#low libido in men treatment

[sexologistdoctorsblog]

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[icarusredwings]

This has been on my mind for NO Fucking reason so to make it shut up, lets talk about it.

"Why doesn't Wade just do chemotherapy?"

In this essay, I will explain the answer to that question, looking at Germ cancer cells and testicular cancer rates to decide-

Can Wade have biological kids?

Let's start with the basic facts.

What a germ cell tumor?

A germ cell tumor is a mass made of reproductive cells, also called germ cells. “Germ” is short for “germinate,” which means to mature. For men and people assigned male at birth (AMAB), germ cells mature into sperm. Related, germ cell tumors most often form where eggs get made (ovaries) and where sperm gets made (testicles).

[ https://my.clevelandclinic.org/health/diseases/23505-germ-cell-tumor]

Testicular cancer.

Most testicular cancers start in cells known as germ cells and are called germ cell tumours. Germ cells in men produce sperm. Testicular germ cell tumours can develop from germ cell neoplasia in situ (GCNIS). GCNIS means that there are abnormal cells in the testicle.

[https://www.cancerresearchuk.org/about-cancer/testicular-cancer/types#:~:text=Most%20testicular%20cancers%20start%20in,abnormal%20cells%20in%20the%20testicle.]

More than 90% of testicular cancer start in the germ cells, which are cells in the testicles and develop into sperm. This type of cancer is known as testicular germ cell cancer. Testicular germ cell cancer can be classified as either seminomas or nonseminomas, which may be identified by microscopy.

[https://www.cancer.gov/ccg/research/genome-sequencing/tcga/studied-cancers/testicular-germ-cell-study ]

Treatments.

At the moment there is not a lot of options, the most common are:

Chemotherapy

Radiation

Surgery

Chemotherapy.

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Because of his healing factor, this would probably not work and if anything cause Wade more illness seeing as Chemo causes

Fatigue

Hair loss

Easy bruising and bleeding

Infection

Anemia (low red blood cell counts)

Nausea and vomiting

Appetite changes

Constipation

Diarrhea

Mouth, tongue, and throat problems such as sores and pain with swallowing

Peripheral neuropathy or other nerve problems, such as numbness, tingling, and pain

Skin and nail changes such as dry skin and color change

Urine and bladder changes and kidney problems

Weight changes

Chemo brain, which can affect concentration and focus (serve mind fog)

Mood changes

Changes in libido and sexual function

And last but not least Fertility problems

[https://www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy/chemotherapy-side-effects.html ]

Radiation.

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body. In theory this would work a little bit, for about 12 minutes and then he immediately would have all of those dead cells back because while the radiology killed one spot, cancer spreads. Quickly. With his healing factor its MUCH quicker too. All that pain for nothing.

Fatigue

Hair loss

Memory or concentration problems

Throat problems, such as trouble swallowing

Cough

Shortness of breath

Taste changes

Skin changes (such as burning and peeling)

Less active thyroid gland

Sexual problems

Fertility problems

Urinary and bladder problems

[https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy]

Surgery.

I dont even need any sources for this. We saw what happened to his legs when ripped off. They just grew back. And if removing cancer cells makes newer cancer cells? That's useless.

Summary.

Wades entire body is cancerous. Yes. His ENTIRE body. Every arm, toe, and fingernail on this man is cancerous. His healing factor is literally just having rapid cancer growth (amongst other things)

Chemotherapy and radiation will not work on him. Chemotherapy works by killing cancerous cells in order to grow healtheir ones. Except Wade can only produce cancerous cells. Yes, while they are new and much more likely in the very early stages, it's still cancerous.

This being said, there is no cure or treatment for Wades Cancer (that we know of at this time) Its quite physically the only thing keeping him with super hero powers yet still remains even after his powers are taken.

Hate to say it.

I hate to say it but statistically removing older, more advanced cells to replace with newer, less progressive cells (aka removing or ripping off his limbs/ parts of his body so they can grow back as new and fresh) is probably the best 'treatment' Wade has right now. Radiology would work the same, right?

Yes, but A. Not as B. Too many side effects that he he'll have to deal with MORE making him even more crazy and sick. Why would he do that when he can just tease Logan into slicing a hurt leg off and go from there?

Will the treatment help him be fertile?

Realistically, without his powers, he probably would be dead in a week, perhaps less due to just HOW much cancer this man truly has.

Chemo would also make it worse. So much worse, in fact. Both pain wise and his chances at ever biologically having a child.

Result(s) Before the cancer was diagnosed, (66%) 79/120 couples who attempted to conceive succeeded within 1 year. After (Cancer) treatment, (43%) 38/88 couples conceived within 1 year.

[https://www.fertstert.org/article/S0015-0282(03)00335-2/fulltext]

Testical Germ Cell Tumors are associated with semen abnormalities before orchiectomy. This review shows an increase in abnormal semen parameters among men with TGCT even outside the treatment effects of orchiectomy, radiation, or chemotherapy.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270136/ ]

The way that TGCT affects the sperm is that it's very common for not only lower sperm count (obviously, it's hard to produce when you're fighting an entire body illness) but also changes the shape of the sperm which makes it very difficult to reach the egg. Sperm with crooked tails, double tails, double heads, or even broken sperm have a very hard time reaching the egg (think of it like natural selection) and die off before they get anywhere. If you already have low countage and most of them can't make it?

Well that's much lower chances of fertility.

In the comics.

In the comics, Wade has a daughter named Eleanor Camacho in which he was unaware of because her mother saw his face and ran away in terror. The entire thing is that her mother thought she was going to die and decided fuck it, if im gonna die Im gonna die happy so decided to spend these last moments with wade (who she literally just met- if that aint weird in itself idk what is).

She only ever found him to demand child support, and he refused to believe such a beautiful child could he his given his stance of insecurity and well- Just utter shock anyway, I think. He is right. Eleanor is gorgeous as a baby and as an adult.

(There's actually a whole comic where he's trying to fight death so his daughter doesn't die before him because he "couldn't bear the thought of living without her" so they activate a bomb "with the power of a black hole" and comit death together. It's very sweet)

TLDR

In conclusion.

Yes, Wade can have children, but he has a better chance at being successful if he removes his lower half and regrows it so that its *less* cancerous than before cells, therefore hes more likely to have normal shaped sperm and probably more of it during the process.

No, chemotherapy, radiation, and surgery would not be effective. Unfortunately, the most effective thing for him is ripping his limbs off sometimes.

"Forest- why the fuck did you write this?"

You know... I really don't know. I wanted to become a bio geneticist, and here I am. Writing about some bald guys' balls on the Internet. Siiigghh... anyway. Use this. however you want, I don't even care at this point.

[candiid-caniine]

Hey! Long time no see, i know i said id send you a fantasy i thought you'd like but now ive forgotten almost all of it, oop!

Life happened, and uh, i saw that you mentioned your libido being a bit low, which definitely is my case too (im recovering from depression, now that im okay id love to get my FULL libido back, or at least a good percentage of it) do you have any tips on that?

Also any recs of blogs writing in the same vibe as you? (same-ish kinks would be nice but im specifically looking for queer inclusive stuff!) it makes me 10x hornier than the regular video/photo porn!

Hope you're well, you pathetic little thing!

💫

hi friend!! ugh i feel you. sorry i haven't got any advice on regaining ur libido...we just let mine wax and wane as it will, though denial has been a big help in keeping it steady!

i've heard good things abt ginseng and some other herbs. obvs use at your own risk, mind that some herbal treatments can cross-interact with certain medications, remember that pre-packaged supplement pills are often unregulated and may contain toxins, and be aware that some herbal remedies work better on pw certain anatomy than others, and finally that many herbal remedies considered to increase libido are largely untested on trans folx!

finally, sorry it's taken so long to answer this ask...i'm autistic and have been cataloguing lol. i present to you a list of other blog recs under the cut, organized by general vibe! i've tried to primarily include blogs that do their own posts rather than those who primarily reblog :)

note that my headings may provide some context as to what to expect, but you read at your own risk and each blog will typically have its own trigger warnings addressed in the header/pinned. additionally, i've not tagged some of the ppl below because they prefer that "Men DNI" blogs not interact, and idk if "no cis men" qualifies ahah!

all blogs below are queer- and/or trans-inclusive, if not exclusive! there is no detrans/misgendering, at least I don't think - i don't tend to follow those blogs.

hard kinks (blood, knives, etc; includes primarily-cnc blogs):

@puppy-mommy , who also does general t4t kink content, but does state untagged hard kinks!

@visciousest is someone whose blog i scroll when i'm in a Certain Mood ahah,, i won't elaborate

@hell-hound-bites: just. fuck. would drool on his knife blade.

@snuff-fag: its username should give you fair warning as to how wild its content tends to get, so please browse responsibly.

@condor-bait is taking a break right now, and all my love is with him as he takes care of himself. he made me feel so valid and so fuckable as a young trans person learning to love myself in a new way, and i've always been too shy to tell him how much his content meant to me one-on-one (yes, despite its often-extreme themes!), and he deserves as much time as he needs to heal!

@unwillingfvckpuppy for mostly cnc and medical kinks! if you like his style, but not so much their harder content, he also has a more-tame main blog--i just mainly follow/scroll this one!

@vampvictim: top-tier cnc/intox stuff, plus some great knife/bloodplay :)

@cryptidtid is wonderful and holy shit i follow a lot of hard kink blogs lol. incredible

@cnc-pet: i have been following her for a long ass fucking time lol. they post a lot of really good cnc and stories, but you'll also find a lot of aftercare tips and advice on her blog! i really admire blogs who try to balance horny content with best practices

@dollobotomy

general kinky content:

@excessively-queer . just plain old good shit :) there's a good amt of edging and degradation.

@clouded-king was honestly one of my earlier introductions to the queer/t4t kink community on here and how fucking euphoric it can be :) he posts some hard kinks, but generally it's a balance of a lot of different kinks so read his pinned at your leisure!

@ / cottontailx : just good kinky nsft posts :)

@ / digitalpenetration: often specifically t4t which i love!!

@femmelovefemme can step on me :)

@bigothteddies: could not build this section w/o mentioning him :) they had a big influence on my fantasies for a long time!

@hazelj-xoxo: bigtime want her to cuck me. have followed her across multiple blog deletions lol

@transpidered is forever an icon!

@subspaceemo

@writefinch for great stories and text posts

edging and denial, specifically:

@6irlpet is 1 of my go-to hands-down-pants scroll sessions :)

@droolkink is my inspiration!

@flustersluts does exactly what the name implies lol. a good helping of other kink content too :)

@puppycvnt is a 10/10!

@barkwoofbarkwoofbark: we r denial friends imo!!

@strawbrrysub

@blyssful-abyss

@urhighnessbitch is a big fav <3

non-detrans genderplay:

@butchviolence does amazing butch supremacy stuff and i,,, fucking hell. even just seeing their username puts me in a Particular state of mind ahah. they also post hard kinks so be aware as you proceed!

@mtfdomme: i literally just reblogged from her today lol. tbh i want to be their little stupid pupthing. it's not all transfem supremacy undertones/overtones, but that's what i mainly follow her for, plus just general t4t goodness! also, their general personality? and the way she shuts down people who disrespect their boundaries? huge inspiration for me!

@cuntboydestroyer: take me to the animal shelter and neuter me. good lord.

@the-kind-of-dame is the main inspiration for my recent genderplay post lol

@terfbreaking-tgirl (be warned of dykebreaking if that's an issue for you)

@barbarian-lesbian is my other inspiration for the recent genderplay post

@superiorineveryway

weird asf (/complimentary; my favorite type of shit. robots, ND-focused posts, etc):

@specksizedgoddess has introduced me to things i didn't know, like...existed, and that's saying a lot as one of my special interests is kink! never knew how down bad i was to be a tiny buggirl, nor how much i wanted to be someone's stupid little robot... BIG tw tho: there is snuff and gore content here, so proceed with caution if you don't wanna see that!

@sapphling fucked me up real good with some bird!sub bondage posts awhile back lol

@nobelisha: found them through their ghost cnc post so that's why they're in this category ahah! they don't have a pinned so proceed w awareness :)

@devout-cleric: hierophilia/religion kink, and i'm something of an acolyte of hers :) if you've read this far down you may as well know i'm her Little Lamb anon lol

piss/omo:

@latenightomo

@pissheartmybeloved - their URL makes me crack up every time, plus good content!

@hold-it-a-little-longer - good scenarios/imagines!

@ohmyrashi - (i think) my original intro to omo!

monsterfucking/terato:

@septimus-moonlight was my first real introduction to trans-positive terato and i've never settled for half-fun cis-oriented terato ever since :) mind tags!

@eggedbellies as well!

@bredpun doesn't appear to be active lately but still good for a scroll!

@steamandcream

@of-mutts-and-men

[nonartrose]

Transgender Woman's Anecdotal HRT Changes For The First Month

So, I am a trans woman and looking into transgender HRT (Hormone Replacement Treatment) before getting it, I noticed that the listed changes start from 1 month after starting HRT, however, I started to notice changes literrally 1 hour after I started (vein collapse in hands, felt like slow Pop Rocks). So, since then I have kept a diary of changes over those first 4 weeks, so that I could add to the existent anec-data out there. I don't feel like going day by day is necessary or useful, so I will just condense my findings into a giant list. CAVEAT: Hormone Treatment is different for everyone, everyone's body reacts to the treatment differently, so just because I experience something in the first month that you didn't doesn't mean that either of us is wrong. ALSO: fun fact: you don't have to get Transgender HRT to be a "propper" trans person. Anyway, list:

Softer skin

Colder hands (due to hair-line veins collapsing in extremities)

Softer hair on my entire body and the hair on my head can take slightly harsher hair products without frizzing as much as before

Potentially started seeing new hair growth at my hair line (which was quite high before)

Slightly reduced hair growth on face and on legs especially

I smell different and scents/deodorant smell different on me

Mood swings

A general sense of being happier that previous

Anger-based emotions such as frustration and rage feel less "complex", "deep" and intense than they did before

Empathy-based emotions such as love and understanding feel more "complex", "deeper" and more intense than they did before

I am more patient and understand with myself, and slightly more with others

Crying starts much more easily and the tears that come feel less viscous than they did before

My eyes often get wet simply by smiling

I get over big emotional moments more easily and quickly than before

Slight breast growth (soreness started after the first month)

Subjectively it kind of feels like puberty (genuinely thought I had homework assigned one day. I am 29 and not in college)

Alcohol affects me more quickly and intensely than before

Potentially more back problems than before HRT (this is an ongoing situation that I have yet to be tested for, I think it could be that my body isn't great at absorbing Oestrogen and so my body's concentration of sex hormones is too low which can lead to complications with back and joints)

I am personally less attracted to men than I was previous (I wasn't Bi, but I did have a man fetish, which seems to have disappeared)

I bruise slightly more easily

Several times I have woken up half an hour before my alarm because I had to go to the bathroom in spite of the fact that I went just before bed

(intimate details, don't read if you don't want to know) my penis is smaller when flaccid, it is more difficult to get erect, it is more difficult to cum, my libido is almost non-existent, and ejaculate lost the white colour after a couple of weeks Hopefully this can be of some anecdotal use to some people and give at bit of hope that changes are coming, and as soon as you start. They are slow, but they start from day one.

[youremyheaven]

https://www.tumblr.com/youremyheaven/754471721589997569/httpswwwtumblrcomyouremyheaven75444648981897?source=share

Gonna go find me a Venusian man. Only they can fix me now. Literally the perfect man for me I think would be a Venusian.

Me lmfao 😂🤭

Manifesting a healthy evolved Venusian man for u bbg, YOU DESERVE IT 🥺✨😩🤌🏻

I know I hype Venusian men up a lot etc but I just want to take this opportunity to say that they're not immune to being flawed.

It's just that I have more patience for a Venusian man's flaws than I do for other planetary types. At the end of the day, it's about what you're willing to put up with 👀

An imbalanced and immature Venusian man will be a womanizer, they have a crazy high libido but they don't enjoy sex for its own sake because of their Venusian nature BUT they will keep chasing that high repeatedly and it WILL corrode them from within.

Sex addicted Venusian men who sleep around always look like they're rotting

Venus naks are predominant in the charts of many many notorious sex offenders 😭😭😭💀 (including Harvey Weinstein 🤡)

Venusian men take their "I wanna spoil my woman" thing a little too far sometimes. It can feel like all they want is a pretty little doll to play dress up with and look at. They'll give you everything but it can feel empty if you're not in the right headspace for it.

Venusian men are very masculine men. If you're not comfortable with a guy with a heightened sense of masculinity, they're not the ones for you. They're kind of traditional in the sense that it hurts their pride immensely if they can't be the guy who protects and provides. If you're someone who is very independent, they're NOT the ones for you.

They'll cashapp you money and ask you to go get your nails done and many women will enjoy that kind of treatment but I can also see how many others will feel like they're being talked down to or something 😖

Venusian men fall for women who are feminine, a bit trad yet still freaky (the whole lady in the streets but stripper under the sheets bit was written by a Venusian man for sure) and they expect you to be that way always. This can be exhausting for anyone who isn't naturally inclined to be like that. All they want is for you to be pretty and be submissive enough to make them feel like a man 🫣so if you just run your life by yourself and act like you don't "need" him, you'll end up hurting his feelings.

The key is to never need anything from any man but to make him feel like you do 😈

They really really enjoy showing off their partner like she were a trophy. They take pride in being with their woman. But if you feel uncomfortable being a little bit objectified then Venusian men are not for you 🚫 they very much think of their woman as a status symbol and take immense pride in bagging beautiful women so 😬😬he may speak of you like a conquest at times

If you have a low libido, stay away from Venusian men bc they have to bang all the time 😩😩

Also they can be very cheesy and cringey. Their displays of affection can be very over the top at the most unwarranted of occasions.

I know that sounds like a good thing but bbg it gets tiring after a while cause it can feel performative and it is but Venusians just are performative by nature. They LOVE putting on a show.

If you can't stand a man being lowkey deranged and highly obsessed, texting you 24/7 and remembering every random detail (can feel stalker-y or like your space/privacy is being invaded) then Venus is not the way to go. They'll drool all over you and sing praises to you 24/7 to such an extent that you'll just be like "ok give it a rest king I've had my fill" lmao

If you're insecure about being complimented then a Venus man will be hell bc all they do is compliment their lady. I know some people think others complimenting you is fake etc and are disgusted by it but yeah you'll get the ick from Venus men that way 😬😬

Honestly Venus attracting Venus makes sense bc only a Venusian women could put up with all this and not feel exhausted and even enjoy it. Obviously everyone's a mix of influences and you absolutely can find a Venus man even without being Venusian but you should have a lot of Yin to be naturally receptive to their giving energy

[maggiec70]

Antoinette Redux...

...and doubtless for far longer than I'm around.

Some time ago I replied to an earnest but largely inaccurate defense of Marie-Antoinette that bemoaned the alleged myths surrounding her. I only remembered this when someone “liked” my response, and I looked at it again. This time, I noticed the five added comments extolling Antoinette and Louis and tossing out red herrings and additional historical bloopers. More important, however, was that the original poster shut it down to any further comments. I wonder why? Disapproves of criticism? Dislikes historical accuracy when it challenges the pretty view she extolls of her historical heroine? Wants the two “fans” to have their say but no more from the nay-sayers?

I will not let this pass, petty as it may seem.  Besides, there are times that I refuse to allow crap about specific historical figures to pass unchallenged.

These are the comments posted in Antoinette’s defense. I haven’t changed a word, but I deleted the names because they are unimportant. My responses are in italics.

Commenter #1:

“There is evidence King Louis XVI and Queen Marie Antoinette gave to the poor, provided education and other needs to the poor, and that the queen took a special interest in local children in need.”

In my reblog, I described specifically how Antoinette treated the poor; this is a regurgitation but more generalized, perhaps to make this charity seem much more extensive and continuous than it was. One point here for some accuracy, though marred by clear exaggeration.

King Louis was very 'wholesome' and was the first king not to take a mistress. Yet cartoons of the time portrayed all the royals and nobles as debauched.

Louis had some well-documented physical issues—the two most critical were tight, painful phimosis, which generally inhibits erection and ejaculation, and hypogonadism, which causes diminished libido. I suppose those conditions would preclude a mistress. These conditions also meant that he did not consummate his marriage until Antoinette’s brother, Joseph II, came to Paris to explain the mechanics of sex to Louis. Nevertheless, Antoinette didn’t have a child until eight years later. The contemporary historical records, including reports from his doctors, are replete with medical details. Quite a few are on Gallica, and even more are in the various French archives. Have a look, why don’t you?

Does this low libido and physical condition make Louis “wholesome?” Absolutely not. But it does explain why he never had a mistress. And yes, the cartoons and broadsheets more often showed Louis as impotent and hopeless, watching as Antoinette frolicked with legions of men. Louis was undoubtedly sexually dysfunctional, but Antoinette was not debauched or promiscuous.  These broadsides were the late 18th century’s equivalent of X, formerly known as Twitter, where folks trashed royals and aristocrats.

“Marie apologized to the executioner for stepping on his toe.”

Excuse me, but why on earth does this matter? After almost a lifetime of indifference at best toward anyone not in her intimate circle, Antoinette’s “apology” means squat. However, if this means a great character trait, go right ahead.

Commenter #1, second comment:

“Some of the worst treatment was meted out toward their son, a helpless child, while imprisoned. It is too horrific to repeat here.”

No, this treatment is not “too horrific” to repeat here or anywhere if you want people to know what happened. However, you have to be careful here or regarding any other subject regarding what sources you use. Yes, indeed, the removal of the then eight-year-old dauphin, Louis-Charles, from his mother and sister, Marie-Therese, was harsh. His imprisonment was brutal: cold, filthy, with little water and less food, and no human contact other than his jailers who kept him under constant surveillance and who beat him almost daily, continually criticized Antoinette and Louis, as well as trying to force him to deny God, sing bawdy songs, and learn how to curse. The more gruesome allegations of sexual abuse are plentiful as well but not confirmed in the historical record. All the other types of abuse are documented in plentiful archival documents.

Commenter #2:

“…yes...and this poor child was litterally [sic] taken from his mother [sic] arms... Knowing how difficult it was for Marie Antoinette to have children in the first place ( in the Sofia Coppola movie my heart sinks every time when the young Queen runs to her private chamber to cry when her SIL gives birth) that was the worst thing her enemies could do to hurt her.”

Removing a child from its mother’s arms is a dreadful experience, but certainly not unique to Antoinette. So why is this an issue? Because it truly is not. Think of the many thousands of impoverished French mothers whose children dead from disease and starvation were removed from their arms for burial. Changes the perspective a bit, or it should.

The danger of using movies for any historical knowledge should be obvious. Coppola’s version certainly failed to explain any of the real reasons and backstory for these tears. And they are also exaggerated. You don’t read any history—real history, not Wikipedia, not historical novels, do you?

Commenter #1, third comment:

“Too horrible to imagine.”

I was tempted to omit this part of the chorus as too inane and uninformative, but, you know, truth.

I have no idea this will change anyone’s mind—it probably won’t, since breathless fangurl love for Antoinette, Anne Boleyn, and any one of the Romanov girls is generally firmly in place and generally idealistic.

However, I’m a historian, and I don’t often let misinformation unsupported by archival, primary, and even valid secondary sources go unchallenged. I also know how to evaluate those sources regarding when and by whom they were written and in what political, social, religious, and economic environment.

So here we are. I’ve said my piece—again—about Antoinette. Disagree all you like, but please state on what your disagreement is based: fact, or opinion.

[sexologistdoctorsblog]

Low libido in treatment males can be caused by physical or psychological factors. Treatment options include addressing underlying medical conditions, lifestyle changes, and counseling. Medications such as testosterone replacement therapy may also be effective. Consult with a healthcare provider to determine the best course of action.

[jcsmicasereports]

Hydroxyurea and Sperm Abnormalities in Patients with Sickle Cell Disease by Dr. Salma M. AlDallal in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

Hydroxyurea is a key treatment option for patients having sickle cell disease. Although the treatment has been effective in improving the survival rate, new concerns over improving quality of life are forthcoming due to spermatogenesis-related toxicities and teratogenic effects. The available evidence shows that hydroxyurea might exacerbate the existing sperm abnormalities. There is a lack of comprehensive, systemic evidence to demonstrate the precise effects and role of hydroxyurea on sperm abnormalities in patients with sickle cell disease. Patients and healthcare providers require accurate and extensive information on sperm-related toxicities to make informed decisions. Here, I discuss the effects of hydroxyurea (HU) on sperm parameters, clinical study evidence, and treatment options available for fertility preservation in these patients.

Keywords: Sickle cell disease, Hydroxyurea, Sperm abnormalities

INTRODUCTION

Sickle cell disease (SCD) is a group of genetic blood disorders that leads to abnormality in hemoglobin. In patients with SCD, newer medical treatments have improved survival rates and quality of life along with a reduced disease-related morbidity. Consequently, the focus of the treatment is diverging to encompass the reproductive issues associated with these treatments. In adolescents and young patients with SCD, sexual maturation is delayed by 1.5-2 years [1, 2], and approximately 24% of SCD patients may have hypogonadism, infertility, erectile dysfunction, and poor libido [3]. The issues related to fertility and reproductive organs in SCD are either related to disease or to the treatments used to treat SCD-related morbidity.

Reduced SCD-related morbidity has been observed with treatments like hydroxyurea (HU) and hematopoietic stem cell transplantation (HSCT). However, adverse effects and toxicities associated with these therapies are a concern. HU use has been associated with sperm abnormalities and teratogenic effects [4, 5]. However, HU affects rapidly dividing cells, raising concerns about related toxicities. Therefore, it is essential to evaluate if there is an exacerbation of fertility problems in men with SCD. This review summarizes the spermatogenic effects of HU in males with SCD.

Fertility issues in males with SCD

Some of the disease-related fertility issues observed in patients with SCD are hypogonadism, sperm abnormalities, erectile dysfunction, delay in sexual maturation, and abnormal hormone (testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)) levels.

The sperm abnormality rate is as high as 91% in males with SCD [6]. Although some reports attribute sperm abnormalities to delayed puberty in males with SCD [7], some others attribute it to testicular infarction or hypogonadism. It is also worth noting that sperm abnormalities also exist with normal testosterone, FSH, and LH levels [8].

In addition to sperm abnormalities, the incidence of erectile dysfunction in men with SCD is reported to be 21%–35% [9-11]. Also, a decrease in semen is reported in men with SCD [12]. Laboratory findings show low testosterone levels with variable FSH and LH levels. Moreover, abnormalities in accessory organs like seminal vesicles and prostate glands may be present due to recurrent urinary tract infections. These reproductive issues are exacerbated by therapies like HU, which have therapeutic effects through impairing DNA synthesis.

HU in treatment of SCD

HU is approved for the prevention of vaso-occlusive pain in SCD. HU is a ribonucleotide reductase inhibitor that impairs DNA synthesis due to its S-phase-specific cytotoxic action. It is an antimitotic agent that can impair human spermatogenesis. It is a disease-modifying therapy that decreases episodes of acute pain and acute chest syndrome in SCD patients [13]. The HU therapy increases the fetal haemoglobin, which does not sickle under low oxygen tension. Low-dose HU therapy (10 mg/kg/day) has been effective in improving clinical and hematological parameters, reducing painful crises, and reducing blood transfusion requirements in SCD patients. Although HU has improved the quality of life and survival rate, its use is limited by its toxicities, particularly its effect on fertility parameters.

SCD itself manifests in some abnormalities like spermatogenesis, and seminal fluid, which may be exacerbated with cytotoxic HU therapy. HU is associated with abnormal sperm morphology [14] and a decrease in sperm count [14-16] in patients with SCD. At a therapeutic dose, it has short-lived, irregular cytotoxic effects on dividing cells [4]. Since it is an antimetabolite, it is hypothesized to have a risk of affecting sperm development [4]. These effects are often brief and reversible with discontinuation of the drug administration.

Infertility in Men with SCD

Although HU treatment has improved outcomes in patients with SCD, it has been associated with effects on spermatogenesis and teratogenicity, for example, testicular atrophy, hypogonadism, decreased sperm count, abnormal sperm motility, and abnormal sperm morphology.

Hypogonadism

Male hypogonadism is decreased functional activity of the gonads that results in a testosterone deficiency. Testosterone deficiency can cause infertility, muscle wasting, and the absence of secondary sex characteristics. The mechanism for the cause of hypogonadism may be primary gonadal failure [17-19], repeated testicular infarction [20], zinc deficiency [21, 22], and partial hypothalamic hypogonadism [23].

Abnormal spermatogenesis

Impaired spermatogenesis has been reported in male patients with SCD receiving HU therapy, which leads to testicular atrophy, oligozoospermia (low sperm count), abnormal sperm morphology, and azoospermia (decreased sperm motility) [6, 15, 16, 24-31]. It is yet unclear if the abnormalities directly affect HU therapy. However, some researchers believe that the extent of sperm abnormalities might be associated with the length of HU therapy [29, 30]. Since SCD is a genetic condition manifesting at an early age, the duration of HU therapy remains long.

Abnormal Hormone level

A few studies have reported altered levels of testosterone and dihydrotestosterone, FSH, and LH in patients with SCD [12, 32, 33]. The testosterone levels have a direct effect on fertility [6], reduction in semen volume, sperm count, and motility in sickle cell male patients [10].

Priapism

Priapism is defined as a prolonged and lasting continued penile erection unrelated to sexual interest or stimulation [34]. The prevalence of priapism and erectile dysfunction in patients with SCD is 45% and 30%, respectively [35-37].

Penile erection is regulated by the neurotransmitter nitric oxide (NO). In SCD patients, the bioavailability of NO is decreased, disturbing the relaxation of penile smooth muscle [38, 39]. Also, the adenosine regulation pathway might be contributing to the pathophysiology of priapism in SCD patients.

Studies evaluating the effect of HU therapy on spermatogenesis SCD patients

Several studies have reported the role of HU in the exacerbation of various sperm abnormalities in patients with SCD. A non-interventional study (ESCORT-HU-European Sickle Cell Disease Cohort-Hydroxyurea) evaluated safety, morbidity, and mortality in 422 SCD patients of age 15years and older treated with HU [40, 41]. The study reported 67 pre-treatment and 24 during treatment semen analyses. Before treatment with HU, 49% of sperm analyses were normal, and 25% were abnormal (at least 1 abnormality: sperm mobility, sperm count, appearance). The rate of abnormalities during HU treatment increased to 50%. The abnormalities observed were asthenospermia, hypospermia, oligospermia, azoospermia, and atypical forms. These results confirmed that sperm abnormalities are exacerbated after HU treatment.

A prospective, Phase 4 multicentre study called HYDREP (NCT01609192) assessed the effect of HU treatment in patients with SCD [42]. The study reported a significant and rapid decrease in mean total sperm count from 129.8 million at baseline to 24.1 million at month 6. Furthermore, 86% of patients had an abnormal value of total sperm count at month 6 compared to only 40% at baseline. Researchers also found that 6 months of HU treatment did not affect the semen volume. They reported that the treatment of SCD with HU causes significant abnormality in spermatogenesis. After treatment, the number of men with abnormal total sperm count and cryptozoospermia increased to 30 patients and 5 patients, respectively. Additionally, six patients (17%) became azoospermic, and 19 were oligozoospermic.

An unmatched case-control study in Nigeria compared serum testosterone concentration among 47 patients with hemoglobin phenotype SS and 28 volunteers with hemoglobin phenotype AA [43]. The concentrations of serum testosterone in 44 of 47 hemoglobin phenotype SS patients were significantly lower as compared to 7 of 28 volunteers with hemoglobin phenotype AA.

A group of researchers evaluated the effect of long-term HU treatment from childhood to adult age in four patients [44]. These patients were receiving HU treatment for more than 8 years. They observed that two patients experienced severe oligozoospermia and two azoospermia. The treatment exposure in patients experiencing oligozoospermia was shorter (8 and 9 years) compared to patients experiencing azoospermia (12 and 15 years). There was also an increased percentage of abnormal spermatozoa morphology in these patients.

Furthermore, a study assessed spermatogonial quantity in prepubertal patients who received alkylating agents to compare with patients who received non-alkylating agents. They demonstrated that the quantity of spermatogonia per transverse tubular cross-section was significantly low in patients with SCD receiving hydroxyurea (0.3 ± 0.6, n = 6; P = 0.008) [45].Contrarily, a recent study reported no difference in semen volume, sperm concentration, total sperm count, or spermatozoa motility, morphology, and vitality between patients with SCD who received HU before puberty and who did not receive HU during puberty [46].

Semen analysis

A significant reduction in sperm density, ejaculate volume, sperm motility was reported in the SCD patients compared to the control subjects [43]. Likewise, some former studies that performed semen analysis in men with SCA reported a reduction in sperm motility, sperm density, and sperm morphology [44]. Similarly, Osegbe et al. and Agbaraji et al. analyzed sperm density, motility, morphology, and semen volume in patients with SCD. They reported a decrease in sperm motility, sperm density, and abnormal morphology in patients with SCD. [12, 47] Osegbe et al. observed no difference in semen volume [33]. Additionally, Friedman et al. reported oligospermia in 3 out of 4 patients with SCD [47].

Similar to Osegbe et al., a recent study also reported a normal volume of ejaculate in 75% of the samples of SCD patients. However, all sperm parameters during HU treatment were affected [47]. There were no incidents of azoospermia in five patients, although a marked decrease in sperm density during the HU treatment compared to before the HU treatment was reported. Interrupting HU treatment did not help recuperate the sperm parameters to initial levels.

However, before HU was established as a standard of care to treat SCD, subfertile range sperm parameters had been reported in patients. More recent studies have reported at least one abnormal sperm parameter in about 90% of patients [47].

HU treatment, even in low doses, exacerbates sperm parameters abnormalities in SCD patients. Therefore, routine seminal fluid parameters assessment is recommended to monitor sperm parameter changes during treatment with HU.

Treatments Available

For patients who have abnormal spermatogenesis due to their underlying condition or treatment of the conditions, the option of fertility preservation can be considered. The “optimal” age for fertility preservation is still a discussion. Below are some of the options available [46]-

Erectile dysfunction can be managed with penile implants effectively

Testicular tissue cryopreservation

Gonadal shielding

Sperm cryopreservation

Testicular sperm extraction

Electroejaculation- electrical current to trigger ejaculation.

Symptoms of hypogonadism can be treated with testosterone undecanoate injections12 and clomiphene13

In prepubertal males, patients have very limited experimental options, for example, removal and preservation of part of the testicle [47]. However, there have been no reports of live human births from re-implanted testicular tissue yet.

Counseling about infertility risk associated with the disease and treatments, and options for fertility preservation is important in these situations. Many unresolved ethical dilemmas arise for pediatric patients regarding counseling about fertility issues and preservation. The first dilemma is with whom the responsibility of making the decision should rest. Although some guidelines consider it should be parents, often patients (mostly children in case of SCD) and parents may have different opinions and choices. The American Academy of Pediatrics has published guidelines encouraging healthcare providers to discuss the issues and options with patients and guardians [48].

Since fertility preservation may not be feasible in all cases of SCD, regular monitoring for sperm abnormalities during HU therapy has been suggested.

Conclusions

HU has significantly improved the treatment outcomes in SCD patients. However, some concerns regarding the cytotoxic effects of HU on spermatogenesis emerge. Extensive research is required to evaluate the before and after treatment sperm parameters and the effects of treatment with HU on spermatogenesis.

Newer medical advances have improved survival rates and reduced disease-related morbidity in SCD patients, bringing reproductive issues to the forefront. Prospective, large population-based studies among patients with SCD are required to determine cellular and functional impairment of fertility and evaluate the impact of HU therapy on the impairment.

The clinical practice and future research should be streamlined to focus on improving the quality of life along with the prognosis of the patients. The patient-centric research will help in better management and treatment of patients with SCD with HU therapy.

[althafrana]

Kerala's Leading Ayurvedic Sexologist: Healing Sexual Disorders Naturally

Dr. Rana’s Medical Hall, An Exclusive Men’s Sexual Health Clinic in Kerala

Holistic Treatment for All Your Sexual Disorders ● Premature Ejaculation ● Erectile Dysfunction ● Penis Enhancement ● Low libido problems ● Stamina issues ● Infertility ● Hijama and many other sexual problems ● Pre-marital Counselling ● Post Marital counseling

Set up as a single clinic in Kochi, we branched out to Kottayam, Angamaly, Alappuzha, Thrissur, and multiple clinics in India and abroad, apart from online consultation, with thousands of satisfied clients.

Meet us at the following locations ● Ernakulam: https://ranamedicalhall.com/sexologist-near-me-ernakulam/ ● Kottayam: https://ranamedicalhall.com/sexologist-near-me-kottayam/ ● Thrissur: https://ranamedicalhall.com/sexologist-near-me-thrissur/ ● Alappuzha: https://ranamedicalhall.com/sexologist-near-me-alappuzha/ ● Angamaly: https://ranamedicalhall.com/sexologist-near-me-angamaly/

feel free to call us @ +918848511462 for a direct appointment or an online consultation WhatsApp us: https://wa.me/918848511462

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[a-frog-in-a-bog]

… why do you agree that aro/ace people are “privileged”?

is there a specific post i reblogged you're referring to? i don't think i've ever said that. anyway non-LGBT aces and aros definitely benefit from cishet privilege, even if they're not heterosexual (a cis aro-ace person for example, who is neither straight nor queer). oppression operates on a systemic level, upheld by the law.

here's an example from the stonewall riots wikipedia: "Throughout the 1950s and 1960s, the FBI and police departments kept lists of known homosexuals and their favored establishments and friends; the US Post Office kept track of addresses where material pertaining to homosexuality was mailed ... bars catering to gay men and lesbians were shut down and their customers were arrested and exposed in newspapers. Cities performed "sweeps" to rid neighborhoods, parks, bars, and beaches of gay people. They outlawed the wearing of opposite-gender clothes and universities expelled instructors suspected of being homosexual".

today's bathroom bills, gay wedding cake bs, bans on gay couples adopting kids, and limits on testosterone levels in women's sports are just a few of many laws upholding oppression. non-LGBT aces and aros are not affected by these laws or cultural stigma.

that isn't to say that non-LGBT aces and aros don't face any discrimination, just that it's not a result of them being ace or aro. being pressured to have sex when you don't want to is rape culture, and it affects everyone, especially women (misogyny). the outdated idea that adult happiness depends on getting married and having kids (which is fortunately dying out) isn't amatonormativity, it's the christian ideology that's permeated into our culture. being asked about your libido at the doctor's isn't ace discrimination, it's bc changes in libido can indicate something serious. in order for low/no libido to be characterized as a disorder in the medical and psychiatric fields, it must explicitly cause the patient significant distress, and even then, treatment is usually regular ol' couples counseling, not conversion therapy. btw conversion therapy involves harmful methods to force patients to associate homosexual attraction with pain and disgust, it's not a therapist asking "but are you sure your lack of attraction doesn't stem from trauma?"

do aces and aros get bullied for their identities? yes. but that's not what oppression or privilege refers to.

[dubeyclinic]

Ayurveda Efficient Sexologist Doctor in Patna, Bihar | Dr. Sunil Dubey

What to do if I lose my sexual drive day to day….

If the man or woman is below 40 years of age and is experiencing decreased libido or sexual desire then it is a difficult situation. Generally, it is said that the peak age of women sexual desire is from 30 to 35 and it may be more than 35. The peak age of libido in men is starting from 16 to 24 or it may be more than 24. 

Dr. Sunil Dubey, World famous Ayurvedacharya says that in today’s time, below the age of 40, 10% people are suffering from this sexual disorder. In other term, low sexual drive or libido is known as sexual desire disorder in which a man or woman gets his/her sexual desire lower due to medical, physical, and psychological reasons.

The large number of sexual patients who come to Dubey Clinic and say that they had been addicted with masturbation and this hypoactive sexual desire disorder happens with them. This best sexologist doctor in Patna says that people should quit this myth of masturbation because there are many factors those lead a man or woman to low libido sexual disorder.

Causes of Low Sexual Drive in a person:

Those are the causes of low sexual drive in persons such as- Mental Health Issues, Conflict between couples, Medical Conditions, Aging, Disturbance, Hormonal Changing, Stress of Work, and Irregular of Daily Life. The sexual patients will have to study this problem sincerely why it happens with their sexual life. If they are unable to identify their problems, then they should consult the experienced sexual medicine counselor to get treatment and medication.

Dr. Sunil Dubey is one of the most experienced sexologist doctors in Bihar who treats married, unmarried, male, female, young, and couple sexual patients. He has researched on loss of libido sexual dysfunction, and then he has found that mostly persons are disturbed with their daily and family life. They have become pessimist and their strong will power has abolished due to stress and irregular routine.

Treatment for low sexual drive patients:

Dr. Sunil Dubey is the first Indian gold medalist sexologist doctor who was awarded with Bharat Gaurav and Bihar Ratna Award. He has discovered many sexual medications for sexual patients those are suffering from erection problems, low libido, premature ejaculation, nocturnal emission, sexual desire disorder, sexual pain disorder, and so on.

He says that the sexual patients who are suffering from hypoactive sexual desire disorder, they should not worry too much. It is curable and the sexual patients can improve his libido and sexual desire through Ayurveda Medicare and Natural medicines. The diagnosis of this sexual disorder is based on the patients’ problems. It is obvious that they will have to take nearly 3-6 months medication and follow some guidelines. He provides fully natural medication to the sexual patients to get rid of their problems.

If you are a sexual patients and having any sexual problem, then you should be aware of your health. Just consult the Ayurveda Specialist Sexual Medicine Counselor who has genuine experience in this Ayurveda and Sexology Medical Science. Dubey Clinic always helps all those sexual patients who are suffering from any sexual, marital, or family problems.

Make an appointment with Dubey Clinic, if you want to get rid of your sexual problems permanently. This certified clinic will be helping you from your first call to the ultimate time of medication.

With best wishes:

https://dubeyclinic.com/

Dubey Clinic

A Certified Clinic of India

Helpline No: +91 98350 92586; +91 93340 58336

Venue: Subash Market, Dariyapur Gola, Langar Toli, Chauraha, Patna, Bihar 800004

Email ID: info@dubeyclinic.com

[holistichealthnews]

A Man-to-Man Talk About Testosterone

Testosterone is a fundamental hormone that plays a crucial role in men's health. It influences everything from mood, libido, and energy levels, to bone and muscle mass. Over time, it's natural for testosterone levels to decline, typically beginning around the age of 30. 

However, abnormally low testosterone can lead to a variety of health issues, which may affect both physical and mental well-being. Fortunately, there are various ways to address this condition. In this blog post, we'll dive into what men can do about low testosterone.

Understanding the Symptoms

Before we get into the solutions, let's talk about the signs of low testosterone. Symptoms include:

- Reduced sex drive or sexual dysfunction

- Fatigue and lack of energy

- Depressed mood or increased irritability

- Decreased muscle mass and increased body fat

- Difficulty with concentration and memory

- Reduced bone density

If you're experiencing these symptoms, it's recommended to consult a healthcare provider who can conduct an accurate diagnosis.

Lifestyle Changes

Dietary improvements: Nutrition plays a pivotal role in maintaining testosterone levels. A diet rich in lean proteins, healthy fats, fruits, vegetables, and whole grains can promote overall health and hormone production. Avoid excessive alcohol and processed foods, which can negatively impact testosterone.

Exercise regularly: Regular physical activity, particularly resistance and high-intensity interval training, can stimulate testosterone production. Exercise also helps in maintaining a healthy weight, which is important as overweight and obesity are linked to low testosterone.

Adequate sleep: Quality sleep is essential for hormone production, including testosterone. Make sure to prioritize good sleep hygiene to improve your overall health and testosterone levels.

Stress management: Chronic stress can impact hormone balance, including testosterone. Techniques such as mindfulness, yoga, meditation, and deep-breathing exercises can help manage stress levels.

Medical Interventions: If lifestyle changes are not enough, you may need to explore medical interventions. 

Testosterone Replacement Therapy (TRT): This treatment involves administering testosterone directly into the body via injections, patches, or gels. TRT can be very effective, and we offer it here at Tri-City Family Care. 

Medications: Certain medications can stimulate the body to produce more testosterone. They are often considered before TRT and can be an effective treatment for some men.

Counseling or therapy: Low testosterone can often lead to mood changes, including depression and anxiety. Speaking with a mental health professional can provide support and effective strategies for coping.

You're Not Alone

Living with low testosterone can be challenging, but it's important to remember that you're not alone. There are numerous strategies to manage this condition, ranging from lifestyle changes to medical treatments. If you suspect you may have low testosterone, the first step is to reach out to a healthcare provider. Together, you can develop a personalized plan that best suits your needs and lifestyle.

Remember, taking care of your body is a holistic process. Balanced nutrition, regular exercise, quality sleep, and stress management not only help with low testosterone but also promote overall health and well-being. Let's embrace these positive habits and foster a healthier future for all men.

Click here or call 405-387-3838 to arrange your first or next visit—and be sure to be prepared with your list of medications, symptoms, and questions!

[sexologistdoctorsblog]

Low libido treatment in males includes lifestyle changes, hormone replacement therapy, medication, and counseling. Consult a healthcare provider for proper diagnosis and treatment options.