Category: For Him

Hair loss has long been the bane of many men’s existence. Millions of men worldwide are affected by male pattern hair loss, a condition caused by an inherent sensitivity to dihydrotestosterone (DHT), a substance produced in the body from the male sex hormone testosterone. Male pattern hair loss can be passed from father and son – bad news indeed for men whose fathers exhibit this condition.

As much as men may not like to admit it, hair loss can leave a serious dent on one’s self esteem. Various inventive combing techniques (called, imaginatively enough, comb overs) have been invented over the years to hide a bald patch, while those with enough budget blow thousands of Ringgit on hair transplant. All to assure the man that he still looks youthful and attractive!

Interestingly, there may be a solution to hair loss – a solution that is already a big part of our daily lives: caffeine. Yes, the same substance that gives our coffee its ‘kick’.

Hold On to Your Cup of Joe

Don’t go washing your hair with espresso just yet, though, as the amount of caffeine consumed by even the heaviest coffee drinkers is not enough to do the trick.

According to Dr Adolf Klenk, a leading German researcher of caffeine and its effects on hair loss, you will need to consume 40-50 cups of coffee to provide the dose of caffeine needed to make its way up to the hair root. Even if someone is foolhardy enough to drink this much coffee, he will most likely end up with a bigger problem than hair loss. After all, caffeine is a drug-like substance, and it would be extremely toxic when consumed in extremely high amounts.

Fortunately, caffeine can be used as an active ingredient in shampoos, hair gels and other hair care products without causing health problems!

Caffeine Control

Dr Klenk, who was recently in Malaysia, explains that research on caffeine indicates that it can control the effects of DHT and therefore prevent premature hair loss in men. “Caffeine can also protect hair roots against hereditary hair loss in men and support hair for healthy growth,” he adds.

The Center for Cosmetologic Research, Catholic University of Sacred Heart in Rome performed an application test on 30 male subjects, aged from 18 to 55 with male pattern baldness. They found that caffeine shampoo, when used over 6 months, can:

• Decrease hair pulled out by 7% after 3 months, 14% after 6 months.
• Significantly improves strength of hair.
• Reduce intensity of hair loss.
• Reduce typical scalp problems such as itch, dryness and tension.

The same centre conducted another research, this time using caffeine liquid hair wash, on men with alopecia (a type of hair loss caused by the cells of the immune system attacking one’s own hair follicles) over 2-4 months. They found that the caffeine liquid hair wash brought about the following benefits:

• Decreases hair loss by 8% after 2 months, 15% after 4 months.
• Reduces premature hair loss by 43%.
• Improves hair structure by 53%.
• Improves scalp condition by 12%.
• Reduces balding by 43%.

These are just some of the more recent research on the potential benefits of caffeine in controlling and reversing hair loss. Therefore, if you are worried about losing your hair, or if you are already losing your hair, it may be worth discussing with a dermatologist or hair restoration expert about using caffeine hair care products.

Don’t forget the B’s

While good nutrition will not bring back your lost locks, B vitamins can help with the formation and growth of new hair follicles. Therefore, it may be worthwhile to load your daily diet with food rich in these vitamins to complement your efforts to prevent or reduce hair loss. Good options are chicken, fish, eggs and dark leafy vegetables such as spinach. Supplements may also be helpful.

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Assoc Prof Dr Christopher Ho Chee Kong   Consultant Urologist & Sexual Medicine Physician, Department of Surgery, Universiti Kebangsaan Malaysia Specialist Centre

How to Make Love All Night: and Drive a Woman Wild! The Way of the Superior Man! Make Her SCREAM: Last Longer, Come Harder and Be the Best She’s Ever Had!

These are just some of the actual book titles found on Amazon should you search for ‘premature ejaculation.’ Regardless of the content between the covers, these titles alone give the impression that a ‘real man’ (or to quote one of the book titles, a ‘superior man’) should be able to please his partner not just sexually, but also all through the night like the Energizer bunny, with the partner screaming and swooning from the ecstasy of it all.

The average man may flinch from the pressure (or try to rise to the challenge), but for someone with the problem of premature ejaculation (PE), the condition can be especially crippling to the self esteem. Furthermore, a lack of sexual fulfilment would eventually threaten the long-term happiness in any relationship.

HealthToday sits down with Assoc Prof Dr Christopher Ho, a consultant urologist and sexual medicine practitioner, to get down to the root of the condition known as PE, and the various treatment options available.

Not So Fast, Man!

Given how closely a man’s sexual performance is linked to his sense of confidence and self-esteem, it is little wonder that many men would prefer not to think about PE. If they do talk about it, it is usually during a ‘men’s only’ moment at the mamak stall, when ‘bros’ share notes and tips on bedroom matters.

Despite many men putting a lid on the problem, PE is actually quite common. While the estimated number of men with this problem can vary from one study to another, Dr Ho states that, generally, about 30% of men around the world have problems that can be defined as premature ejaculation.

How soon is too soon?

A US study found that the average man’s “lasting power” from the start of penetration to ejaculation is 5.4 minutes. If your arrival schedule is around this value, then you are perfectly normal.

“There are two types of PE – lifelong and acquired,” explains Dr Ho. Lifelong PE describes the condition that initially manifested during the man’s first sexual intercourse; the man has never experienced a ‘normal’ intercourse as a result. Acquired PE occurs when a man who has never suffered the condition before starts to show symptoms, often due to psychological factors (stress, anxiety or impatience, especially when the man has a new partner) or organic reasons such as an underlying medical condition.

• For men with lifelong PE, the average ‘staying power’ is one minute or less.
• For men with acquired PE, the average ‘staying power’ is three minutes or less.

Dr Ho goes on to explain that there are three typical signs of PE. One, the man experiences PE (1-3 minutes or less) consistently over a period of time. Two, he has problems controlling (or delaying) ejaculation nearly all the time. Three, his condition is causing emotional distress, and the man may even begin to avoid intimacy out of frustration or shame.

The Root of the Problem

There are several possible causes for PE, and it is possible that the causes for PE can be different from one man to another.

• It’s psychological. Dr Ho says that strong emotions such as anxiety about his performance can cause a man to end things a little too soon in the bedroom. Other forms of stress such as external ones (from work and such) or unresolved interpersonal issues between the man and his partner could also be factors. 
• It is also possible that early sexual behaviour could contribute to PE. For example, if a man is used to hurrying his climax in the past, he may experience problems slowing down the pace later on.
• It’s biological. PE can arise when things go awry in the body. Some of the possible biological reasons for PE include:
  • Thyroid problems. There is a study which suggests that PE can be linked to an overactive thyroid (hyperthyroidism).
  • Abnormal levels of certain neurotransmitters (brain chemicals that transmit signals from nerve cells to brain). Unusually high levels of histamine, for example, can cause PE. 
  • Abnormal hormone levels. Like many other processes in our body, sexual arousal, stimulation and ejaculation are all carefully controlled and coordinated by interactions among various hormones. A little too much or too little here and there can cause the entire process to go haywire!

Don’t Suffer in Silence – Get Help!

If you suffer from PE, the great news is that the condition is definitely manageable. There are ways to help you enjoy a healthy sex life with your partner.

Forget the many ‘special foods’ or ‘special exercises’ out there, all promising to improve one’s sexual prowess. The first step to managing PE is actually very simple.

“Talk to your doctor!” says Dr Ho.

“There is nothing to be ashamed of. The doctor will not judge or reveal your problems to other people. Therefore, there is no need to suffer in silence!” he adds. Some men get uncomfortable when the doctor asks probing questions related to intimacy, but this is a necessary step for the doctor to fully understand the extent of the problem. What is a little temporary discomfort or embarrassment, after all, compared to the promise of a healthy, fulfilling sex life?

Furthermore, sometimes PE may be a symptom of an undetected medical condition (such as thyroid condition, prostate disease, high blood pressure and diabetes), and may go away once the medical condition is treated. Getting treatment or management advice for those conditions do not just improve one’s sex life – it improves the overall health and quality of life!

“I know I have PE, so I can buy my own medications without seeing a doctor!”

Are you really sure that you have PE? While erectile dysfunction (ED) and PE are two very different conditions on paper, in reality, there are a number of men who cannot tell apart these two conditions. Dr Ho has encountered men with PE who believe that they have ED, and vice-versa. Since treatment methods for both conditions can be different, a diagnosis by a qualified healthcare professional is important, to ensure that you are getting the right kind of treatment. Another reason to visit your doctor, whether you have ED or PE!

Dr Ho goes on to share some of the most common methods for managing PE.

Hands-on Techniques

There are some techniques that your doctor can advise you to practice in the privacy of your home to help with PE. Dr Ho offers some examples:

• The stop-and-start method. The man first masturbates on his own, stopping as he comes close to ejaculation. He will then relax until he has calmed down, before repeating this process several times until he cannot hold back any longer. Once he has become used to this, he can bring in his partner and they can initiate sexual activities without involving penetration. Essentially, this method helps the man learn how to control his arousal and delay his ejaculation over time.
• The squeeze method.  A variation of the stop-and-start method, in which the man masturbates until he is close to achieving an orgasm. At that point, he squeezes the base of his penis to reduce his erection and delay ejaculation. Once the man has the hang of this, his partner can get involved and lend a helping hand, so to speak.
• Try Kegel exercises. While there is not much evidence to conclusively prove that Kegel and other forms of pelvic floor exercises can help with PE, Dr Ho believes that there is no harm in adding these exercises into the daily routine of a man with PE. By strengthening the muscles in the pelvic region, the man may have better control over the delay of his ejaculation.
• There are many other options, such as deep breathing techniques to help with focus during sex and the use of condoms to reduce stimulation on the penis. Your doctor would evaluate your case and suggest suitable solutions.
• Dr Ho adds that these techniques are not “instant cures” – they only show results over time. Some men may get frustrated with  what they perceive to be slow progress and wish for a more “instant” solution, while others may get “distracted” while involving their partners in these techniques. For these men, medications may help tide the frustration.

Medications for PE

Dr Ho explains that medications do not cure PE. Similar to pills for erectile dysfunction, they offer the man an opportunity to participate in sexual intercourse for a certain period of time after taking these medications.

Oral medications.

It may seem odd to many people, but medications normally given to people with depression can also help with PE. These medications can inhibit orgasm and delay ejaculation, usually considered unwanted side effects that, for men with PE, turn out to be favourable outcomes.

Of late, the medication of choice for many specialists is dapoxetine. Dr Ho explains that this is due to the studies that demonstrated its effectiveness on men with PE, as well as having fewer side effects compared to other medications offering similar benefits.

Aside from dapoxetine, other oral medications for PE include tramadol and other medications normally used for treating depression (eg, sertraline, paroxetine). All oral medications require prescriptions from a qualified healthcare professional.

Apply externally.

There are gels, creams, and sprays which work to reduce the sensations experienced in the penis that can bring about ejaculation. They typically contain analgesic or numbing ingredients such as lidocaine and lidocaine-prilocaine, and should be applied on the penis before sex. Because they work less specifically than oral medications, they may not be effective on some men with PE. There are also reports of some men’s partners experiencing discomfort or reduced sensation during sex.

The Lowdown on Dapoxetine

According to Dr Ho, in a normal male, a neurotransmitter called serotonin is involved in passing messages from one nerve cell to another. It is found that high levels of serotonin in the nervous system can lead to delayed ejaculation during sexual intercourse. For men with PE, this is obviously a good thing!

This is where dapoxetine comes in. It is a type of drug that helps to increase the concentration of serotonin at the junctions between nerve endings, hence allowing men with PE to last longer during sex.

It is taken “on demand”, from 1 to 3 hours before an anticipated sexual activity.

Side effects.

These include dizziness, nausea and headache. Fortunately, Dr Ho points out that fewer than 10% of men taking dapoxetine exhibit side effects.

Does it really work?

“Dapoxetine has been tested in robust trials involving thousands of men, and results point to it being effective and safe,” explains Dr Ho. This strong amount of research data is one advantage of dapoxetine over many other PE oral medications in the market.

Can someone with no PE still take dapoxetine to improve their ‘staying power’?

Besides the usual side effects caused by dapoxetine, there is no evidence suggesting that normal men taking this drug will experience health problems. However, Dr Ho also points out that there is no evidence to suggest that usage of dapoxetine can improve a man’s stamina in the bedroom. “Men often have unrealistic expectations when it comes to their stamina anyway,” Dr Ho says with a smile, “thanks to the frequently exaggerated portrayal of sex in popular media.”

Are there certain types of people who should not take dapoxetine?

“Men with severe heart and liver problems should avoid taking this medication,” cautions Dr Ho. Also, certain medications such as other selective serotonin reuptake inhibitors (SSRI, these are drugs that work similarly like dapoxetine to increase serotonin levels in the body), monoamine oxidase inhibitors (MAOIs), anti-fungal and anti-viral medications may cause unwanted side effects when taken along with dapoxetine, so consult your doctor if you are also on these medications.

The best of both worlds

According to Dr Ho, men with PE may be given medications while at the same time they are advised to put into practice the control techniques described earlier.

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Mention “erectile dysfunction” (ED) and most men would blanch at the thought of it affecting them even for a second. Benign prostatic hyperplasia (BPH) may not be as familiar a term as ED, but this condition – in which a man’s prostate glands become enlarged – can cause complications, such as the frequent need to urinate – that can wreak havoc in a man’s efforts to be intimate with his partner.

Yet, many men will not admit that they have these problems if they can help it, several prominent and well-respected medical experts concurred during a very special “man cave” session at the PJ Live Arts Centre on 13 August, 2015.

The “man cave” was actually a stage decorated to resemble a den, representing a safe space in which a man feels confident and secure enough to bare his soul and confront his inner demons. Organized by Lilly Malaysia (Eli Lilly (Malaysia) Sdn Bhd), the “man’s cave” brought together Dr Teh Guan Chou (President of the Malaysian Urological Society and a Senior Consultant Urologist), and Dr George Lee (Clinical Associate Professor and Consultant Urological Surgeon). Joining them was Dr Prabhuram Krishnan, the Medical Director of Eli Lilly Malaysia.

ED is a common problem despite most men preferring to avoid addressing it. Dr Prabhuram pointed to a paper published in 2011 in the Malaysian Journal of Andrology, which stated that 20% of Malaysian men over 50 have ED, while the number doubles among men 40 to 60 years old. Worryingly, we are also seeing an increasing number of younger men with ED now!

ED does not just ruin a man’s effort to be intimate with his partner. Dr Lee pointed out that, among certain patients, ED has been linked to an increased risk of future health problems, including heart problems and strokes. “It can be scary if you don’t get it treated soon,” he said. Dr Teh always said that ED is a sign of a “broken heart”, and this can be true – literally!

Dr Teh, touching on BPH, mentioned that the prostate gland, for reasons yet to be determined, can become bigger with time. Due to its proximity to the bladder, its increased size can obstruct or constrict the bladder, slowing urine flow and increasing the time it takes to empty the bladder. Hence, a man with BPH needs to go to the toilet often. Up to about 60% of men aged 70 and above have BPH, Dr Teh claimed, and 80% of these men experience lower urinary tract symptoms such as the urge to urinate often.

All three speakers stress that seeing a doctor for ED and BPH is a far better course of action than turning to alternative remedies, which may not work and only prolong one’s misery.

The event closed with another excellent reason to see a doctor for ED and BPH woes: the launch of the new Cialis 5 mg Once Daily pill. Cialis is the only drug that is approved to treat both ED and the symptoms of BPH.

For men with ED, now they can take Cialis 5 mg Once Daily just once a day, and can engage in sexual activity any time of the day. Compared to the “on-demand” Cialis, which has to be taken before sexual activity can begin, the Once Daily pill offers spontaneity and convenience that would be welcomed by men who need this medication. 

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Assoc Prof Dr Christopher Ho Chee Kong   Consultant Urologist & Sexual Medicine Physician, Department of Surgery, Universiti Kebangsaan Malaysia Specialist Centre

Let us spare a thought for the man who made news in May when he landed in the hospital after having his scrotum stuck in a ring. While everyone probably had a chuckle over it, there was no doubt that his pain was intense and his condition could have taken a turn for the worse if not tended to.

Consultant urologist and sexual medicine physician, Assoc Prof Dr Christopher Ho is no stranger to patients with painful misadventures involving their little buddies. He recalled a similar case in which he had to borrow tools from the nearby fire department to remove a penile ring that was causing his patient great pain.

Put a ring on it?

Dr Ho says that there are legitimate medical uses for penile rings and implants. Men with erectile dysfunction (ED) may use a vacuum pump to help them achieve an erection, and, a ring can be placed at the base of the shaft to sustain the erection.

“However, these rings should be used only upon the advice of a qualified healthcare professional, for specific reasons such as ED,” Dr Ho points out. Otherwise, there may be painful consequences – as seen in the case of that unfortunate person who ended up in the news. 

“The ring prevents blood from flowing out of the penis, which leads to engorgement and increase in girth,” says Dr Ho. For some men, especially those with ED, this sounds like a cause for celebration.

But if blood flow is obstructed for too long, the tissues of the penis become deprived of oxygen. Waste materials such as toxins will begin to accumulate, as the blood trapped in the penis is unable to leave and carry these wastes with them. Over time, these tissues may become damaged and even die, causing all kinds of problems such as ED and more.

A condition called priapism may also occur. This is a condition in which an erect penis cannot revert to its flaccid state after more than four hours. This is a painful condition, and in extreme cases, an amputation may be required. (Ouch!)

If you insist on wearing a penile ring, Dr Ho advises to limit its use to no more than 30 minutes.

Piercings and other “fashion statements”

There are men who subject their penises to other kinds of accessorising, often for aesthetic reasons or, because they believe that it would enhance their sexual prowess.

Dr Ho has come across several patients who tried to embed materials such as ball bearings into their penile shaft. “One tried to perform this procedure on his own, and ended up blocking the urethra – the passage through which urine and semen find their way out of the penis. He could not urinate, and had to be admitted under great pain.”

Piercing is another practice that has its share of painful pitfalls. Pierce the wrong part at the wrong place or even the wrong depth, and the tissues responsible for producing an erection may end up irreparably damaged. Dr Ho also points out that there is also a risk of infection, especially if the person does not exercise proper hygiene down there.

The final call

Dr Ho admits that it is possible that rings, piercings and even the ball bearings may provide increased sexual pleasure to certain men and their partners, but the risks have to be seriously considered.

Complicating the issue further is the fact that selling sex toys is illegal in this country, and services such as piercing the penis are usually performed by untrained personnel. As a result, there is no testing done to ensure that those products or services are effective, and no guarantee that they are safe.

At the end of the day, it is a Wild, Wild West out there when it comes to all these devices and styles, so try them out at your own risk. If you love your friend down below, perhaps it is wiser – and safer – to stay accessory-free.

If you suffer from erectile dysfunction or other problems that affect your sexual performance, you should consult a qualified healthcare professional for safer options.

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