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Premature ejaculation is a common sexual problem and while occasional experiences are not a cause for concern, it can put a strain on your sex life and relationships. 

Ejaculation is controlled by the central nervous system and it usually occurs simultaneously with the male orgasm. Premature ejactulation is when you ejaculate too quickly during sex, while some men orgasm before ejaculation or experience a climax without actually ejaculating semen.

## So, what exactly is premature ejaculation?

On average, men ejaculate after 5 minutes of sexual intercourse. But everyone is different, so this can range from less than 1 minute to more than 30 minutes. Occasionally ejaculating too early is common and absolutely nothing to worry about.

A medical diagnosis of premature ejaculation is determined if early ejaculation becomes problematic, for instance if ejaculation always occurs very early on for you – even before penetration or immediately after.

Often, the cause for premature ejaculation is about low self-esteem, since sex come somtimes come with a high level of pressure to perform. The associated stress can make the problem even worse, and can result in avoidance behaviour and cause other symptoms like erectile dysfunction. 

## How many men are affected by premature ejaculation?

It’s estimated that around 20% of men are affected by premature ejaculation, with far fewer men experiencing the problem speaking to a doctor. It’s therefore assumed that about 4% of men have little or no control over ejaculation and experience stress as a result. 

## Who does it affect most?

Premature ejaculation can occur at any age, from puberty onwards. The initial symptoms often happen when you have your first sexual experiences, and they can reoccur or continue in later life and with different partners.

## What are the key causes of premature ejaculation?

Premature ejaculations can be primary (life-long) or secondary (acquired). Those affected by primary premature ejaculation will experience it during their first sexual activities, whereas acquired premature ejaculation can develop over the course of your life. 

### Possible causes of premature ejaculation include:

- Mental health problems
- Stress and depression can cause premature ejaculation. Relationship problems or unrealistic ideas of sexual performance can further contribute 
- Physical disorders 
- Premature ejaculation may occur as a symptom of various underlying problems, like prostatitis (inflammation of the prostate gland), erectile dysfunction or thyroid issues. 

## What can help with premature ejaculation?

If the issue is troubling you and your partner, try to address it in your relationship. Having open, honest conversations means you can work through it together. Remember that sex can be fulfilling for both partners, even with premature ejaculation.

These methods may also help:

### - The stop-start method
  Just as it sounds, this method means deliberately pausing during intercourse to delay ejaculation. This requires some practice but by doing so, you can learn to pay more attention to how you react sexually and to recognise the point at which ejaculation becomes inevitable. 
### - Pelvic floor training
  You can train the pelvic floor muscle, just like the biceps and abdominals. In the case of premature ejaculation, pelvic floor exercises can help with better bodily control. You’ll find some tips on [pelvic floor training here](https://www.livi.co.uk/your-health/how-to-exercise-weak-pelvic-floor-muscles/).
### - Use a condom
  A condom can reduce the sensitivity of the penis, helping to delay ejaculation during sex. There are even special condoms containing gels that have a slight numbing effect.
### - Try again
Some people benefit from a ‘second round’ of sex, after the initial early ejaculation. Once ejaculation has happened, the level of sensitivity decreases, so sex can last longer the second time around. Masturbating an hour before intercourse can also be helpful.

## When should I see a doctor about premature ejaculation?

If it continues to bother you or becomes a problem in your relationship, you could speak to a doctor. In most cases, premature ejaculation is easily treated. 

The doctor will ask you if you’ve always experienced premature ejaculation (primary) or whether it’s developed over time (secondary). A blood or urine test may also be performed to rule out underlying causes such as prostatitis.  

## Can I get premature ejaculation treatment in the UK?

If it can’t be treated by different stimulation techniques, like the stop-start method, seeking advice from a urologist may be helpful. 

There are different therapeutic approaches – including a drug treatment. However, they can also have unpleasant side effects like nausea and dizziness. Such premature ejaculation drugs should only be used as a last resort and only after a medical consultation. 


livi.co.uk > See a GP about premature ejaculation

See a GP about premature ejaculation

livi.co.uk > Your Health > What causes premature ejaculation – and what can help?

Premature ejaculation

Meta description: Premature ejaculation can put a strain on sex life and relationships. Read our expert advice on managing and treating premature ejaculation. 

livi.co.uk > Your health > What causes premature ejaculation – and what can help?

What causes premature ejaculation? | Livi UK

livi.co.uk > medical reviewer

IMG 20200730 224911 865-33- 1 .jpg

Dr Rhianna McClymont

Lead GP at Livi

Men Health

Men's Health

What causes premature ejaculation – and what can help?

Depression is one of the most common mental health problems around the world. Globally, there are around 280 million people who suffer from the condition, and at its worst, depression in men or women can lead to suicide.

According to the [Office for National Statistics](https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations), around three quarters of registered suicide deaths in England and Wales (in 2019) were among men. The male suicide rate is also at the highest its been since 2000. This is particularly alarming, as men are less likely than women to get help for depression.

The disorder can manifest in men in a multitude of ways, and sometimes without the traditional signs of depression most of us are aware of. 

## What is depression?

Depression is a serious mood disorder that affects both men and women across all age groups. It leads to a persistent feeling of sadness, hopelessness and loss of interest in activities you’d normally enjoy.

There are many symptoms – both emotional and physical. To get a diagnosis of clinical depression, these symptoms of depression need to be present for at least two weeks.

## Depression in men

While the common perception is that women suffer more from depression, and statistics reflect that, men are less likely to speak out and seek help. This means that lots of cases of male depression are going undiagnosed.

‘Sometimes, men would rather not talk about their feelings and instead may turn to other, potentially destructive ways of coping,’ says Lina Anderhell, registered Livi psychologist. ‘Their reluctance can be down to not wanting to show themselves as vulnerable.’

## Male depression may appear differently

Another reason that men don’t often ask for help, says Anderhell, is that they ‘might not recognise themselves in the symptoms that are described.’ For example, the traditional signs of depression like a low or depressed mood, change in sleep patterns and losing pleasure in things they enjoy, may not be the first thing depressed men notice about their experience.

Men may still feel sad and lose interest in activities they used to enjoy but they may also show other signs not necessarily associated with depression.

Here are some of the signs of depression in men to look for.

### Emotional signs
- Anger
- Irritability
- Frustration
- Loss of interest in work, social life or hobbies
- Indecisiveness or inability to concentrate

### Behavioural signs
- Aggressive behaviour
- Withdrawing and isolation
- Drink and drugs
- Overworking
- Suicidal thoughts

### Physical signs
- Sleep problems
- Changes in appetite and eating
- Weight changes
- Unexplained aches and pains
- Loss of libido
- Loss of energy
- Digestive problems

## What causes mood swings in men?

There are several common causes of depression and mood swings in men, and these can lead to depression in women too.

Age, financial circumstances, lifestyle, illness, family history and even genetics have been shown to affect the likelihood of depression in men. There may be a trigger or series of stressful events which can lead to someone becoming depressed.

In men, dealing with any kind of loss is a possible cause to trigger depression. This could include a relationship breakdown, the death of a loved one or the loss of a job.

## How to help a partner with depression

It can be difficult to know how to broach the subject of depression in relationships with sensitivity. This is particularly hard if the man you’re worried about has withdrawn and is not open about his feelings.

‘What’s important as a partner or friend, is to bring up the subject even if it feels scary,’ says Anderhell. ‘Dare to ask the question, “how are you feeling?’’

She suggests expressing what you’ve noticed about their behaviour and what’s worrying you. ‘The key thing is not to blame but to show support and ask the person if there’s anything you can do to help them,’ she says.

Be aware that the form of support they want will be very individual. ‘They might just want somebody to listen, or maybe they’d like you to go with them to see a professional,’ Anderhell says.

## Self-help for depression in men

Talking about your problems to friends, family or professionals, avoiding too much alcohol and maintaining a healthy lifestyle are all beneficial for preventing male depression.

Practicing mindfulness and using [mindful techniques](https://www.livi.co.uk/your-health/why-mindfulness-matters/) can also regulate your mood as they allow you to step back from a problem. Similarly, exercise has been shown to help prevent depression in men, as it releases feel-good chemicals called endorphins into our body.

Low-intensity exercise can improve nerve cell connection too, and so helps reduce recurring or long-term symptoms of depression in men.

## Getting depression treatment

Knowing when to see a doctor is hard, especially as men have a tendency to avoid seeking help. When dealing with depression, it’s important to seek help as quickly as possible. This can make treatment a slightly easier and shorter process. 

A Livi GP can help you to better understand your problems as well as give you advice and support on how to deal with things that feel difficult. 

Depression treatment can vary a lot depending on the individual. Some men benefit more from psychological support like Cognitive Behavioural Therapy (CBT) and talking therapies, whereas others see more improvement from antidepressants, or a combination of both.

__This article has been reviewed by Livi psychologist Lina Anderhell__


Speak to a GP about depression

livi.co.uk > Your health > Signs of depression in men

signs of depression in men

Expert medical guidance on managing and treating the symptoms of male depression

How to spot and treat the signs of depression in men | Livi UK

Signs of depression in men

## Quick facts

- Over half of men between 40 and 70 will experience erectile dysfunction (ED)
- 90% of men have at least 1 underlying physical cause 
- Underlying causes can include cardiovascular disease, diabetes and hormone problems, which is why it's important to speak up

Most men experience trouble getting or maintaining an erection at some point in their lives. This is often referred to as erectile dysfunction or ED. According to the British Association of Urological Surgeons, ED affects more than half of men between the ages of 40 and 70.  

But awareness of ED is low in men and women aged 20 to 70, a recent survey commissioned by the European Association of Urology (EAU) has found. The majority of the respondents did not know what ED was, and 1 in 4 had never heard of any of the most common treatments for ED. 

## Why you should talk to a doctor about erection problems

It’s not helpful that our culture often refers to men as having to ‘perform’ in bed. This can lead to undue pressure and anxiety, which can compound the problem.

But while many will keep quiet, feeling ashamed or too awkward to broach the subject witha doctor, it’s essential they do. 

That’s because ED isn’t just a problem that affects your sex life. It can also be one of the first signs of underlying health problems that may have no other symptoms, including [heart disease](https://www.livi.co.uk/conditions/congenital-heart-disease/) or type 2 diabetes. 

What’s more, ED can affect self-esteem and lead to frustration, anger and mental health issues.

The good news is, simple lifestyle changes can sometimes reverse ED. Where they don’t, a variety of medical and psychological help is available, starting with a doctor's appointment.

We’ve called on the expertise of Dr Rhianna McClymont, Lead GP at Livi, to help raise awareness of ED and answer some commonly asked questions. 

## What’s the best way to talk about erectile dysfunction (ED) with a partner?

Whether you’re the person affected, or you have a partner who is experiencing ED, it can be a tricky thing to talk about. Of course, it’s worrying when ED happens but don’t panic and assume your sex life is over.

‘Any man can struggle to get or maintain an erection at times, and there can be a number of reasons — in particular, psychological factors — why this might occur,’ says Dr McClymont.

‘So, give your partner time, gently encourage him to get help but don’t pressure him, listen in a non-judgemental way if he’s experiencing stress or struggling with mental health, and try not to take your partner’s erection difficulties personally.’

And remember, penetration doesn’t have to be the endgame of sex. ‘You can adjust your sexual activity as a couple to find other ways to please each other and remain intimate.’ 

## What causes erection problems?

There are many factors that can contribute to erectile dysfunction and 90% of men have at least 1 underlying physical cause for their problem. 

These can commonly include underlying or undiagnosed [cardiovascular disease](https://www.livi.co.uk/conditions/cardiovascular-disease/) or diabetes — which is why it’s so important to talk to a doctor about it. 

ED can also be caused by hormone problems, neurological disorders, pelvic surgery or physical trauma.

Around 10% of men’s erection problems are caused by psychological factors like stress, [anxiety](https://www.livi.co.uk/conditions/anxiety/), depression or ‘performance anxiety’.  

Although it’s rare, around 1-3% of men may have an anatomical abnormality like a tight foreskin or penile inflammation or curvature. 

## What is ED and who commonly get it?

Getting and maintaining an erection requires a healthy supply of blood flow to the penis. But common circulatory problems that restrict blood flow such as atherosclerosis (a narrowing of the arteries due to fatty deposits of substances like cholesterol) can impede this process, resulting in erection problems. 

‘Occasional episodes of erectile dysfunction can happen to a man at any age,’ says Dr McClymont.

‘Persistent difficulties in erections, however, are more common in men over the age of 40, when conditions that may contribute to it, such as diabetes, high blood pressure, heart disease or neurological conditions, more frequently occur,’ Dr McClymont points out.

‘Various medications can also cause ED as a side effect,’ Dr McClymont adds. These include widely prescribed medicines for conditions such as [depression](https://www.livi.co.uk/your-health/help-for-depression-7-daily-tools-to-improve-your-mood/), high blood pressure and prostate enlargement.

## What lifestyle changes can help erection problems?

Simply becoming more active may reduce your risk of erectile dysfunction by up to 70%.  

In fact, a review of studies  found that doing 40 minutes of moderate to intense cardiovascular activity (the type that gets you sweaty), 4 times a week could decrease ED within 6 months.

Stopping smoking, losing weight, reducing alcohol intake, lowering stress levels and avoiding illicit drugs can also play a big part in alleviating erectile problems.

‘Things like stress and excess alcohol are common triggers for ED,’ says Dr McClymont. ‘So, if occasionally a man struggles to get or maintain an erection when perhaps he’s had a bit too much to drink or is under exceptional pressure at work, then he should not worry,’ says Dr McClymont. 

If you ride a bike for more than 3 hours a week, your doctor might recommend you try a period without cycling to see whether that helps improve things. If you do cycle, it’s vital you have a properly fitted, comfortable seat — some saddles are specifically designed to relieve pressure on the blood vessels and nerves supplying the penis. 

## When should you see a GP?

Many men find this issue embarrassing so they wait for more than 2 years before seeing a medical professional, research has found — but doctors are trained to deal with ED. 

If you’ve been having erection problems for a few weeks, book an appointment with a Livi doctor. 

‘If it’s your partner that’s affected, and he is reluctant, encourage him to seek further help as his doctor may need to run further tests to exclude a physical cause,’ says Dr McClymont.

## How can a GP treat erectile dysfunction?

Thankfully, the majority of cases of ED can be treated. A doctor will first ask you for your full medical history and may also perform blood and urine tests to help detect any underlying medical conditions. 

Your doctor may then recommend lifestyle changes. If these don’t help, other treatments are available for ED:

#### Medication 
There are currently four tablets available: sildenafil (brand name Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). These belong to a group of medicines called phosphodiesterase inhibitors (PDE5i).

Viagra is now available in the UK to buy without a prescription and at least two-thirds of men have improved erections after taking it. 

But you should always talk to a doctor or pharmacist before taking such drugs — and never buy them online as they may be fake. 

Drugs used to treat ED can produce side effects which commonly include headache, stuffy nose, flushing or upset stomach. If that happens to you — or they don’t work for you — a GP may prescribe other treatments to support erectile function. These may include penile injections or, if physical trauma is the cause, surgery.

Occasionally, Viagra-type drugs can produce serious side effects such as chest pains, seizures, painful erections and a sudden loss of vision. Always call a doctor straight away if you suffer from any of these.  

If atherosclerosis is the cause of your ED, a doctor may also prescribe statins to control your cholesterol levels and drugs to lower your blood pressure.

#### Vacuum pumps 
You’ve probably read reports online about treatment options like vacuum pumps. These cause an erection by encouraging blood to flow to the penis. They can be used if drugs are not suitable and work for most men. Speak to your doctor about the best way to get a pump.  

#### Testosterone treatment 
Your doctor may find your hormone levels are contributing to your ED . They may be able to prescribe Testosterone Replacement Therapy (TRT) or refer you to an appropriate specialist to consider this.  TFT comes in the form of a gel rubbed into the skin every day or as a long-acting injection given every 6-12 weeks.  

## Does depression cause erectile dysfunction?

This can work in two ways. ‘[Depression](https://www.livi.co.uk/conditions/depression/) can cause erectile dysfunction,’ says Dr McClymont, ‘and some of the medications that are used to treat depression can also contribute to erection issues.

‘Conversely, many men who suffer with persistent erectile dysfunction from another cause such as heart disease or diabetes find that having ED adversely affects their mental health — with men suffering feelings of anger, sadness and frustration.’

In both instances, counselling or Cognitive Behavioural Therapy (CBT) may help. A Livi doctor can help refer you for a course of psychological therapies to help with dealing with ED.


Livi.co.uk > Your health > Erection problems — a doctor’s guide to getting help 

Erection problems — a doctor’s guide to getting help 

Erectile dysfunction is common and it can be embarrassing at times, but there are plenty of solutions available. Dr Rhianna McClymont, Livi Lead GP, has advice

Livi.co.uk > Your health > Erection problems — a doctor’s guide to getting help Erection problems 

Reviewer > Dr Rhianna

IMG 20200730 224911 865[33] (1)

If you’re trying for a baby, what defines healthy sperm is probably high on your list of concerns. 

In fact, the quality and quantity of the sperm people produce can vary considerably as a result of all sorts of external factors. 

Here, we outline everything you need to know about sperm health and its impact on fertility.

## What constitutes healthy sperm?

There are 4 main factors that doctors look for when checking the quality of a person’s sperm:

### Sperm count
On average, there are between 40 and 50 million sperm in a millilitre of semen, and anything below 15 million per millilitre is classed as a low sperm count, according to the NHS. Having a low sperm count reduces the chance of conception but, as long as some sperm are present, it doesn’t rule it out – only one is needed to fertilise the egg. 

### Sperm motility
This is measured by looking at the semen sample under a microscope to see how many sperm are moving, how well they can swim, and how many are swimming in a straight line or going around in circles. It also takes into account whether sperm are clumped together or moving freely.

### Sperm morphology
This refers to how healthy the sperm look and is assessed by looking at the shape of the sperm to see if there are any obvious defects to the head, body, or tail of each gamete. 

### Volume of semen
This relates to the amount of fluid that is ejaculated, which might be a factor in how many sperm are released, and also provides a guide to how well glands within the testicles are working. 

## Are sperm problems common?
Sperm problems are a factor for 1 in 3 couples who are struggling to conceive, and in another third of cases the cause may not be known. Dr McClymont advises, ‘If you’ve been trying for a baby for a year, and your partner has not become pregnant, then it’s best to see your doctor to discuss further tests such as semen analysis.’

This routine test involves providing a fresh sample of semen so a laboratory can check several measures of sperm health. 

## Does abstaining from sex make your sperm more effective?
It’s not clear whether long periods without sex may increase the risk of some damaged sperm.

‘Aiming for sex every day during a person’s most fertile days will give you the best chance of conceiving,’ Dr McClymont advises. ‘But if that seems a little too much, then every 2 or 3 days will still give you an excellent chance.’

## Is there such a thing as healthy sperm colour?
Most semen is white-greyish. ‘Some men may notice a variation in colour from time to time,’ Dr McClymont says. But if you notice a persistent change – particularly if you also experience pain when passing urine or in your testicles, or there is blood in your semen – it should be investigated.’

Infections including chlamydia, gonorrhoea, and prostatitis can all impact male fertility. So can a structural problem like damage to the tubes that carry sperm, having undescended testicles as an infant, or previous surgery to the testicles or for a hernia.

## 6 lifestyle factors that affect sperm quality
Sperm health can be affected by a number of lifestyle factors. But if you’re trying to start a family, the good news is that it takes just 70-90 days for sperm to develop and mature. That means improvements to your diet and lifestyle should show benefits within 2-3 months.

### 1. Being overweight or obese 
This is associated with lower sperm counts. If you’re trying for a baby, and are overweight or obese, talk to a doctor about the treatment and options available for healthy weight loss.

### 2. Alcohol
Drinking any alcohol impairs semen volume and sperm morphology to some degree, according to an analysis of studies involving more than 16,000 men. The research found that drinking daily was the most damaging.

‘If you’ve started trying for a baby, or are thinking of doing so, then drinking alcohol at below the recommended limit of 14 units per week is recommended’, says Dr McClymont. ‘Drinking excessively can reduce sperm production, as well as adversely affecting the shape, size and swimming ability of sperm. For couples who are already experiencing fertility issues, men may wish to consider abstaining from alcohol completely.’

### 3. Temperature
Working in a hot environment reduces the quality and quantity of sperm. That’s why it can be helpful to avoid using a laptop on your lap or having saunas  if you’re trying to start a family. 

Wearing boxers, rather than close-fitting briefs can also help keep the testicles cooler and improve sperm concentrations and counts.

### 4. Diet
A healthy diet provides the fuel needed to produce healthy sperm. A recent Danish study found that men who ate plenty of fruit and vegetables, high-fibre foods, and fish, but minimised their intakes of red and processed meat, and sugar also had better sperm. Fat intakes did not seem to make any difference. 

### 5. Smoking
The harm smoking can do is well known, so it probably comes as no surprise that it’s bad news for sperm health too. Studies show smoking reduces sperm counts, motility, and morphology. This is probably due to increased oxidative stress, with one study describing the impact on sperm as ‘devastating’. 

### 6. Anabolic steroids
Illegal use of these muscle-building drugs is a growing problem in the UK, Sweden, and other European nations. Research shows that anabolic steroids can not only render men infertile, but it can also cause organ damage and violent outbursts.

See a GP about sperm health

Livi.co.uk > Your health > Is my sperm healthy? 6 things that can affect sperm quality

Is my sperm healthy?

How can you tell if your sperm is healthy? Dr Rhianna McClymont, Livi Lead GP, has a guide to healthy sperm, including the lifestyle changes that may help

Is my sperm healthy? 6 things that can affect sperm quality

Livi.co.uk > Your health > Is my sperm healthy? 6 things that can affect sperm quality | Livi UK

Changes in hormone levels are a natural part of ageing. For women, oestrogen levels drop drastically during the menopause – but do men experience something similar?

A term predominately used by the media, the ‘male menopause’ is used to describe an age-related decline in testosterone and the symptoms associated with it – including low energy, poor concentration, weight gain and [erectile dysfunction](https://www.livi.co.uk/your-health/erection-problems-a-doctors-guide-to-getting-help/).

‘The term “male menopause” isn’t quite right because the declining fertility in men is very different from menopause in women,’ explains Dr Céline Guyomar, a Livi medical doctor. ‘Male hormones decline gradually with age. However, a small proportion of men experience testosterone deficiency, also known as hypogonadism and androgen deficiency, where the body is unable to make enough testosterone,’ she says.

## So, what exactly is testosterone and what happens to it as I get older?

Testosterone – often described as the male sex hormone – plays an important role in emotional and physical wellbeing. In men, it’s primarily made in the testicles – also called the testes. ‘Testosterone is responsible for the production of sperm and red blood cells. It also stimulates sex drive, maintains muscle and bone strength and regulates the distribution of body fat,’ says Dr Guyomar. 

Men start to produce testosterone during puberty, peaking at around the age of 20. From the age of 30, testosterone levels normally start to decrease by around 1% to 2% per year. Known as the andropause, this decline happens more gradually than female menopause and is unlikely to cause any issues in itself.

## Can certain lifestyle factors trigger menopause-like feelings? 

Reaching middle age can mean a few life adjustments. Many of us experience changes to our health, the loss of relationships or loved ones, or problems with money. Thinking about your life as if it’s at the halfway stage could also lead to a ‘midlife crisis’. In situations like these, some people may get ‘male menopause’-like symptoms, such as self-doubt, shifts in energy levels, mood changes, lowered motivation, a lack of self-esteem and [changes in sexual drive](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/#:~:text=A%20low%20libido%20can%20be,an%20issue%20within%20the%20relationship.).

Other things that can contribute to menopause-like feelings include:

- A poor diet
- Not exercising enough
- Lack of sleep
- Drinking too much alcohol

## But what about testosterone deficiency? 

In some cases, symptoms of the ‘male menopause’ may be caused by testosterone deficiency – or hypogonadism – which happens when the testes begin to work less efficiently and make few or no hormones. One large European study found that testosterone deficiency affects about 2% of males aged 40-79 and about 5% of men aged 70-79.

Although hypogonadism can occur at any age, men are more likely to develop it as they get older. Known as late-onset hypogonadism, this condition affects around 2% to 6% of older men. Some of the most common symptoms include:

- An increased risk of breaking a bone 
- Decreased muscle mass and strength
- Decreased growth of body hair
- Hot flushes and sweats
- A decreased libido
- Erectile dysfunction
- Infertility 
- Low self-esteem
- Changes in mood, e.g. [anger](https://www.livi.co.uk/your-health/how-to-cope-with-anger-in-yourself-and-those-close-to-you/), depression, irritability and sadness
- Fatigue
- Poor concentration and memory
- Increased body fat
- [Trouble sleeping](https://www.livi.co.uk/your-health/5-sleep-problems-to-discuss-with-a-doctor/)

## What causes testosterone deficiency? 

Hypogonadism can be caused by normal ageing. ‘Other factors that can affect testosterone include injury to the testicles, being overweight, alcohol misuse, a sedentary lifestyle, certain medical conditions – such as cancer, HIV, lupus, mumps and organ failure – and some medicines,’ says Dr Guyomar. 

Hypogonadism rates are also higher among men with high blood pressure, diabetes, prostate disease, [asthma](https://www.livi.co.uk/conditions/asthma/) and chronic obstructive pulmonary disease (COPD).

## What can I do to help boost my testosterone?

‘Certain lifestyle choices can speed up the decline of testosterone,’ says Dr Guyomar. Here are some lifestyle changes you can make to increase your testosterone levels naturally:

__1. Maintain a healthy weight__
A raised body mass index (BMI) can have a direct and negative impact on testosterone levels. One study found that being overweight was the most significant risk factor for testosterone deficiency in men.

__2. Cut back on alcohol__
Drinking excessive amounts of alcohol affects the system of endocrine glands and [hormones involved in male reproductive health](https://www.livi.co.uk/your-health/male-fertility-9-lifestyle-factors-that-help/#:~:text=For%20couples%20experiencing%20difficulties%20in,fertilise%20an%20egg%20during%20conception). It reduces levels of luteinising hormone (LH), one of the main hormones that controls the body’s reproductive system. Produced in the pituitary gland, LH stimulates the production of testosterone. 

__3. Stay active__
Exercising regularly has heaps of health benefits, from improving muscle strength to reducing the risk of disease. One study found that resistance strength training may also boost testosterone levels. 

__4. Prioritise sleep__
Sleep is essential for the body to function correctly. As well as lowering the risk of heart disease and [depression](https://www.livi.co.uk/conditions/depression/), sleep can also help to maintain testosterone levels. Research has shown that one week of sleeping just five hours a night lowered testosterone by as much as 15%. 

__5. When should I speak to a doctor?__
If you’re in your late forties or older and you’re experiencing symptoms, it’s important to talk to your doctor. As well as ruling out low testosterone levels, they can also check for other conditions that may be causing your symptoms. 

‘Your doctor may also ask you some questions from the screening questionnaire for androgen deficiency in ageing males (ADAM),’ says Dr Guyomar. These questions include: 

1. Do you have a decrease in libido?
2. Do you lack energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

__This article has been medically reviewed by Dr Céline Guyomar, a Livi medical doctor.__


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Speak to a GP about ‘male menopause’

Livi.co.uk > Your health > The ‘male menopause’ – what does the medical evidence say?

The ‘male menopause’ – what does the medical evidence say?

Can a decline in male hormones be compared to the menopause? Dr Céline Guyomar, a Livi medical doctor, explains what you need to know about the ‘male menopause’

What is the ‘male menopause’? | Livi UK

The testes have two basic functions. First, they’re responsible for the production of sperm. Second, they help manufacture testosterone in a man’s body — this is the hormone that helps develop male traits like a deep voice and beard growth. 

## Testicular cancer — what are the risks?

Though it’s rare, testicular cancer is on the rise in Europe. It usually affects Caucasian males and is frequently the most common cancer in young adult men — usually in their early 30s. 

In the UK, it only accounts for 1% of all cancers, but since the 1990s, the rate of testicular cancer has gone up by 24%.

Unlike prostate cancer, testicular cancer risk decreases as you get older. Though the exact cause is not known, there are factors that can increase your risk — these include:

__Having an undescended testicle__ – ‘This is where the testes do not descend from the abdomen into the scrotum by early childhood, and is the most important risk factor,’ says Dr Rhianna McClymont, Livi GP. 

__Family history__ – ‘If your dad or brother developed testicular cancer, you’re at higher risk,’ Dr McClymont explains.

__Twins__ – Especially if they’re both male, twins may be at increased risk.

__Height__ – Men who are taller than average are also more at risk. 

## What are the signs of testicular cancer?

Most men’s testicles are roughly the same size, though one is usually slightly bigger than the other and one may hang lower than the other. 

Testicles should feel smooth, without any lumps or bumps and firm but not hard. You may feel a soft tube at the back of each testicle, called the epididymis (this transports and stores sperm from the testes). 

__Common signs of testicular cancer include:__
- A lump in the testicles
- A change in size or shape of testicles 
- A dull ache or pain
- A feeling of heaviness in the testicles

Rest assured, though, that there are several other reasons why the testes may be painful, like an infection, trauma, inflammation or cysts. 

Testicular cancer is rare — and very treatable — so make sure you get any symptoms checked by a doctor. 

## How is it diagnosed?

A diagnosis is usually reached through a combination of a testicular ultrasound scan and blood tests. 

## How do you do a self-check? 

It’s important to check the testes regularly and get to know what’s normal for you, so you can spot any changes. 

Do regular self-checks from puberty onwards. Testicular cancer is nearly always cured, but it’s easier to treat when diagnosed early. 

The best time to check is during, or immediately after, a warm bath or shower when your scrotal sac is relaxed. 

Hold your scrotum in the palm of your hand and use your fingers and thumb to examine each testicle. 
Feel for:
- Lumps or swellings
- Anything unusual
- Differences between your testicles (it’s normal for them to be different, but look out for anything new)

If you notice any of these changes, talk to a doctor straight away.

## How is testicular cancer treated?

Treatment will depend on the individual case and stage of cancer. It nearly always involves surgical removal of the affected testicle (orchidectomy). 

Men shouldn’t worry about their sexual performance as a result. ‘Having an orchidectomy will not prevent erection,’ says Dr McClymont. And, most men will still be fertile with one remaining testicle. 

‘In some cases of testicular cancer where chemotherapy is needed in addition to surgery, men will usually be offered “sperm banking” in case the chemotherapy affects fertility afterwards,’ she says.

The key thing is early detection — so make self-checking (or partner-checking) a habit — and report any changes to a doctor. You can see a GP the same day with the Livi app.

__This article has been medically approved by Dr Rhianna McClymont, Lead GP at Livi__


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See a GP about a testicle lump

Livi.co.uk > Your health > Testicular cancer: how to spot the signs

Testicular cancer: how to spot the signs

Movember has made us more aware of men’s health issues and male cancers.  Here, we get expert advice on testicular cancer

Testicular Cancer - How to Spot the Signs of Testicular Cancer

Testicular Cancer - How to Spot the Signs 

### Quick facts
- Prostate cancer is the second most common cancer in men
- Most cases are diagnosed in men over 50
- It might not show symptoms, and may require little or no treatment

It’s that time of year again, when men grow moustaches — ranging from flattering to funny — in support of Movember. 

The campaign raises awareness and funds in three areas: [male suicide](https://www.livi.co.uk/your-health/signs-of-depression-in-men/) — which claims 60 men every hour globally — as well as [testicular cancer](https://www.livi.co.uk/your-health/testicular-cancer-how-to-spot-the-signs/) and prostate cancer. 

Here we talk to Dr Rhianna McClymont, a Livi GP, about the facts on prostate cancer.

### What is the prostate? 

Around the size of a walnut, the prostate is located just below the bladder and in front of the rectum. It’s a gland only men have.

Its main function is to produce the thick, white fluid that creates semen when mixed with sperm produced by the testicles. 

### Prostate cancer — common among older men

The Movember campaign has made many of us more aware of prostate cancer. Thankfully so, as it’s the second most common cancer in men, and the fourth most common cancer overall.

In fact, more than 1.2 million new cases of prostate cancer were recorded globally in 2018 and in excess of 350,000 deaths. 

The UK is in the top 18 countries with the highest rate of prostate cancer.

### What increases the risk of prostate cancer?

__Age__ – Most prostate cancer cases are diagnosed in men over 50. ‘Age is an important risk factor, with the risk of getting prostate cancer rising as you get older,’ says Dr McClymont. 

__Ethnicity__ – ‘Research has shown that men from an African-Caribbean or African descent are more likely to get prostate cancer’.

__Family history__ – ‘If you have a dad or brother who has developed prostate cancer, particularly if this developed earlier in life before the age of 60, then the risk is higher,’ Dr McClymont says. 

__Obesity__ – According to the NHS, recent research suggests obesity increases the risk of prostate cancer.

### What are the symptoms?

Prostate cancer often shows no symptoms in its early stages and, in fact, may require no or minimal treatment. 

However, as the disease progresses common symptoms can include:
-  Passing urine more frequently (particularly at night)
- Difficulty in starting to pee, or a weak flow of urine
- Feeling like your bladder hasn’t emptied completely 
- Feeling like you need to pee urgently

### How is prostate cancer tested?

‘If you have any of the above symptoms, you may be offered a Prostate-Specific Antigen (PSA) test (taken as a blood test) and an examination of your prostate by your GP,’ says Dr McClymont. The latter will include a rectal exam. 

‘A PSA test can indicate a problem such as prostate cancer, but your PSA level can also be raised for a number of other reasons, so it’s not conclusive,’ she points out. 

‘Usually, an MRI scan will also be used to assess the prostate if a PSA level is raised, and prostate cancer is then diagnosed with a biopsy.’ 

### How is it treated?

Treatment for prostate cancer depends on the severity of the cancer, whether it has spread outside the prostate to other areas of the body, your general medical fitness, and other health conditions you may have. 

‘There are numerous treatment options, including surgery, radiotherapy, hormone therapy or “watchful-waiting”. This is where the cancer is unlikely to affect your natural lifespan, so symptoms are controlled while the cancer is monitored, to make sure it’s not progressing,’ says Dr McClymont. 

‘Any form of treatment involves potential side effects,’ she points out. ‘If surgery to remove the prostate gland is recommended to treat the cancer then these are important considerations. 

‘Following a prostatectomy (removal of the prostate), for example, many men subsequently suffer with difficulties getting or sustaining an erection, and also with urinary incontinence.’

It‘s worth remembering that while prostate cancer may be a serious disease, most men who are diagnosed with it do not actually die from it. 

Watchful waiting has advantages and disadvantages. You won’t have side effects from any treatment or need regular scans or biopsies, and if you begin to suffer from symptoms such as pain or swelling, there is treatment to help manage them. But most men never need treatment. 

Disadvantages can include the possibility of the cancer growing and spreading, and the man and his loved ones having the psychological worry that he’s not being treated.

‘Usually, the watchful waiting approach is for men with mild cancers that are not causing significant problems — and are unlikely to develop them throughout their lifetime. Or for men with other health problems who may not benefit from more invasive treatments like surgery or radiotherapy,’ Dr McClymont points out.

Talk to a doctor if you have any symptoms or concerns.

__This article has been medically approved by Dr Rhianna McClymont, Lead GP at Livi__


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See a GP about prostate cancer

Livi.co.uk > Your health > Prostate cancer — a doctor’s guide

Header GettyImages-1181205697

Men are less likely than women to see a GP over worrying symptoms. But here’s why prostate cancer shouldn’t be ignored

Prostate cancer — a doctor’s guide

Around a fifth of men have a low sperm count. For couples experiencing difficulties in conceiving, male infertility is the main cause in about 20% of cases.
  
But research has found that lifestyle factors play a key role in semen quality and healthy sperm motility (this refers to the sperm’s ability to move forward or ‘swim’ to fertilise an egg during conception).
 
In fact, 3 months before you’re planning to start trying for a baby, it’s advisable to deal with pre-existing health problems with your doctor and to make healthy lifestyle changes such as those listed below. This will help to make sure that your sperm quality is the best it can be.

## 1. Lose excess weight

If you have a raised body mass index (BMI), then try to lose weight. Obesity has a massive influence on male fertility problems, and studies show that it can affect hormone levels causing reduced sperm production and concentration. Similarly, although the evidence is more conflicted here, there may also be a link between obesity and reduced sperm motility and morphology (this refers to the shape of a sperm). All of this can reduce the chances of the sperm fertilizing the egg. 

It is also becoming clearer that male obesity can affect the molecular health of sperm and damage sperm DNA. Integrity of sperm DNA is essential for successful fertilization and normal development of a baby.
Some research shows that paternal obesity can even affect the health of your future children, through increased susceptibility of offspring to chronic disease. 

The best way to achieve an ideal weight is through healthy diet and exercise.  

## 2.  Stop smoking

Smoking can reduce ejaculate volume as well as sperm density and motility. Smokers might have a lower zinc content in their semen, which can reduce sperm production.
 
The tiny hairs that help semen move along the tubes of the epididymis (the tube that transports sperm produced in the testes) may be damaged in smokers, which can also negatively affect sperm function. Smoking can also harm erectile function.
 
Continuing to smoke also puts your partner at risk through passive smoking.
 
The good news is that these negative effects can be reversed if you give up smoking. Do ask your doctor if you need help stopping smoking, as there are NHS stop-smoking programmes that could improve your chances of stopping.

Want to give up smoking? Read our guide on the options available.


## 3.  Cut back (or cut out) alcohol

Drinking alcohol excessively can affect the quality of sperm. It lowers levels of testosterone, follicle-stimulating hormone and luteinising hormone (LH), which is one of the main hormones that controls the reproductive system. Alcohol raises oestrogen, which can contribute to reduced sperm production: one study found that drinking as little as 5 units of alcohol a week could adversely affect sperm quality.


## 4.  Avoid recreational drugs

Marijuana and cocaine are thought to affect male fertility, but large-scale studies are perceived as unethical, so it’s impossible to say for sure.
 
Anabolic steroids (sometimes taken by men to bulk up their bodies), amphetamines (speed), as well as heroin and methadone also damage sperm quality. If you’re using any of these drugs then talk to your doctor to work out a way to stop your habit.


## 5.   Do regular exercise

It’s important to be active for good cardiovascular health and to be at an ideal weight for fertility.
 
But research has repeatedly shown that generally active men also have higher sperm counts than their sedentary counterparts. Aim for at least 30 minutes of moderate exercise, 5 times a week.


## 6.   Manage your stress levels

Stress can reduce hormones such as LH and testosterone. In theory, this can affect sperm quality, although more studies are needed to make a definite connection.
 
‘Mental stress affects us in many ways. It affects our libido, potentially our reproductive abilities and probably also sperm quality,’ says Dr Rosen, Livi GP.
 
Learn a few simple breathing and meditation techniques that you can regularly turn to during stressful moments. [The Headspace app](https://www.headspace.com/headspace-meditation-app) is a great starting point.


## 7.    Keep an eye on temperature

Increased temperature of the testicles might impair sperm quality. Try to avoid sitting for prolonged periods with a warm laptop on your groin area or carrying a warm phone in your pocket. Also, don’t take long hot baths, saunas and Jacuzzis.
 
Instead, wear loose-fitting trousers and undergarments (such as boxer shorts). If you work in a hot environment or sit down for hours at a time, it’s important to move around and get outside regularly.


## 8.    Eat a healthy diet

Diets that are high in processed meat, caffeine, red meat, saturated fatty acids and trans fats are linked to low quality semen.
 
Fruit, vegetable, wholegrain and fish rich diets are linked to better sperm quality. In fact, a Mediterranean style diet for heart health will support fertility.
 
Make sure your diet is rich in antioxidants such as vitamin C, folate, zinc and B12. These are best obtained from your diet, so aim to eat at least 5 portions of fruit and vegetables each day. Talk to your doctor about your diet specifically, just in case you might need to take a food supplement - for example, because you’re vegan.
 
Foods rich in omega-3 fatty acids such as walnuts or oily fish (including salmon, sardines, mackerel and herring) help sperm production.


## 9.    Talk to your GP

If you have existing medical conditions that might affect fertility, such as sickle cell or thalassaemia or other hereditary diseases, take the opportunity to see your doctor for a preconception chat.

Similarly, if you are a man who has had groin surgery or treatment for testicular cancer, then you might want to discuss fertility with a doctor sooner.
 
Remember to get STI excluded (or treated) by being tested as soon as possible, if that’s appropriate.
 
If you have not conceived as a couple after having unprotected sex for a year, then consult your doctor together; fertility treatment options such as IVF might be a consideration.


__Reviewed by: Dr Rhianna McClymont, Lead GP, Livi__




