Can alcohol cause erectile dysfunction?

Contrary to popular belief, alcohol is not always an effective aphrodisiac. While one glass may help you relax in the bedroom, too many can actually hamper your sexual performance.

Ever come home from a night out and find yourself unable to perform in the bedroom? If you’re one of the millions of men who have experienced difficulty getting or maintaining an erection after drinking, you likely understand the frustrations of the issue. Jokingly referred to as “whiskey dick”, the condition is much more prevalent than it seems. While estimates vary, researchers believe that most men will suffer from alcohol-induced impotence, whether that be for the long-term or just for the night.

What is erectile dysfunction?

Erectile dysfunction is an ongoing condition in which men have difficulty getting and keeping their erections. While it’s normal for most men to experience the occasional erectile difficulty, (especially after a particularly long night of drinking), if it begins to happen in more than 25% of all sexual encounters, it may be ED.

Erectile dysfunction can be caused by several physical and psychological issues, as well as lifestyle choices, including:

  • Diabetes
  • Heart disease
  • Depression
  • Anxiety
  • Alcohol or drug abuse
  • High weight
  • Certain medications

If you have questions or concerns, you should bring them to your doctor who can offer advice or diagnosis.

How does alcohol affect sexual performance?

Ever notice how drunk people walk a little funny and slur their words? Alcohol is a natural depressant, meaning it inhibits the nervous system, blocking nerve impulses and messages from the brain to the body. This is what makes it difficult for people to act as they normally would.

With regard to sex, however, alcohol’s effect on the body has an interesting role, with both the nervous system and hormone levels.

In the short-term, an inhibited nervous system causes the blood vessels (that normally fill the penis with blood and then close to maintain an erection), to relax and allow backflow out of the groin. It typically allows men to get an erection, but not keep it for a prolonged time period, affecting their ability to have penetrative sex.

Similarly, a 2015 study found that five or more drinks begin to affect natural hormone levels, suppressing testosterone production and ultimately lowering a man’s ability to get hard at all.

Drinking occasionally will cause these types of erectile difficulties within a few hours but doesn’t necessarily mean that you have ED. Over the long-term, however, alcohol abuse can damage blood vessels and cause several health issues that often lead to erectile dysfunction, such as high blood pressure and heart disease.

Treating ED after alcohol use

Unfortunately, there’s not a lot that can be done for alcohol-induced erectile difficulties other than sobering up.

While oral treatments like sildenafil citrate (Viagra) can help combat symptoms of ED by improving blood flow to the penis, mixing prescription medications with large amounts of alcohol can cause dizziness and headaches. You should only use a medication if you’re experiencing erectile dysfunction while sober.

While you are waiting to sober up, there are always other, non-penetrative options that you and your partner might enjoy.

If chronic alcohol abuse has led to other health problems that caused ED, consult with a doctor about how to best move forward. There are several treatment options as well as lifestyle changes, like weight loss, exercise, and stopping drinking, that can improve erectile function.


Erectile Dysfunction (2018, March 9). In Mayo Clinic.

Bergin, R., & Benjamin, C. (2015, November). The Effects of Alcohol on Athletic Performance. National Strength and Conditioning Association, 3(4).

Michelle, J. (n.d.). “Can Alcohol Cause Erectile Dysfunction?”. In Livestrong.

Arackal, B. S., & Benegal, V. (2007). Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian journal of psychiatry, 49(2), 109–112. doi:10.4103/0019-5545.33257

Steady under Pressure: how to address premature ejaculation

Suffering from a short sex life? You aren’t alone. Millions of men suffer from premature ejaculation, though it’s an issue that’s often swept under the rug. While estimates vary, most literature states that between  20-30% of men have experienced  the issue at some point in their lives.

What is premature ejaculation?

Premature ejaculation is a condition in which a man ejaculates sooner than he or his partner want. Occasional issues with climax are likely not a cause for concern, but consistently short duration of sex and an inability to delay ejaculation are problems about which you should consider speaking with your doctor.

How short is too short? Doctors have had a difficult time pinning down a definition around what constitutes true PE. They consider the amount of stress it causes for the individual or in the relationship, the ability to control ejaculation and how quickly ejaculation occurs. Most medical guidelines define premature ejaculation as ejaculation regularly occurring within one minute of vaginal penetration.  Most men experience variable time to ejaculation and average between 5-6 minutes (in case you were wondering).

So, how can you tell if you have an ejaculatory disorder? Here are a few questions to ask yourself, and discuss with your doctor, if you think you might have PE:

  1. How long are you able to last following penetration?
  2. Is the duration from penetration to ejaculation consistent or variable? Can you last longer sometimes?
  3. How much control do you have over your ability to ejaculate?
  4. Has time to ejaculation always been short or has it changed over time or with different partners?
  5. Would you and and/or your partner be more satisfied if you could last longer?

Doctors treat lifelong, episodic and variable PE differently. Discussing the details can help the doctor determine underlying cause and provide good solutions to help improve sexual function and decrease stress and anxiety related to sexual encounters.

What causes premature ejaculation?

The male reproductive system is a bit more complex than most people give it credit for. The ejaculation process is a carefully orchestrated sequence of triggers that carry sperm from the epididymis to the prostate where it is joined with semen and eventually shot out of the body.

Ejaculatory dysfunction can occur if there are issues anywhere along the line. Often, it occurs when a man has a sensitive penis or becomes overly stimulated during a sexual experience. It can also be caused or aggravated by performance anxiety, stress, or relational problems. An enlarged prostate or other reproductive tract problems can also contribute to ejaculatory dysfunction.

Is premature ejaculation curable?

Most men are able to improve time to ejaculation and better enjoy their sex lives through open and honest conversations with their doctors and partners. It takes two to tango so involving your partner in your planning can help reduce stress, improve intimacy and your relationship.

Step 1: Talk to your doctor

Doctors will often review your medical and sexual history as a first step toward identifying the best treatment. A quick physical exam is also commonly performed to look for any other issues in the reproductive system that could be contributing to ejaculatory function.  Doctors often recommend several different treatment methods at once as they’re often most effective when used together.

Here are the most common treatments:

PE Medications and supplements

Most medications (topical or oral) are designed to reduce response to physical stimulation of the nerves. Some work locally on the penis itself, reducing sensitivity directly, while others slow the speed at which the signal travels to the brain or the brain’s response time.

Topical medications: A first-line treatment option is topical medication that alters penis sensitivity temporarily. Applied before intercourse, this medication uses the numbing agent, lidocaine, to help delay ejaculation. If you decide to use a topical treatment, be sure to apply it 10-15 minutes before sex to ensure it has enough time to begin working.

Oral medications: Doctors prescribe several different types of oral medications that may be effective in treating PE including various classes of antidepressants, chronic pain meds, drugs that are used to treat issues of the urinary tract and even certain ED medications to improve time to ejaculation. Having an honest conversation with your doctor and getting a full medical check-up can help identify the root issue of ejaculatory dysfunction and identify the best treatment options.

Caffeine: Though the method of action is not well understood, doctors may recommend a cup of coffee or other caffeinated beverage about 2 hours prior to intercourse. Some studies have shown that the caffeine boost can significantly increase duration. It’s worth a try, especially for some afternoon delight.

Folic Acid: Folic acid supplementation has been found to support sperm production, erectile function and ejaculatory function. A daily multi-vitamin, a prenatal or a diet rich in folate may help spice things up between the sheets in more than one way.

Over-the-counter supplements: Many over-the-counter supplements and herbs claim to improve sexual performance. Many of these claims are unstudied or unsubstantiated. If you are looking at some sort of dietary supplement, take time to read the ingredients and do your homework to make sure the product is safe and healthy. If you have questions or concerns, feel free to bring them to your doctor who can serve as a sounding board.

As a note, some medications indicated for PE may interfere with fertility, so it is important to have a complete conversation with your doctor about your personal and life goals as well as your medical history to understand what treatment options could be most effective in your situation.


Often paired with drug therapy, counseling is another great way to address intimate health issues like premature ejaculation. Speaking with a mental health professional can help reduce performance anxiety and provide effective ways to cope with stress. It also offers a safe place to address feelings of inadequacy or frustration that are common in patients with premature ejaculation. Therapy can improve your life outlook, self-esteem, and relational health, all of which are key to a confident sex life. If you’re uncomfortable speaking with someone in person, consider online therapy to discuss your health issues privately.


Self-stimulation can provide a unique opportunity to practice manually delaying your ejaculation. While masturbating, try paying attention to what you feel right before ejaculation and use that insight to learn how to control the feeling. It can inform when you should slow down or change your behavior to lengthen your sex duration. Once you’re able to halt your orgasm during masturbation, you should be able to achieve it with a partner. Keep in mind, however, that this form of sexual control is a learned habit made over weeks of practice, not a quick fix. If you’d like some guidance, there is an app made by leading sex therapists that can walk you through some exercises to help gain control and track your progress.

The Stop-and-Start method

There are also techniques to employ in the middle of sex to avoid premature ejaculation, such as the “stop-and-start” method. This practice requires you or your partner to stimulate your penis until you are close to ejaculation. Then, stop the stimulation for about 30 seconds until you can get back in control of your response. Continue this process at least three times before allowing yourself to ejaculate. Taking these breaks should lengthen the amount of time you’re able to have sex and improve your, and your partner’s, experience.

Pelvic floor strengthening

Kegel exercises can strengthen the pelvic floor and positively affect sexual function in men such as ejaculation timing. To begin Kegel exercises, be sure you identify where your pelvic floor muscles are: they are the ones you use to stop urination prematurely. Then, tighten your muscles for three seconds, release, and then tighten again. Ideally, you should repeat this process in a set of ten, three times a day for the best impact on your sex life. If this seems tricky to get the hang of, there are companies developing kegel exercisers to help men perform exercises correctly.

Alternative Treatments

Both acupuncture (don’t worry, the needles won’t go “there) and yoga have shown some efficacy (though studies are limited) in improving ejaculatory function. Though there is limited understanding into the method of action, researchers propose that yoga may serve to strengthen the pelvic floor and acupuncture may interact with the nervous system (as it is also used as a form of pain management). Both are associated with other positive health outcomes and, like folic acid, may be worth a shot just for the health benefits.

Surgical Corrections

In extreme cases, there are surgical options to discuss with a urologist who specializes in sexual function. Some men will undergo circumcision to reduce sensitivity, which has been shown to be effective in many cases. There are other experimental procedures in development that are promising for some special cases.


Premature Ejaculation.Family Doctor, American Academy of Family Physicians, 11 Oct. 2018.

Diseases & Conditions: Premature ejaculation.” Mayo Clinic, MayoClinic, 16 May 2018.

Thomas, Lisa. “Struggling with Premature Ejaculation? Keys to Control.” Psychology Today, 7Feb. 2018.

Serefpglu EC, et al.  Premature ejaculation: Do we have effective therapy? Translational Andrology and Urology. 2013;2:45.

Martin C, Nolen H, Podolnick J, Wang R. “Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going”. Int J Urol. 2017 Jan;24(1):40-50. doi: 10.1111/iju.13202. Epub 2016 Oct 5.

Chung E, Gilbert B, Perera M, Roberts MJ. “Premature ejaculation: A clinical review for the general physician.” Aust Fam Physician. 2015 Oct;44(10):737-43.

Hisasue S “The drug treatment of premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):482-6. doi: 10.21037/tau.2016.06.10.

McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJ. The pathophysiology of acquired premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):434-49. doi: 10.21037/tau.2016.07.06.










Join this NEW STUDY on Weight Loss, Fertility, and Virility

Men who are overweight or obese are more likely to have lower libido’s, sperm counts, semen volumes, and testosterone levels compared to other men.

Nutrient, a company that makes nutrient-rich foods, has shown in two previously published studies that consuming five Nutrient meals each day produces significant weight loss. 

Now, Nutrient is looking for overweight men willing to track changes to their Sperm Count, Testosterone, and Virility while following their proven weight-loss meal plan for 16 weeks. All at no cost to you, and all from the comfort and privacy of your home. Nutrient is partnering with home testing brands Trak Fertility and EverlyWell to power this revolutionary study on men’s health.

If you think you meet the above criteria, click below to learn more about the study and apply!

Learn More

Do antioxidants improve male fertility?

There is a lot of buzz about the use of antioxidants to improve male fertility, but why? What exactly are antioxidants? Why do people talk about them as a way to prevent cancer and how does that link to improved fertility? This article breaks down the science of antioxidants and gives some practical information about how to improve your diet to boost sperm health.

What do antioxidants do?

To understand antioxidants, we’re going to need to take a quick trip back to high school chemistry. Oxygen is a reactive element. It causes trucks to rust and cut apples to turn brown. Oxygen is also essential for life. We breath in oxygen and deliver it, via our bloodstream, to cells that in turn use it for energy. The process of oxidation, or creating energy from oxygen, creates molecules known as reactive oxygen species (ROS), sometimes called “free radicals” which can float around in the body and cause damage to our cells and our DNA. Elevated levels of ROS or “free radicals” is called “oxidative stress” and is linked to a number of medical conditions such as cancer, Alzheimer’s and heart disease.

Antioxidants are a group of vitamins and minerals that chemically bind to reactive oxygen species and prevent them from damaging tissues or DNA. Different types of antioxidants can reach ROS in different places – fat-soluble nutrients like Vitamin E are often able to pass through the cell membrane and work within the cell, while water soluble nutrients like Vitamin C are most active between cells or in the blood stream. Collectively, antioxidants work together to prevent the body from accumulating too much oxidative stress, which in turn can protect against certain diseases such as cancer.

The connection between antioxidants and sperm

Sperm are lean, mean swimming machines. Movement means they need a lot of energy. To help improve speed, they generate their energy by directly using sugar in the environment around them rather processing it inside their cellular body. Consequently, they produce more ROS than other cells. Think of them as sports cars with double exhaust pipes. The energy they use pollutes the environment around them with reactive oxygen species.

Knowing this, researchers have studied the effects of various antioxidants on male fertility and have found that diets that are low in antioxidant nutrients are correlated with reduced sperm count, poor sperm motility, abnormal sperm morphology and increased DNA fragmentation. All bad for male fertility. Inversely, men who have adequate nutrition and antioxidant intake have higher sperm counts, better motility, improved morphology and better-quality sperm DNA. The key take-away here is eat your fruits and veggies, they are good for you.

Certain conditions and lifestyle choices are known to increase the oxidative stress on sperm – the presence of a varicocele, smoking and environmental toxins such as pesticides, air pollution and other chemicals.

Measuring Oxidative Stress in Semen

There are a variety of methods used by labs to measure oxidative stress in semen. Normal values will vary from lab-to-lab as the methods are not yet standardized across the industry.
It is not a typical measurement performed as part of a semen analysis because it is time-consuming and expensive to do. But it can provide useful insight as to an underlying cause of abnormal semen parameters or to the effectiveness of recommended dietary changes or nutritional supplements.

Innovative technology and ongoing research is in development to standardize the measurement of oxidative stress in semen and hopefully provide more future insight into the relationship between oxidative stress and male infertility and the effectiveness of various supplements or dietary changes on male fertility.

Dietary sources of antioxidants

Some of the most powerful antioxidants that are known to have an impact on male fertility include Vitamin C, Vitamin E, Coenzyme Q10, Selenium and Zinc. A well-balanced diet that includes a variety of fruits and vegetables will typically provide sufficient quantities of these key nutrients to keep sperm healthy. Here are is a list of foods that are particularly rich in sperm friendly antioxidants:

  • Asparagus
  • Avocado
  • Bell Pepper
  • Berries (strawberries, raspberries, blueberries, etc)
  • Broccoli
  • Citrus or Tropical fruits (orange, lemon, pineapple, etc)
  • Dark Chocolate
  • Greens (spinach, kale, collards, etc)
  • Tomatoes
  • Nuts (peanuts, pistachios, walnuts, etc)
  • Olive oil
  • Seafood (shrimp, oysters, scallops, etc)
  • Tuna and Salmon
  • Seeds (pumpkin, sesame)
  • Squash (pumpkin, butternut, etc)

Should I buy antioxidant supplements to boost my sperm count?

Sometimes it is difficult to access a well-rounded variety of foods to ensure proper nutrition. Nutritional supplements can help ensure that you get enough antioxidants while trying to conceive. There are several blends out there labeled as “male fertility blends” which include key nutrients shown to improve semen quality. If you are considering a supplement, here are a few things to keep in mind:

Don’t overdo it: Too little of a nutrient is a problem, but so is too much. Selenium, zinc and vitamin E, in particular, can be harmful if too much is consumed. Stick to a single supplement and follow the recommended daily dose. If you are considering multiple supplements, make sure to research maximum recommended values.

Keep it simple: Physicians often recommend prenatal vitamins to men who are looking for a fertility supplement. Prenatals tend to have simpler formulations and higher quality / traceable ingredients as companies are extra careful to protect mother and baby health during pregnancy.

Research any exotic additives: Many supplements (particularly ones marketed to men) have additional herbs or other substances in them. When researching potential supplements, make sure to research any additional herbs or other ingredients to see if they have a known impact on fertility (positive or negative).

How semen is made

High quality educational resources about semen are few and far between. I would venture to say that most of us learn about it either from self-experimentation, talking to friends or from porn. Semen is one of those taboo topics that carries a lot of cultural weight. Here’s a quick overview about how semen is made by the body, what it is made out of and how to tell if your semen is healthy.

What’s the difference between sperm and semen?

First things first, sperm and semen are completely different things. The terms are often used interchangeably but there are some important differences between the two. Semen is the fluid that comes out of the body during an ejaculation. Sperm are tiny cells that live inside the semen.

How are sperm made?

Sperm are created in the testicle when germ cells divide, grow tails and start swimming around. Sperm take about 72 day to mature and are stored inside the genital tract until they are ejaculated. In a normal ejaculate, there are usually millions of sperm cells swimming around in search of an egg to fertilize. Prior to ejaculation sperm cells are stored throughout the genital tract. Most of them are in a long-coiled tube on the backside of the testicle called the epididymis or at the very end of the vas deferens. The epididymis connects to the vas deferens which connects the testicle to the seminal vesicles and prostate where most of the seminal fluid is produced. During an ejaculation, sperm is joined with seminal fluid and pushed out of the body.

The purpose of semen

Semen, technically called seminal fluid, is specially designed by the body to protect, nurture and transport sperm cells on their journey into the female body to give them the best chance of fertilizing an egg. It is highly optimized to do this job perfectly. It contains key nutrients (such as zinc and vitamin C) that provide energy and protect sperm cells from getting damaged. It is thicker than most liquids and is designed to stick to the cervix to help sperm get as close to the egg as possible. It has a slightly alkaline pH and works to counteract the acid (hostile) vaginal secretions which can harm sperm. It is also full of proteins and hormones that send signals to the female immune system and reproductive tract that prime it for potential pregnancy. Like John Stockton, Magic Johnson or Russell Westbrook, semen is untouchable in the sheer number of assists that it provides to would be sperm on their journey to the egg. Sperm make babies. Semen provides all the support.

What is semen made of?

What is the magic formula to semen that makes it such a potent fertility fluid? Scientists have studied seminal fluid in depth and written up a list of ingredients and described the role of each.

Here are some of the headlines:

Sugar: Semen contains relatively high amounts of both fructose and glucose (2-5 mg per mL). Unlike other cells that have internal machinery to produce energy, sperm relies on the fluid around it for energy source allowing them to be leaner and swim faster. If it contains sugar, it must have calories, right? It does. Semen is has roughly 5 calories per mL or 10 – 30 calories per ejaculate.

Zinc: an element that is essential for DNA replication and is involved with many cellular functions. It is particularly important for healthy prostate function and the development of sperm cells. As such, semen has high amounts of zinc. Th e zinc level is about 135±40 micrograms/ml for healthy men. Zinc serves to help to stabilize the DNA-containing chromatin in the sperm cells.

Prostaglandins: proteins that act like hormones and have several functions in the body which range from inducing labor to helping individual cells grow. There are different types of prostaglandins present in semen which both nurture sperm directly and interact with the female reproductive tract to create a friendly environment for sperm cells and newly formed embryo.

PSA:  a protein that is made by the prostate with the specific job of liquefying thick semen after ejaculation. Semen is naturally thick and coagulates following ejaculation to help it stick inside the woman’s body. It slowly liquefies over time releasing sperm into the cervix. PSA controls the liquefaction process. PSA is also used as a biomarker for prostate health.

Other things found in semen: Additional components of semen include salt, various proteins and amino acids, vitamin C and other antioxidants, calcium, magnesium, potassium, mucus, testosterone and other hormones. Semen can also carry bacteria and virus that cause sexually transmitted diseases including gonorrhea, syphilis, HIV, Zika Virus, HPV and others.

What part of the body makes semen?

Contrary to popular belief, semen is not made by the testicle. The testicles have two important jobs – they make sperm and they make testosterone – but they don’t make semen. The production of semen is mainly controlled by two small glands next to the prostate called the seminal vesicles which generate about 70% of seminal fluid. The remaining fluid mostly comes from the prostate (about 25%) and trace amounts from the testicle and the bulbourethral glands.

The Seminal Vesicles

Two small glands that sit atop the prostate are responsible for the lion’s share of seminal fluid. The size of these glands is influenced by testosterone levels which may be part of the reason that men with low T have lower semen volumes. Unlike their neighbor, the prostate, seminal vesicles rarely experience medical disorders.

The Prostate

The prostate gland plays an important role in male reproductive health. It is responsible for about 25% of seminal fluid adding key elements such as PSA and a bulk of the zinc. It is also responsible for controlling whether urine or semen pass out of the body. Can’t pee because you have a stiffy, you have your prostate to thank for that. As men age, problems with the prostate can cause issues with urination. It is also quite susceptible to developing cancer, so prostate cancer screenings generally start for men in their early 50s.

What is normal semen like?

Semen can change a bit in color, texture and volume from day to day and month to month. Most of these changes in semen quality are normal and can be influenced by frequency of ejaculation, diet, medications and drug use, testosterone level and a host of lifestyle factors.

Here’s a rundown of normal variations in semen quality:

Viscosity: Semen can be thick as toothpaste or watery. Typically, thick semen should liquefy over time (generally within an hour though sometimes it takes a bit longer) as PSA breaks down the coagulated proteins that cause semen to become viscous. Viscosity is influenced by frequency of ejaculation, diet, medications or chemical exposures and health of the prostate.

Color: Semen color can be transparent, white, grey or even yellowish. Color is determined by the relative contribution from each of the glands that make seminal fluid. It can also be influenced by diet and frequency of ejaculation.

Volume: A normal semen volume is 1.5 – 6.8 mL. Semen volume is most sensitive to frequency of ejaculation. Like sperm, seminal fluid is generated over time and it takes a day or two to fully recover fluid following an ejaculation. During long periods of abstinence, seminal fluid production slows or stops until ejaculation.

Healthy semen is a sign of a healthy man

Like sperm and a strong erection, healthy semen shows that all systems below the belt are in good working order. Signs that you could have a problem include consistently low semen volume, smelly, abnormally colored or consistently viscous semen. Also, if ejaculation is painful or if no semen comes out during orgasm, these issues are also worth a discussion with a urologist.


Mann, T (1954). “The Biochemistry of Semen”. London: Methuen & Co; New York: John Wiley & Sons.

Du Plessis SS1, Gokul S, Agarwal A. Semen hyperviscosity: causes, consequences, and cures. Front Biosci (Elite Ed). 2013 Jan 1;5:224-31.

Bygdeman M., Bendvold E., Gottlieb C., Svanborg K., Eneroth P. (1985) Prostaglandins in Human Seminal Fluid and Its Relation to Fertility. In: Bailey J.M. (eds) Prostaglandins, Leukotrienes, and Lipoxins. GWUMC Department of Biochemistry Annual Spring Symposia. Springer, Boston, MA

Bardin TP. The role of prostaglandins in reproductive physiology. Ohio State Med J. 1970 Oct;66(10):1008-12.

Isidori A, Conte D, Laguzzi G, Giovenco P, Dondero F. Role of seminal prostaglandins in male fertility. I. Relationship of prostaglandin E and 19-OH prostaglandin E with seminal parameters. J Endocrinol Invest. 1980 Jan-Mar;3(1):1-4.

Harvey, Clare (1948). “Relation between the Volume and Fructose Content of Human Semen”. Nature. 162 (4125): 812

Owen, D. H.; Katz, DF (2005). “A Review of the Physical and Chemical Properties of Human Semen and the Formulation of a Semen Simulant”. Journal of Andrology. 26 (4): 459–69.

Hampl R1, Kubátová J, Sobotka V, Heráček J. Steroids in semen, their role in spermatogenesis, and the possible impact of endocrine disruptors. Horm Mol Biol Clin Investig. 2013 Jun;13(1):1-5. doi: 10.1515/hmbci-2013-0003.

Adamopoulos DA, Lawrence DM, Swyer GI. Determinantion of testosterone concentration in semen of men with normal or subnormal sperm counts and after vasectomy. Acta Eur Fertil. 1976 Sep;7(3):219-25.

Kline EE1, Treat EG, Averna TA, Davis MS, Smith AY, Sillerud LO. Citrate concentrations in human seminal fluid and expressed prostatic fluid determined via 1H nuclear magnetic resonance spectroscopy outperform prostate specific antigen in prostate cancer detection. J Urol. 2006 Nov;176(5):2274-9.

Gonzales GF1, Kortebani G, Mazzolli AB. Leukocytospermia and function of the seminal vesicles on seminal quality. Fertil Steril. 1992 May;57(5):1058-65.

Abyholm T, Kofstad J, Molne K, Stray-Pedersen S. Seminal plasma fructose, zinc, magnesium and acid phosphatase in cases of male infertility. Int J Androl. 1981 Feb;4(1):75-81.

Mann T, Lutwak-Mann C. Evaluation of the functional state of male accessory glands by the analysis of seminal plasma. Andrologia. 1976;8(3):237-42.

Mann T. Secretory function of the prostate, seminal vesicle and other male accessory organs of reproduction. J Reprod Fertil. 1974 Mar;37(1):179-88.

Jung A1, Schuppe HC, Schill WB. Comparison of semen quality in older and younger men attending an andrology clinic. Andrologia. 2002 Apr;34(2):116-22.

Telisman S1, Cvitković P, Jurasović J, Pizent A, Gavella M, Rocić B. Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men. Environ Health Perspect. 2000 Jan;108(1):45-53.

Gonzales GF1, Villena A. Influence of low corrected seminal fructose levels on sperm chromatin stability in semen from men attending an infertility service. Fertil Steril. 1997 Apr;67(4):763-8.

Bonnici J1, Fenech A1, Muscat C1, Calleja-Agius J2. The role of seminal fluid in infertility. Minerva Ginecol. 2017 Aug;69(4):390-401. doi: 10.23736/S0026-4784.17.04049-7. Epub 2017 Apr 10.

Robertson SA1, Sharkey DJ2. Seminal fluid and fertility in women. Fertil Steril. 2016 Sep 1;106(3):511-9. doi: 10.1016/j.fertnstert.2016.07.1101. Epub 2016 Jul 30.

Verze P1, Cai T2, Lorenzetti S3. The role of the prostate in male fertility, health and disease. Nat Rev Urol. 2016 Jul;13(7):379-86. doi: 10.1038/nrurol.2016.89. Epub 2016 Jun 1.

Bieniek JM1, Drabovich AP, Lo KC. Seminal biomarkers for the evaluation of male infertility. Asian J Androl. 2016 May-Jun;18(3):426-33. doi: 10.4103/1008-682X.175781.

Cui D1, Han G1, Shang Y1, Mu L1, Long Q1, Du Y1. The effect of chronic prostatitis on zinc concentration of prostatic fluid and seminal plasma: a systematic review and meta-analysis. Curr Med Res Opin. 2015;31(9):1763-9. doi: 10.1185/03007995.2015.1072707. Epub 2015 Aug 27.

Adefuye A1, Katz AA1, Sales KJ1. The regulation of inflammatory pathways and infectious disease of the cervix by seminal fluid. Patholog Res Int. 2014;2014:748740. doi: 10.1155/2014/748740. Epub 2014 Aug 11.

April is Testicular Cancer Awareness Month

We believe that an open and empowered male culture  results in more proactivity around health and preventative self-care.  Where better to start than with testicular care?  Testicular cancer is the most common cancer for men between the ages of 15-44 and you catch the signs of cancer soon enough and take action, it is virtually curable. Self-checks are relatively easy to do and can help you catch testicular cancer and other testicular conditions early.

How to check yourself for testicular cancer

1) First, take a warm shower. When you’re done, dry off properly and stand in front of the mirror. The best time to examine yourself is when your scrotum is relaxed. Check for any swelling or soreness around the scrotal area.

2) It is essential to check for lumps and bumps in both testicles. Take your index and middle finger under your testical with your thumbs placed on top. Gently roll your fingers around the area. This is the best way to tell if you have any irregularities in the testicle. Keep in mind, it is totally normal for one testicle to hang lower than the other, and they should feel smooth, firm but not hard.

3) Find the epididymis, is the part behind the testicles where the sperm is sent through to the vas deferens. If you are informed about this, you won’t mistaken this for a lump.

4) If you notice any differences, make sure to contact your doctor immediately. While a vast majority of lumps are not cancerous, it is better to be safe than sorry.

Don’t be hesitant to self examine. When you’re armed with the correct knowledge and know what to lookout for, it can easily become a regular part of your routine.

Know the facts: Key information about testicular cancer

TC has a wide variety of treatment options and depending on your stage, full recovery is possible. To help you better understand, we’ve created a concise and digestible graphic that provides clarity on TC, and pinpoints the most important information.

Hims testicular cancer sexual health infographic

How does testicular cancer impact your sex life?

If you are affected by TC, treatment will vary depending on the stage at which it was detected. In rare cases, if both testicles are removed and you would like to have children, it is often recommended that you preserve your sperm at this point for the future. Often after surgery, you can experience a loss in your libido, which prevents having an erection sustainable for sex. This is totally normal and is something else that can be dealt with. Hims, a telemedicine company, prescribes Sildenafil (generic Viagra), which helps to relax blood vessels and increase blood flow to the penis, which allows you to hold an erection for an extended period of time. They set you up with online doctors, so after answering a few questions, it will discreetly arrive at your home.

Don’t wait for signs of Testicular Cancer to show up on their own. Arm yourself with as much knowledge as possible and know what to look for. The route to treatment vastly depends on the stage at which the cancer is found. Start taking care of yourself by performing monthly checks and being hyper aware of your sexual health moving forward.

Support your Balls: Talkin’ testicular cancer with Tommy John & the Testicular Cancer Foundation

April is testicular cancer awareness month and Tommy John, which makes the most comfortable underwear on the planet, has teamed up with the Testicular Cancer Foundation to support your balls in a whole new way. During the month of April, they are donating 5% of all purchases of a limited-edition cancer awareness print to the Testicular Cancer Foundation to help educate and support men who face testicular cancer.

Testicular cancer is the most common form of cancer in men from 15 – 34 years old. It is 95% curable when detected early. Regular self-exams can help men find suspicious lumps early. Getting to know your balls will help you know if something is abnormal. While most lumps are not likely to be cancerous, testicular cancer often does not have any other symptoms, so it is important to get them checked by a urologist.

What if it is testicular cancer?

Getting educated about the process of treating and recovery from testicular cancer can remove some of the fear around getting checked out, so Tommy John sat down with the Testicular Cancer foundation to learn more about the recovery process. Here’s what they learned

Tommy John: We talk a lot about early detection and the time leading up to surgery, but what does the post-surgery and recovery process look like to most patients?

Testicular Cancer Foundation: When Testicular Cancer is caught early, the surgery (inguinal orchiectomy) to remove the cancerous testicle can be minimally invasive. Generally speaking the patient returns home the same day of surgery and recovery time is rather short. This is why early detection is crucial. A simple surgery and the patient is back to daily life. When testicular cancer metastasizes not only do your chances of survival decrease, but more invasive surgery, radiation, and chemotherapy are likely to follow – all of which have their own risks and side effects.

Tommy John: What type of lifestyle changes do survivors need to make post-surgery/treatment (diet, exercise, work, etc.)?

Testicular Cancer Foundation: We urge men to be advocates for their own health. This includes living a healthy lifestyle – a well-balanced diet and exercise. Additionally, we urge men to take their time and be patient when jumping back into work and daily life.

Tommy John: How often do survivors follow-up with their doctors/oncologist/urologist after the surgery/treatment?

Testicular Cancer Foundation: No one follow up regimen is appropriate for every TC survivor, but standard protocol would be a doctors visit every 3-6 months the first year, 6-12 month the 2nd and 3rd year, and annually for year four and five. Each of these visits would include some or all of the following tests; blood work, CT Scans, Chest X-rays and Testicular Ultrasound.

After having a testicular cancer diagnosis, there is a slightly higher risk for a re-occurrence of cancer, so survivors are advised to become advocates of their own health, and look for any changes they see/feel.

Tommy John: What are some of the biggest difficulties that survivors face post-surgery and possible treatment?

Testicular Cancer Foundation: Life after cancer can be one of the biggest struggles for some after a cancer diagnosis. This is another reason why we emphasize early detection. If caught in stage one, often there is no need for additional treatment which minimizes some of the struggles guys often face after surgery and additional treatment (additional surgery, chemotherapy, radiation).

Some TC survivors go through what can be an extremely traumatic experience, and after treatment are given the “all clear” from their doctor. They are then expected to jump back into daily life like nothing happened. For some, healing for both mind and body can take time, and we urge men struggling to discuss their options with their social worker or doctor.

We have found that there is high numbers of TC survivors that suffer from PTSD. Some men suffer from depression, feel as if they have lost their “manhood”, and fear re-occurrence. Some men struggle with infertility as well. At TCF we have bolstered our support system to ensure that men have resources and support groups to deal with life after cancer.

Learn More:

The Testicular Cancer foundation is a great resource to learn more about the signs, symptoms, treatment options and recovery from testicular cancer. Taking steps to get educated can give you more control over your health and even save your life. In the meantime, treat your balls to the support they deserve with a pair of underwear that never need to be adjusted.

Thanks, TCF and Tommy John for being on the front line of improving men’s reproductive and sexual health!

Know your rights: The Ohio Infertility Mandate

The Ohio infertility mandate requires health maintenance organizations (HMOs) to provide basic health services, which includes infertility care, when medically necessary. A bulletin released by the department of insurance clarifies that IVF and other forms of assisted reproduction are outside of the scope of the law.

Further information is clarified in Ohio Chapter 1751 of the Ohio Revised Code Annotated. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

The Ohio mandate does not provide a definition of infertility. However, it does define infertility services at “diagnostic and exploratory procedures to correct medically diagnosed diseases of the reproductive organs, including but not limited to: Endometriosis, Clogged or collapsed Fallopian tubes, and Testicular failure.”

Eligibility requirements

Plan requirements: The mandate extends only to HMO but not other forms of health insurance.

Service Requirements: There is a focus on “medically necessary” procedures

How the law treats male infertility

The Ohio Mandate provides testicular failure as an example for a condition that should be treated under the law. This means that there is a legal recognition of male infertility. The “medically necessary” language may favor treatment of conditions that cause male infertility.

Services that are covered

Diagnostic testing and exploratory and corrective procedures aimed at repairing function of reproductive organs.

Limitations on coverage

There aren’t clearly defined exemptions listed in the law, however bulletins provide clarifying language that IVF and assisted reproduction is outside the scope of the law.


The following are exempt from providing coverage:

  • Other forms of insurance outside of HMO plans
  • Self insured employers

Tips & Resources

Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.

Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what your out-of-pocket costs are likely to be.

Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).

Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with other people in your area via our local forum boards.


Know your rights: The New York Infertility Mandate

The New York infertility mandate requires treatment for conditions that result in infertility, such as endometriosis and hypogonadism. It does not require insurance companies to cover costs associated with assisted reproduction but pushes for the treatment of underlying medical conditions that result in infertility. In addition to the mandate, the state has created a public funding source to assist couples with costs associated with assisted reproduction, in the case that insurance benefits do not cover treatment. In 2015, there was a new bill to require coverage for IVF, but as of the beginning of 2018, the bill was still held up in committee.

Further information is clarified in New York Consolidated Laws, Insurance, Sections 3221 and 4303. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

The New York mandate states that infertility shall be determined in accordance to the guidelines established by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.

Eligibility requirements

Patient requirements: Patient must be between the ages of 21 and 44 and have been covered under the policy for at least 12 months.

Clinic Requirements: IVF procedure must be performed at a fertility clinic or medical facility that conforms to standards and guidelines set by the American Society for Reproductive Medicine (ASRM) or the American College of Obstetricians and Gynecologists.

How the law treats male infertility

The New York Mandate looks at male and female infertility equally. It specifically calls out male focused tests and procedures as eligible for coverage including semen analysis, blood tests and testicular biopsy.

Services that are covered

The following treatments are specifically listed in the law:

  • Diagnostic tests and procedures
  • Hysterosalpingogram
  • Hysteroscopy
  • Endometrial biopsy
  • Laparoscopy
  • Sono-hysterogram
  • Post coital tests
  • Testis biopsy
  • Semen analysis
  • Blood tests and ultrasound
  • Medications approved by FDA for treatment of infertility

Additional services: In 2002, New York State passed legislation called the Infertility Demonstration Program, which provide grants to select IVF clinics. The grants help subsidize payments for most services associated with IVF, including patient assessment (1 allowed per patient for the life of the grant) and the IVF cycle (maximum of 2 complete cycles for the life of the grant). The amount of treatment funding provided to the eligible individual/couple is based on the individual/couple’s combined household income; coverage can range from 2.5% up to 97.5% of IVF treatment costs.

Limitations on coverage

The following procedures are explicitly excluded from the mandate:

  • In vitro Fertilization (IVF)
  • Vasectomy Reversal


The following are exempt from providing coverage:

  • Individually purchased plans
  • Self-insured plans

Tips & Resources

Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.

Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what your out-of-pocket costs are likely to be.

Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).

Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with other people in your area via our local forum boards.


Know your rights: The New Jersey Infertility Mandate

The New Jersey infertility mandate formally called the New Jersey Family Building Act was enacted in 2001 and requires that any health insurance policy that covers more than 50 people and covers pregnancy related benefits must also cover costs related to infertility diagnosis and treatment. It covers a wide range of diagnostic and treatment procedures, included IVF with ICSI making it one of the most friendly states for men who suffer from infertility.

Further information is clarified in the New Jersey Family Building Act. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

The New Jersey mandate defines infertility as ” the disease or condition that results in the abnormal functioning of the reproductive system, in which a person is unable to impregnate another person, become pregnant by trying to conceive with unprotected sexual intercourse after two years if the woman is younger than 35, or one year of unprotected sexual intercourse if the woman is 35 or older, or carry a pregnancy to produce a live birth.”

Eligibility requirements

Patient requirements: Patient must be under 45 and have infertility as defined above.

Clinic Requirements: IVF procedure must be performed at a fertility clinic or medical facility that conforms to standards and guidelines set by the American Society for Reproductive Medicine (ASRM) or the American College of Obstetricians and Gynecologists.

How the law treats male infertility

The New Jersey Mandate is one of the most progressive in terms of recognizing that infertility affects men and women equally. The law specifically acknowledges male infertility by stating that infertility is “..condition that results in the abnormal functioning of the reproductive system, in which a person is unable to impregnate another person…” It explicitly covers medication and surgeries which are the primary treatment options available to men and covers use of ICSI in an IVF cycle.

Services that are covered

The law specifies that less expensive options should be exercised prior to use of more costly procedures.

The following treatments are specifically listed in the law:

  • Fertility tests and diagnostics
  • Fertility medications
  • Fertility surgery
  • In vitro fertilization (IVF)
  • Embryo transfer
  • Artificial insemination
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intra fallopian transfer (ZIFT)
  • Intracytoplasmic sperm injection (ICSI).

Limitations on coverage

A woman has a lifetime limit of 4 egg retrievals.


The following are exempt from providing coverage:

  • Small employers (< 50 employees)
  • Self-insured plans
  • Organizations that oppose these treatments on religious/ethical grounds
  • Couples who have a had a permanent elective sterilization procedure (tubal ligation or vasectomy)
  • Companies not based in New Jersey
  • Compensation paid to egg donors, surrogates or recruiting agencies

Tips & Resources

Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.

Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what your out-of-pocket costs are likely to be.

Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).

Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with other people in your area via our local forum boards.