’ diet, on the other hand, has shown a positive impact in improving men’s health.

As men age, circulating androgen levels decline. Between the ages of 20 and 70, serum testosterone levels fall, with an increase of SHBG of 30–50 per cent, causing a decline in free testosterone of 30–50 per cent. The principal androgen in the prostate is dihydrotestosterone (DHT) and, as men age, the balance of DHT is increased with the reduction in serum testosterone. Oestrogen levels also decrease unless men put on weight. Men with higher body fat have higher levels of oestrogen as testosterone is converted to oestrogen in body fat. Oestrogen also rises when liver function is compromised.

DHT is a metabolite of testosterone and the conversion occurs through the action of the enzyme 5-alpha-reductase in the testes. In the blood the circulating testosterone is about 10 times higher than DHT, but in the prostate DHT is higher as it’s critical for prostate activity.

Androgen (male hormone) receptors for these hormones occur in the prostate but are also widely distributed throughout the body, including in vascular endothelial and smooth muscle cells. As such, many physiological systems of the body are influenced by androgens, including the cardiovascular system (nitric oxide release, lipid metabolism, insulin sensitivity), calcium mobilisation (bone density), vascular integrity, regulation of the stress response (sympathetic nervous system), inflammatory enzyme systems and reactive oxygen species (free radical) generation.

The impact of low testosterone levels

Testosterone deficiency is a major health issue today and can generate many symptoms, including a decline in libido, erectile dysfunction, increased fat deposition, decreased muscle mass and muscle quality, reduced bone mass, reduced production of haemoglobin, decreased energy and motivation and impaired brain function. As men age, these symptoms may also include fatigue, decreased self-confidence, irritability, increasing frailty and weakness, osteoporotic (bone) pain, depression and reduced cognitive ability, and the lethargy associated with anaemia.

Testosterone deficiency also contributes to cardiovascular disease, including atherosclerosis, heart attack and strokes, metabolic syndrome and type 2 diabetes.

Causes of low testosterone

Testosterone deficiency is a complex issue and can be related to ageing, stress levels, diet and lifestyle choices, obesity, smoking, alcohol consumption, various medical conditions and some pharmaceuticals.

Research has shown that increasing levels of abdominal (visceral) fat in ageing men contributes to a reduction in levels of testosterone — total levels of testosterone, free testosterone and SHBG. This pattern of weight gain is also a major indicator of type 2 diabetes, insulin resistance, cardiovascular disease and obstructive sleep apnoea.

Male Sexual Health and Fertility

Testosterone is essential for normal quantity and quality of sperm and therefore for male fertility. It takes about 70 days for sperm to mature and be able to fertilise an egg. This short time for their maturation makes them more susceptible to environmental influences. When released from the testes, the sperm take 2–10 days to travel through the epididymis and become motile (gain the ability to swim strongly) so they can attach to and penetrate the female egg.

Rising infertility in couples is a global health issue involving about 15 per cent of the world’s population; male infertility accounts for about 40 per cent of cases. Low sperm count and quality (oligozoospermia) is a significant issue impacted by problems that affect sperm production or the sperm transport process. These may be genetic, physiological or environmental. Sperm production problems can be caused by undescended testes, varicose veins or torsion (twisting) in the testes, genetic factors or environmental factors such as radiation, infections, chemical exposure and some pharmaceuticals. Sperm problems can also be related to infection or prostate disorders (or vasectomy).

One area receiving significant attention in the research is the level of damage to sperm due to oxidative stress, now being recognised as a probable cause of idiopathic male infertility. Sperm contain a high level of unsaturated fatty acids, making them very prone to oxidative damage.

Sexual problems are related to erection or ejaculation issues: erectile dysfunction, failure of ejaculation, prostate surgery, some medicines or spinal cord injuries. Hormonal problems such as low testosterone, pituitary hormone disorders or steroid abuse (widespread among bodybuilders) are also common.

Monash University in Victoria houses a specific unit conducting research on men’s health and has a group called Andrology Australia. According to the Australian statistics, more than half (54 per cent) of men aged 18–55 had experienced some difficulty with erectile dysfunction — lasting at least three months — during the past 12 months.

Prostate disorders

The most common symptoms as men age are the development of lower urinary tract symptoms and prostate disorders.

Nocturia (having to repeatedly get up in the night to urinate) plays a significant role in men’s health, causing lack of sleep, sleepiness during the day, reduced sense of wellbeing and vitality, lowered productivity and deteriorating mental health. It’s associated with a negative feedback mechanism where it’s caused by low testosterone but, in turn, also lowers testosterone. Nocturia is also commonly associated with benign prostatic hyperplasia as the enlarged prostate starts to block the urethra.

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH), an enlargement of the prostate, is one of the most common conditions in older men. More than 50 per cent of men aged over 70 show symptoms of this condition. With the age-related decreases in serum testosterone, a rise in hormones such as oestrogen and growth factors contributes to this condition.

The first symptom often noticed is nocturia. Other common symptoms are dribbling and a sensation of incomplete emptying of the bladder. In advanced stages of the condition, there’s an increase in the incidence of obstructive symptoms: delayed beginning of micturition, weak urinary stream and residual urine in the bladder. These symptoms can significantly disrupt quality of life.

Diagnostically, prostate-specific antigen (PSA) is the main blood test along with a rectal examination for enlarged prostate. Ideally, the PSA level should be less than 4.0ng/mL, but as the prostate gland increases in size it produces more PSA. The rate of change can be a useful marker — a rise of 0.75ng/mL per year is considered normal.

A PSA level by itself is not a useful diagnostic marker for prostate cancer but, if it steadily rises to 20ng/mL or more, it requires medical assessment — whether or not the man has any symptoms. The risk of having prostate cancer can increase with increasing PSA levels. A biopsy (the only definitive diagnostic tool at this stage) will usually be performed to see if there are any cancer cells present.

Prostate cancer

Prostate cancer is the sixth leading cause of death for males; however, from 1984 to 2013, according to the Australian Institute of Health and Welfare, the five-year survival rate from prostate cancer improved from 58 per cent to 95 per cent. From a health perspective, figures from a longer period of time would be more relevant as earlier detection can skew these statistics. Early detection also has positive benefits as the condition is more easily treated successfully, from both a medical and a herbal and nutritional perspective.

Changes in testosterone and dihydrotestosterone play important roles in the development of this condition. As men age, their prostate becomes increasingly sensitive to androgens, demonstrating an increased metabolism towards the production of dihydrotestosterone which, in combination with oestrogens, contributes to abnormal growth and cell accumulation (by a reduction in the rate of cell death rather than an increase in cell replication).

With the age-related alterations in the androgen-oestrogen balance contributing to prostate pathology, androgen deprivation therapy (ADT) is the common focus for medical treatments. Unfortunately, due to the enormous susceptibility of prostate cells to androgen deprivation, many men will develop hormone refractory cancer or castration-resistant prostate cancer. Androgen deprivation therapy may also increase cardiovascular risk, particularly in men with pre-existing cardiovascular disease.

Surgery and radiation are other treatments for prostate cancer, but these can also have major side-effects such as urinary incontinence and impotence.

Testicular cancer

Testicular cancer is a cancer that develops in the testicles. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. It is the second most common cancer in young men aged 18 to 29 and the incidence is increasing. Increased risk is associated with undescended testicles as an infant and with a family history of this condition.

There is evidence that testicular cancer may be triggered by environmental (chemical) factors such as endocrine disruptors, which impact on oestrogens and androgens, particularly in the developing male.

If the tumour hasn’t spread, the main treatment is an orchidectomy: removal of the testicle affected. This is often the only treatment necessary and, if the tumour is detected early, is usually successful.

Bone density

Testosterone is critical for bone mass. So, if this is low, men become prone to osteoporosis. Today this condition is much more common in men than is acknowledged.

Cardiovascular disease

According to the Australian Bureau of Statistics, men are three times more likely to die from heart disease than women. Testosterone plays a critical role in the health of the cardiovascular system.

Supporting Male Health

There is a long and recorded history of the use of herbal medicines in the treatment of the male reproductive system. The regulating effect of medicinal plants on male reproductive function is associated with many activities: their ability to regulate testosterone levels, their anti-inflammatory activity and their antioxidant activity. Antioxidants provide the critical defence against free radical-induced male infertility as well as prostate disorders such as BPH and prostate cancer.

While the herbs discussed here have broad-ranging activity, they have been collated into groups related to specific conditions and are effective as preventive measures, as well as treatments, for these conditions.

Increasing testosterone levels

In recent years there has been an increase in testosterone prescriptions; however, while this treatment may improve symptoms in some men, it can be associated with adverse events, including increased risk of serious cardiovascular events. Pharmaceutical testosterone as a medication is sometimes used to enhance muscular physique and performance — for example, in athletes or bodybuilders. This also can have adverse side-effects. There are better options.

Nutritional options

A Western-style diet impacts negatively on testosterone metabolism and is associated with lower circulating testosterone levels, although negative feedback mechanisms balance this to some extent. The “Mediterranean” diet, on the other hand, has shown a positive impact on men’s health. Eating organic food improves nutrient levels and reduces chemical exposure.

An interesting study published in 2018 showed that the consumption of sugar-sweetened beverages (soft drinks) was inversely correlated with testosterone levels in 20- to 30-year-old men. The more soft drinks they consumed, the lower their testosterone levels. While part of this may have been related to the level of phthalates (and BPA) consumed from the drink in plastic bottles, the role of the glucose cannot be excluded. Their risk of weight gain, type 2 diabetes, cardiovascular disease, hyperuricemia and gout was also increased. Sugar-sweetened beverages are associated with weight gain and obesity, metabolic syndrome, some cancers and diabetes.

Weight management

For many reasons it’s important to reduce weight if overweight. Research has shown that testosterone levels normalise as overweight men lose that excess flab, particularly abdominal fat.

Reduce or eliminate sugars, especially processed sugars and soft drinks. Avoid all high-fructose corn syrup and commercial sweeteners, as they impact adversely on weight gain and insulin resistance.

Exercise

Exercise regularly. High-intensity exercise in short bursts is very beneficial for overall health and cardiovascular function. Exercise to your level of fitness and make sure it’s something you enjoy. It must be done for a minimum of 3–4 times per week.

Both resistance and high-intensity exercise are beneficial in normalising levels of testosterone and cortisol (the stress hormone) in both lean and obese individuals. There are also significant improvements in cardiovascular function and metabolic syndrome.

Fasting

Intermittent fasting along with regular exercise has been shown to improve hormonal levels and reduce the risk of cardiovascular disease, metabolic syndrome and inflammation.

Vitamin D

Vitamin D is essential for the healthy development of the nucleus of the sperm cell and helps maintain both sperm health and sperm count. It also increases levels of testosterone (when measured over one year) and therefore increases libido. Vitamin D deficiency is at epidemic proportions in the Western world. Vitamin D also has a major role related to calcium metabolism. As such, it improves bone metabolism but is critical in the health of the cardiovascular system where it influences blood pressure, coronary artery disease and cardiovascular conditions such as heart failure and atrial fibrillation.

Vitamin K₂

Vitamin K₂ has many roles in the human body, including the regulation of bone metabolism in the prevention of osteoporosis. It also has shown promise in inhibiting cell proliferation in prostate cancer cells that are hormone resistant, possibly due to its antioxidant activity.

Stress reduction/management

Reproductive system hormones and the stress hormone cortisol are both produced in the adrenal glands in inverse proportions. Under stress, cortisol levels rise and reproductive system hormones like testosterone diminish. Managing stress effectively is beneficial for testosterone levels.

Male Sexuality and Fertility: Environmental Impacts

Increasing evidence suggests environmental factors can be a cause of deteriorating sperm quality. These include exposure to various chemicals, heat, radiation and heavy metals such as lead and mercury (infertile males had a 40 per cent higher mercury level in their hair than fertile males). High mobile phone use may also be a factor.

Exposure to environmental oestrogens, pesticides and herbicides is linked to alteration in spermatogenesis. Synthetic oestrogens are used agriculturally in the livestock, poultry and dairy industries. Many commonly used pesticides such as organochloride compounds have oestrogenic effects in the body, and chemicals such as DDT, dioxins and PCBs are known to interfere with spermatogenesis. Roundup (glyphosate) has been shown to inhibit steroidogenesis and adversely affect sperm quality in many animal studies. Research is indicating that it reduces male fertility.

Bisphenol A (a plasticiser common in plastic water bottles and in the water they contain) is a well-known endocrine disruptor that affects both the male and female reproductive systems. BPA (and associated chemicals) is a known oestrogen disruptor causally linked to adverse health effects in humans, including disrupting normal development of the male reproductive tract.

Cigarette smoking has been associated with decreased sperm count, alterations in motility and an overall increase in numbers of abnormal sperm.

Lifestyle

Male fertility is reduced by infection, inflammation (which inhibits sperm maturation) and oxidation, closely linked with the inflammatory response.

Obesity has been shown to be a factor in male infertility as well as in type 2 diabetes, metabolic syndrome, cancer, high cholesterol, heart disease, hypertension, sleep apnoea and renal failure. Infertility in obese men is three times higher than in men of normal weight, related to the negative impact on erectile dysfunction and sperm health.

Diets rich in processed meat, soy foods, potatoes, full-fat dairy, cheese, coffee, alcohol, sugar-sweetened beverages and sweets are inversely associated with semen quality. As far as fertility and male sexual health are concerned, a high intake of alcohol, caffeine, red meat and processed meat by men has a negative effect on the chance of pregnancy or fertilisation rates in their partners.

There is significant evidence of a global decline in sperm quality, but observational studies have shown that when men shift to a healthier diet and lifestyle their sperm quality and fertility increase. A total of 1944 articles were identified, of which 35 were selected for qualitative analysis. Generally, the results indicated that healthy diets rich in nutrients such as omega-3 fatty acids, antioxidants (vitamins E, C, beta-carotene, lycopene) and minerals (selenium, zinc and magnesium), vitamins D, K₂ and folate, and low in saturated fatty acids and trans-fatty acids (hydrogenated oils) were positively associated with sperm quality. Similarly, diets focused on fish (low mercury), shellfish and seafood, organic poultry, cereals, vegetables and fruits and unsweetened fermented dairy products such as kefir, were also associated with higher sperm quality.

Sildenafil (commonly sold under the brand name Viagra) is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. It relaxes the muscles in the walls of the blood vessels and increases blood flow. However, it can interact adversely with nitrate drugs taken for chest pain or recreational drugs such as amyl nitrate and cause a dangerous decrease in blood pressure. While it can be useful, especially for men who have had their prostate removed surgically, be aware that it does have side-effects. If in doubt, check with your doctor.

Male herbal tonics

There is a long and rich tradition of use of male tonics in medicine globally. Compared with Viagra, most will only deliver modest effects, but there are a few that have a credible basis as male tonics. Long-term use is more effective.

Ginseng (Panax ginseng)

Ginseng is a well-known male tonic in Chinese medicine, with substantial research. Two major clinical trials showed that at a dose of 2.7g/day for eight weeks, versus placebo, there was a significant improvement in erectile dysfunction in 45 men who had been diagnosed medically with this condition.

In another study comparing ginseng (1.8g/day) with the drug trazodone, the patients with impotence who received the ginseng showed a 60 per cent improvement in erectile dysfunction (and in libido) compared to 30 per cent in the trazodone group.

Systematic reviews of Korean ginseng have shown it improved cardiovascular risk factors and hypertension, quality-of-life parameters, cognition and type 2 diabetes — many of the problems associated with low testosterone.

Ashwagandha (Withania somnifera)

To improve male reproductive health, the Ayurvedic herb ashwagandha has multiple uses. It relieves anxiety and assists with stress management and it improves muscle strength and recovery. With its significant antioxidant activity, ashwagandha increases fertility by improving sperm count and motility and has been shown to improve the symptoms of benign prostatic hyperplasia.

Nutrients to improve male fertility

Antioxidant nutrients are critical to raise testosterone levels, including vitamins E, C and carotenoids, as well as the minerals zinc, selenium and magnesium.

Zinc

Zinc is a critically important nutrient for testosterone production. It has been calculated that 45 per cent of men over the age of 60 are critically low in zinc. It’s vital for healthy sperm production, sperm formation and motility. Even a marginal zinc deficiency can manifest as a reduced sperm count. A deficiency of zinc is an important risk factor for low sperm quality and idiopathic male infertility.

The prostate gland contains the highest level of zinc of any body tissue and zinc is therefore essential for the health of this gland. Zinc is secreted into the seminal fluid and has a multifaceted role in sperm release and motility. It acts as an important anti-inflammatory factor and protects against sperm oxidative damage. It has multiple roles in male reproductive health and is essential for conception and embryonic implantation. It has a role in all aspects of inherent immunity, so any deficiency will result in a weakening of the immune system. It’s a critical nutrient for overall health, especially in men.

Selenium & glutathione

Low levels of selenium have serious adverse consequences for male fertility. It plays a crucial role in the antioxidant protective system, preventing free radical damage to sperm. A major study (meta-analysis) showed that serum selenium was inversely correlated to prostate cancer susceptibility. Higher levels of selenium were associated with lower risk of metastases in men with prostate cancer.

Magnesium

Low levels of magnesium may increase blood levels of C-reactive protein, a significant marker of inflammation and heart disease. Drinking alcohol and reduced consumption of green leafy vegetables play a role in this deficiency, the symptoms of which also include anxiety, spasms and cramps, high blood pressure and stress. Magnesium plays a major role in the stress response (both mental and physical stress), so higher stress levels increase magnesium elimination from the body.

Vitamin E

Higher vitamin E status is associated with lower risk of prostate cancer. It is a vital fat-soluble antioxidant molecule in cell membrane. As such, it protects sperm integrity and motility.

Grapeseed extract

Grapeseed extract is anti-inflammatory, antioxidant and antimicrobial. It has cardioprotective, hepatoprotective and neuroprotective activity. It has been shown to increase sperm count, viability and sperm motility as well as protect the sperm cell against DNA damage.

Grapeseed extract has a complex mix of polyphenols containing proanthocyanidins. In a comprehensive study of men taking supplements for five years, grapeseed extract showed 41 per cent reduced risk of prostate cancer, even when compared to the intake of other supplements. Men taking this supplement over 10 years showed a 62 per cent reduction in risk.

Essential fatty acids: omega-3

Ideally, healthy fats should comprise 50 per cent of the dietary fats and come from a variety of sources: animal, vegetable, seafood, game, nuts and seeds. High omega-3 fatty acids are particularly important as they reduce inflammation, improve cardiovascular function, reduce depression and improve cognitive function. They also play a significant role in the management of healthy prostate function.

In an interesting rat study, fish oil supplementation prevented reproductive dysfunction in rats on high-fat diets and improved the function of genes that synthesise testosterone. Krill oil is recommended at 3–4g per day. Krill oil has a higher bioavailability than fish oil for omega-3 supplementation. Make sure it’s sustainably sourced.

Treating the prostate

Medically, 5-alpha reductase blockers such as finasteride are commonly prescribed. Finasteride suppresses DHT by about 70 per cent in serum and by as much as 85 per cent in the prostate. It is prescribed for both benign prostate hyperplasia and for male pattern baldness.

Benign prostatic hyperplasia is a common issue. Substantial research has confirmed the history of herbal medicines in the prevention and treatment of this disorder. When compared with pharmaceutical treatments, the risk-benefit ratio of herbal medicines was distinctly positive with a clear improvement in symptoms (especially in the early stages of BPH) and was associated with an increased quality of life with negligible side-effects.

A double-blind placebo-controlled clinical trial tested a combination of selenium and silymarin (St Mary’s thistle) in men with lower urinary tract symptoms, benign prostatic hyperplasia and a PSA level <2.5ng/mL. In the men receiving the selenium-silymarin supplement for six months there was a significant reduction in the PSA markers with no effect on testosterone levels. The decrease in PSA levels was as effective as 5-alpha-reductase medical treatment — without the side-effects.

Tribulus terrestris

Research shows tribulus, or bindii, has substantial effects on male health. It is a tonic, aphrodisiac, stomachic, diuretic, antilithic and astringent. A potent herb in Ayurvedic medicine for the genito-urinary tract, it is prescribed particularly for the removal of kidney stones (it inhibits oxalate formation). In Bulgaria it has a long tradition of use to treat impotence, venereal disease and sexual debility as well as to build muscle strength in weightlifters. It is also cardiotonic and antihypertensive, has been shown to regulate blood sugar in diabetics and lowers serum cholesterol. The fruit and seeds are commonly prescribed but the whole plant can be used. The leaves are used as a diuretic and contain significant concentrations of potassium.

Saw palmetto (Serenoa repens)

A meta-analysis of clinical trials on serenoa published in 2018 showed that, at a dose of 320mg daily (as a monotherapy), it reduced nocturia and improved maximum urinary flow in men diagnosed with benign prostatic hyperplasia. It has similar efficacy to tamsulosin (an alpha blocker) and the 5-alpha-reductase inhibitor finasteride in relieving the symptoms. It was also found to be well tolerated and an effective therapeutic option for long-term treatment of lower urinary tract symptoms and benign prostatic hyperplasia.

Nettle root (Urtica dioica)

Five hundred and fifty-eight patients were studied in a trial using nettle root for BPH. Over a six-month period, there was a measurable improvement in the international prostate score as well as improved lower urinary tract symptoms. Testosterone levels were unchanged. No adverse side-effects were reported. Many participants continued taking the root for 18 months with continued improvement.

Willow herb (Epilobium parviflorum)

Epilobium extracts have been effective for a range of symptoms, including urethral inflammation, micturition disorders, prostatic adenoma and benign prostatic hyperplasia (reducing PSA levels) as well as in improving gut disorders such as gastric and duodenal ulceration.

Foods for prostate health

Clinical trials have shown protective effects on prostate health from selenium, vitamins D and E, curcumin, resveratrol, lycopene, omega-3 fatty acids and the phyto-oestrogens genistein and daidzein. Green tea (Camellia sinensis), pumpkin seeds (Curcubita pepo) and St Mary’s thistle seeds (Silybum marianum) have been shown to have preventive and anticancer properties for prostate cancer as well as to significantly improve liver function.

Tomatoes & lycopene

Lycopene is the major carotenoid associated with male reproductive health. It is a powerful antioxidant present in red fruits and vegetables, particularly tomatoes and tomato-based products and in watermelon, red papaya and red grapefruit. Tomato intervention alone decreased median serum PSA levels, and PSA levels were shown to be inversely related to plasma lycopene, both before and after intervention.

Tomatoes improved mild to moderate erectile dysfunction when eaten daily (with 20mL extra-virgin olive oil) for three months. Lycopene was shown to have a vasodilatory effect (related to nitric oxide release), which promotes blood flow throughout the body including to the penis, improving erections. Lycopene is more concentrated in the testes than in any other part of the body and plays a major role in maintaining sperm integrity and reversing male infertility. Lycopene is also a major antioxidant and has been shown to have a positive effect on the genes governing the androgen stimulation of prostate growth as well as reducing cytokine production, providing a hormone-regulating, anti-inflammatory and antioxidant impact.

Processing tomatoes can increase the bioavailability of the lycopene content. Making tomato soup or tomato sauce improves its bioavailability and therefore the effectiveness of tomatoes as a treatment for prostate disorders, reducing PSA levels, reducing the symptoms of benign prostatic hyperplasia and reducing the risk of prostate cancer.

Cooking tomatoes with olive oil improves lycopene absorption from the digestive system. Cooking tomatoes with olive oil (5–10 per cent of the mix) for up to 15–30 minutes significantly improved bioavailability, supporting the effectiveness of the Mediterranean diet — high in both tomatoes and olive oil — in overall health protection.

Fermented soy (non-GMO, organic)

Miso and tempeh are useful foods for male reproductive health. When soy is fermented, the antioxidant isoflavone genistein is produced. High plasma genistein concentrations were strongly linked to a 69 per cent decrease in the risk of developing prostate cancer in Chinese men. Another study showed that isoflavones in soy inhibited prostate inflammation. Isoflavone intervention did not affect testosterone or PSA levels.

Pumpkin seeds

Pumpkin seeds have been used to improve symptoms of lower urinary tract disorders and BPH. A study was conducted over 12 months on 1431 men with these symptoms eating 5g of seeds per day. After 12 months, the most improvement was noted in the relief of the lower urinary tract symptoms and nocturia, indicating an improvement in BPH. Animals eating pumpkin seeds showed reduced prostate weight. The explanation for the seeds’ efficacy is in their anti-inflammatory fatty acid composition, zinc levels and vitamin E.

Pomegranate (Punica granatum)

Pomegranate fruit extract has been shown to have powerful anti-inflammatory and antioxidant properties and regular consumption resulted in the inhibition of cell growth followed by apoptosis of even highly aggressive human prostate carcinoma cells. It was also associated with significant reduction in PSA levels.

Green tea (Camellia sinensis)

Green tea has significant antioxidant properties that improve major semen parameters such as sperm concentration, motility, morphology, DNA damage, fertility rate and gamete (reproductive cell) quality. These unique properties of green tea catechins improve male reproductive health.

To support the health of the men on this planet, rebalancing testosterone is a critical factor and the maintenance of health — and therefore the prevention of illness — is a lifelong process. While our current medical system is very useful when we are diagnosed with disease, it has little concept of or practice in the maintenance of health, which requires a different approach.

To improve health, all men should have a preventive program implemented before any symptoms manifest. It’s an exciting and rewarding process that benefits male health and fertility and increases both quality of life and longevity.