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Juan Manuel Corral: “Sexual expectations exceed reality. They tell you: 'I am not capable of having five ejaculations'. Sure, what do you expect?

2022-12-07T11:10:32.024Z


The urologist at the Hospital Clínic, an expert in andrology, warns of the misinformation men have about the sexual sphere and warns of the health risks of consuming testosterone as an anti-aging therapy


Men also undergo a process similar to that of the female menopause.

From the age of 40, testosterone levels gradually decrease and, in some cases, this hormonal decline translates into a range of symptoms as diverse as lack of sexual appetite, impotence, fatigue, loss of muscle mass or cardiovascular problems.

On the street, it is known as andropause, but the correct medical term, corrects Dr. Juan Manuel Corral (Barcelona, ​​53 years old), an expert urologist in andrology at the Hospital Clínic de Barcelona, ​​is late-onset hypogonadism in men.

Men of all ages come to his consultation, sometimes by their own decision and others, referred by the family doctor.

They go for a check-up, often for fear of prostate cancer, "and then they open up and explain their sexual problems," says the specialist, who is also secretary general of the Spanish Association of Andrology and Sexual Medicine.

Times have changed, he assures him: although little by little, and without raising his voice much, the shame to talk about the sexual sphere is increasingly lost and doctors are consulted more.

More information

The taboo of menopause: "There is shame, it worries being identified as old or incapable"

Ask.

Menopause is still a taboo for many women.

What happens in men with late hypogonadism?

Response.

Taboos begin to be broken.

Among men there is the myth of "I am the most virile, the most powerful", but when they are alone, in isolation, they recognize their shortcomings and consult a specialist.

Nowadays, there are already many people who start talking about their lack of sexual appetite or their difficulty in maintaining an erection.

Q.

What makes hypogonadism different from menopause?

R.

Menopause is a more marked process, with flowery symptoms, such as hot flashes, sweating... In men it does not have this explosive manifestation: it is a progressive loss, but constant and sustained, which, in those people to whom it occurs , ends up being a real problem.

But not only in the sexual sphere, but beyond: there is beginning to be cognitive deterioration, weight gain, a loss of interest in doing the basic things of daily life, inattention to work... he doesn't want to go out to dinner or is apathetic…

Q.

But that symptomatology is also very non-specific.

It can be for a thousand things.

R.

There can be multiple causes, but one of them is this.

You have to make a diagnosis, rule out other causes and remedy it.

That reason for consultation due to asthenia, that fatigue, that lack of appetite due to sexual desire, has to make you go deeper and go beyond giving Viagra [to the patient] and covering the problem with a patch.

Q.

In women, menopausal hormone therapy has been highly controversial.

What therapeutic alternatives are there for late hypogonadism?

R.

Hormone replacement therapy with testosterone is indicated when there are low levels of this hormone and associated symptoms.

In Spain it is marketed in gels or injectables.

But, first of all, you have to make sure that there is no suspicion of prostate cancer or any disease that prevents you from giving testosterone.

These treatments also require monitoring of many variables: blood pressure must be controlled, monitoring with complete blood tests... People are very happy because they recover their quality of life, but this treatment is not for everyone: it is not indicated to give substitution treatment to someone with correct hormone levels.

Some people use it as an anti-aging therapy: in men, the rejuvenating hormone is testosterone and it is used everywhere to try to slow down,

delay or return the normal biological process of the body.

But that leads you to overtreat.

Q.

What impact does this anti-aging use have?

R.

People think that nothing happens by giving testosterone, but just as the deficiency of this hormone has its side effects, the excess is very bad and also has some not inconsiderable side effects: these 30-year-old bodybuilders can present a significant decrease in testicular volume and become infertile;

It can also lead to cardiovascular, bone or central nervous system problems...

Q.

Is it used to get muscular?

R.

Yes, but not only for that.

Also to have more vitality, to be more active.

Whoever uses substitution therapy without indication is the one who wants to appear a better image, either for personal or even work reasons.

But it must be taken into account that, at certain ages, prostate cancer may be present and it is a testosterone-dependent tumor in its initial phases, so the administration of these treatments without prior medical advice may favor its extension;

In young people it is very dramatic because many of them remain infertile and, after the withdrawal of testosterone, they may not be able to recover the endogenous capacity to produce their own testosterone and thus require it as replacement therapy for life.

It's like a menopause at 35 and then,

Among men there is the myth of 'I am the most virile, the most powerful', but when you leave them alone, in isolation, they recognize their shortcomings and consult a specialist”

Q.

What are the most disabling symptoms of late-onset hypogonadism in men?

A.

Apathy, the loss of the will to live, for example.

It is not only the sexual sphere, which already has enough consequences because it leads to problems with the couple and misunderstandings;

It's not wanting to do anything.

Q.

How many people have symptoms associated with hypogonadism?

A.

Between the ages of 60 and 70, there are between 20% and 30% of men who have low testosterone levels with symptoms.

And after 70, it is 40% or 50%.

Q.

Is the most stigmatizing symptom the lack of sexual desire or impotence?

R.

Sure, it is what affects the most because it is what can have the most impact on your immediate environment, which is your partner.

If your male partner does not look at you with desire, does not touch you, does not caress you, his head aches every night, it catches your attention and you may think that there is another external relationship when, really, what is happening to him is that he does not have you win physiologically.

Q.

Does low testosterone happen to all men?

A.

We all lose, from the age of 40 or 45, between 0.4% and 1.2% of testosterone levels each year, gradually.

But it is not the same to lose testosterone in a 50-year-old person with obesity, diabetes and hypertension than in another 50-year-old who plays sports, does not smoke and leads a healthy lifestyle.

You will not notice this second case because the small progressive lack is simply compensated with regular physical exercise.

Q.

Is it noticeable in fertility?

R.

That is another field.

The man does not lose fertility.

There is less and less chance of pregnancy spontaneously, but the sperm are still there.

Q.

Is there a point of no return in the loss of sexual appetite or impotence problems?

R.

It is that there is a point at which sexuality is not only organic, but also psychogenic.

It's like a loop: you have people in their 40s who don't have any organic problems, they have good erections on their own with masturbation, but they've had a problem with their partner because they've had a relationship that hasn't been satisfactory.

What happen?

That creates insecurity and the next relationship they already go with the doubt and fail again.

The next time, they think about it and the level of anguish is already much higher and there begins to be avoidance and rejection behaviors.

And it all goes into a loop.

This problem of dysfunction has a more favorable solution: it is to give them security, confidence, they gain self-esteem and at the moment they have a series of relationships followed satisfactorily, they get back into the routine and it is not necessary to give them testosterone.

Q.

How much does the psychological variable influence the physiological one?

A.

It weighs a lot.

Let's start from the fact that we are in a macho society in which the concept that man is the Iberian macho still exists.

The association of a medical treatment with behavioral treatment or with a sexologist greatly improves the results of the therapies in patients with alterations in the sexual sphere.

Taking too much testosterone sucks: these 30-year-old bodybuilders can become infertile”

Q.

What are the problems you most often encounter?

R.

Now, regarding the sexual sphere, you have problems since you were 15 years old.

This happens with the availability of pornographic content because the expectations that one creates are much higher than reality.

It is common for them to tell you: "Hey, I can't have four relationships in a row" or "I'm not capable of having five ejaculations."

Sure, what do you expect?

Or they tell you: "I'm frustrated because I finish in 12 or 15 minutes."

Well, and do you know how much is the average time of a sexual relationship in Europe?

Five and a half minutes, seven minutes the most.

And you tell me that you are 12, well, fantastic!

But, of course, they argue that the video was 25 minutes.

Yes, but, in how many days did they record that?

Q.

Is there a mismanagement of expectations?

R.

There is a lot of bad information around the sexual sphere.

They tell you: 'It's just that, of course, I ejaculate little'.

But do you know how much is the normal ejaculate volume?

1.5 milliliters.

Perhaps one reason why men begin to consult more is because they have more access to bad information, to bad content, not real, and then, when comparing, they feel aggrieved.

Q.

Do many young people come to the office?

R.

Before the age of 30, there are a large number of alterations in the sexual sphere such as: "I don't have erections that last 20 minutes" or premature ejaculation due to anxiety.

Above all, young people, 18 years old, who think they have a real problem when they have nothing.

We have to act as a social educator: make them see the reality of the normal physiology of the male body.

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Source: elparis

All news articles on 2022-12-07

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