Author and lecturer Nelson Vergel speaks about erectile dysfunction, testosterone replacement, nutrition, supplementation and exercise techniques for best health and performance. You can find this information in www.ExcelMale.com and www.TestosteroneWisdom.com

1.
Latest Advances in Men’s Health
Nelson Vergel
TestosteroneWisdom.com
Copyright © 2011 by Nelson Vergel

2. This information (and any accompanying printed
material) is not intended to replace the attention or
advice of a physician or other health care professional.
Anyone who wishes to embark on any dietary, drug,
exercise, or other lifestyle change intended to prevent
or treat a specific disease or condition should first
consult with and seek clearance from a qualified health
care professional.

3. Copies of these slides (plus a few more)
are available free online at
TestosteroneWisdom.com
on the “Lectures” page

4. Objectives
To Review:
– The most common causes of erectile
dysfunction (ED) and its treatment options
– Best ways to diagnose and treat
testosterone deficiency
– Best ways to increase lean body mass and
decrease fat
– Supplements backed by data
– Nutrition and Exercise tips
Questions and answers

5. ED Incidence
20-30 million American men suffer ED
Age dependent
– 2% men age <40 years
– 25% men age 65
– 75% men >75 years
Not a necessary occurrence of the
aging process

6. An Erection Requires a Coordinated
Interaction of Multiple Organ
Systems
Psychological
Hormonal
Vascular
Neurologic

7. Cause of ED
Psychogenic Causes:
– Anxiety
– Depression
– Fatigue
– Guilt
– Stress
– Marital Discord
– Excessive alcohol consumption
– Crystal Meth

8. Causes of ED
Organic Causes
– Cardiovascular disease
– Diabetes mellitus
– Surgery on colon, bladder, prostate
– Neurologic causes (lumbar disc, MS, CVA)
– Hormonal deficiency

9. Causes of ED
Risk Factors
Massachusetts Male Aging Study¹
Treated heart disease 39%
Treated diabetes 28%
Treated hypertension 15%
¹Feldman Ha, J Urol 1994; 151:54-61

10. Causes of ED
Medication:
Most common cause of ED in men >50
Many men are polymedicated
Also have co-morbid conditions

11. Causes of ED
Medications (cont.)
Anti-hypertensive drugs
– All capable
– Common: thiazides and beta blockers
– Uncommon: calcium channel blockers,
alpha-adrenergic blockers, and ACE
inhibitors

12. Causes of ED
Medications (cont.)
CNS drugs:
– Antidepressants, tricyclics, SSRIs
– Tranquilizers
– Sedatives
– Analgesics
H1 and H2 receptor blockers

13. Treatment Options
Oral medications – Phosphodiesterase
Type 5 Inhibitors (PDE-5): Viagra,
Levitra, Cialis
Urethral suppositories (MUSE)
Injection therapy - Caverject, Trimix,
Bimix
Vacuum constriction device
Surgery
Sex therapy

14. Nonpharmacologic Treatment
Options
Lifestyle changes:
Reduce fat and cholesterol in diet
Decrease or limit alcohol consumption
Eliminate tobacco use and substance
abuse
Weight loss if appropriate
Regular exercise

15. Medication Side Effects
(PDE Inhibitors)
Side effects:
Headache
Flushing
Dyspepsia
Nasal congestion
Visual disturbances
Back ache (Cialis)

16. Drugs
Drug Onset of Duration
Action of Activity
Viagra 60 minutes 4-5 hours
Levitra 30 minutes 4-5 hours
Cialis* 15 minutes 36 hours
* No food effect

17. Medication
(PDE Inhibitors)
Contraindications:
Organic Nitrites:
– Oral
– Sublingual
Severe cardiac disease
– Obtain stress testing
Careful with Norvir since it boosts PDE
blood levels

18. Penile Injection Therapy
Caverject, Edex, Tri/Bi-Mix
Mechanism of action: smooth muscle
vasodilator
Monotherapy (protaglandin E1) or combination
of 2 or 3 agents (Papaverine+ Phentolamine +
Alprostadil )
Administration: 10, 20, 40ug
Inject directly into corporeal bodies of the penis
Results: 70%-90%
Dropout rates: 25%-60%
Side effects: pain (36%), priapism (4%), fibrosis

19. Trimix
(Papaverine+ Phentolamine + alprostadil)
Available by prescription from compounding
pharmacies

21. Signs and Symptoms of Low
Testosterone
 Loss of muscle mass and strength
 Loss of libido and erectile dysfunction
 Depression
 Lethargy (fatigue, lack of focus)
 Bone loss
 Some regression of secondary sexual
characteristics (body hair loss, etc)
 Low or no sperm count
Tenover JL. Endocrinol Metab Clin North Am. 1998;27:969-987
Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html

22. Hypothalamus

23. Testosterone and Aging

24. Testosterone Deficiency
(Hypogonadism)
• Normal levels in blood:
Men... Total test. 300-1100 ng/dL,
Free test. 5 - 21 ng/dL
Women... Total test. 10-50 ng/dL
Free test. 0.10-0.85 ng/dL
• Symptoms of testosterone deficiency:
Fatigue, low or lack of sex drive, poor appetite,
loss of muscle mass & strength, depression

26. Testosterone Fractions in the Blood
Free T
2%
Albumin-bound T
38%
T = testosterone
SHBG-bound T
Only 2% is free
60%
testosterone
and 98% is bound

27. (binds testosterone)

28. Finasteride
Anastrozole
Tamoxifen

29. The HPT Axis

30. Testosterone
Replacement Benefits Mental
focus
Stamina and Bone Strength
Sexual function
Lean
Body
Mass

31. Testosterone Options Gels
Buccal
Injections
Gels Armpit lotion Axiron
Pellets
Patch
New: Fortesta (2 % gel)

32. To Be Potentially Approved by the FDA
in the Next 12-24 Months
First FDA approved for women
To be called Aveed in the US

35. Side Effect: Gynecomastia (breast enlargement in men)
Treatment: Estrogen Blocker Medications or surgery (in worst cases)

36. Side Effect: Increased number of red blood cells (polycythemia)
Watch out for
hematocrit over 52 !
Solution: Donate blood
or therapeutic phlebotomy
(4-5 units every 3-4 months)

37. Side Effect: Testicular Shrinkage (atrophy)
Treatment:
Human Chorionic Gonadotropin
(hCG)

38. Side Effect : Increased prostate size
(benign prostatic hypertrophy)
Prevention:
Digital Rectal Exam (DRE)
Prostatic Specific Antigen (PSA)
blood test

39. Side Effect: Acne
Treatment: Bezoyl Peroxide, salicilic acid lotions, soaps,
showering after exercising, 20 min of sun a day, Zinc supplements

40. For More Information:
TestosteroneWisdom.com

41. COMPREHENSIVE APPROACH TO
WELLNESS
Stress Reduction
Medications Nutrition
Exercise

42. Protecting Your Heart

44. How To Minimize Heart Disease
Do not smoke!
Exercise and low animal fat/sugar diet
Lose weight if you are overweight
Manage stress and keep blood pressure in check
Decrease triglycerides with Omega 3 fatty acids (cold
water fish oils), low sugar intake, exercise.
Improve HDL with Niacin 300-500 mg 3 x day. Start with
lower dose to minimize “flushing” and take an aspirin 20 min before
(Niaspan is the prescription grade)
Soluble Fiber (oats, fiber supplemengts, etc)
If everything else fails, use prescription lipid lowering
agents (statins, fibrates, etc)
A baby aspirin a day (81 mg)
Keep healthy blood levels of testosterone and thyroid
hormones.

45. Insulin Resistance: A Silent Health Threat
Pre diabetes
Keeping a healthy weight, exercising, low glycemic load diet, certain supplements
and medications can decrease Insulin resistance and glucose intolerance

46. Visceral Fat and Health

47. Potential Interventions for Decreasing
Abdominal Fat (visceral adipose tissue-VAT)
Diet- Lower carbohydrate diets, Mediterranean diet
Exercise- cardiovascular and resistance training- Some
pilot data with good results
Anti-diabetic drugs: Metformin (Glucophage)- conflicting
and inconclusive data
Testosterone gel- subcutaneous fat loss only
Anabolic steroids- Oxandrin, nandrolone?- limited VAT
data
Human Growth Hormone
Human Growth Hormone Releasing Hormone- Sermorelin
and Tesamorelin- Approved for the treatment of HIV
related visceral fat accumulation
Surgery- Liposuction of visceral fat very difficult and risky

48. How to Increase Lean Body
Mass
Higher protein intake (whey, egg white protein
supplements, lean meats, nuts, fish, eggs, etc)
and more frequent snacking with right balance.
More in nutrition section
Resistance exercise. More in exercise section
Testosterone Replacement if needed
Growth Hormone replacement
Medical use of oxandrolone and nandrolone
Creatine Supplementation
Healthy sleep habits

49. Supplements- Snake Oil?

50. Supplements- What Works?
Niacin 1000-3000 mg/day
– Increases good cholesterol (HDL). Caution with
“flushing”. Take a baby aspirin 20 min before taking
niacin
Selenium
– Glutathione production (anti-oxidant.) A study
showed people who took 200 mcg/day had better
immune function
Calcium Carbonate- 500-2000 mg/d
– Bone protection, diarrhea control
Vitamin D- Bone protection and other emerging
benefits (2000-4000 IU/d)
SAMe (S-Adenosyl-L-Methionine) – energy,
depression, liver detox

51. Supplements -Any data?
Whey Protein 20-100 grams/day
– Popular with bodybuilders. HIV study found compensatory
response. People ate less food and no increased LBM was found
Creatine 5-15 grams/day
– Muscle voluminizer, strength enhancer. Caution with
diarrhea and kidney overload.
Omega 3 oils (fish oils) 3000- 6000 mg/day
– Decreases cholesterol/triglycerides, anti-inflammatory,
mood stabilizer?
L-Carnitine 1000-3000 mg/day
– Helps use fat for energy, cell protection, lowers lipids, anti-
catabolic, heart muscle protection, N-Acetyl Carnitine may
restore nerve damage in neuropathy
B Vitamins (100 mg each/day)- whole body processes,
possible prevention of mitochondrial toxicity

52. Great Web Site to Find Out
What Supplements to Trust
ConsumerLabs.com

54. What Your Plate Should Look Like….

56. The
ZONE
&
Modified Atkins South
Beach
Diets

57. Low- Fat vs Mediterranean vs Low-Carbohydrate
Diets- Effect on Weight Loss

58. More Nutritional Tips
• Shop the perimeter of the store
• Do not skip breakfast (keep an eye on sugar and
refined flower products!)
• Try to eat several smaller meals or snacks instead of
2-3 large ones
• Eat more almonds, walnuts, pecans and pistachios
(good cholesterol lowering fats)
• Eat fruits and vegetables of all colors
• Avoid sweet drinks and fruits juices. Eat the fruit!
• Eat a high protein, complex carbohydrate- rich meal
after work outs
• Get a slow cooker
• Cook for the week and freeze

59. Nutritional Considerations
• Reduce saturated (animal) fats, fried foods
and hydrogenated oils
• Eat omega-3 fish oil-rich foods- salmon, tuna,
sardines or flax seed oil (alternative)
• Use good fats: olive oil, nuts, avocados,
flaxseed
• Minimize sugar, fructose (sweets, sodas,
foods with high fructose corn syrup )
• Eat adequate amounts (0.7-1 gm/lb/day) of
protein (fish, eggs, cottage cheese, lean
meats, chicken, whey, yogurt, nuts, etc)

60. Best Protein Sources
Building block of muscle mass and food for the
immune system
Dairy proteins - best is cottage cheese (casein),
whey, yogurt… made to make mammals grow
bigger . Be careful with milk allergies/lactose
intolerance
Whole eggs are better than egg white
Fish - cold water fish like salmon and tuna
Lean beef
Chicken (no skin)
Natural almond butter (no added hydrogenated oils
and fillers)
Beans, rice - vegetarian diet requires good
knowledge of protein sources

61. Good Carbohydrates
Bad Carbohydrates
Provide energy and nutrients
Bad carbs can worsen insulin resistance and
triglycerides
Bad: Avoid/reduce high glycemic, high calorie
carbs – refined flour, especially milled grains,
sugar, high fructose corn syrup
Good: Eat more fiber, nutrient, and fluid-rich,
low calorie, low glycemic carbs like: oatmeal,
multi-grain breads, vegetables, fruits, roots,
greens, wild rice and beans

62. Fat is not a Four Letter
Word
Fats are needed for energy, immune
function, vitamin absorption, and
hormones
Good Fats - monounsaturated- Olive Oil
Essential Fatty Acids- polyunsaturated
Omega 3’s- cold water fish (salmon)
Omega 6’s- high oleic sunflower oil, walnuts,
almonds, pecans, avocado
Omega 3’s and 6’s- Flaxseed meal
Bad Fats -processed/hydrogenated
oils,margarine, artificial creamers, any
man-made oil, burned oils, rancid oils, lard

63. Grocery Shopping List
Almonds and other nuts
Beans and other legumes
Spinach and other green leafy vegetables
Low fat dairy, yogurt
Hummus
Whey protein
Oatmeal
Eggs
Lean meats
Whole grain breads and pasta
Peanut, almond , cashew butters
Olive oil and avocados
Raspberries and all berries. Fruits (avoid fruit juices)
One or two glasses of red wine per day (optional)
Flaxseed , pumpkin and sunflower seeds
Sweet potatoes and wild rice
Green tea (optional)

64. Exercise, the Best Therapy for Most Health Problems

65. Exercise: The Best Medicine
Benefits:
↓ total and abdominal fat
improves insulin sensitivity
improves glucose tolerance
increases HDL cholesterol
↓ triglycerides and LDL
increases muscle mass
improves endurance
improves strength
improves bone density
improves mood

66. EXERCISE FOR BEST RESULTS

67. Aerobic
(Cardiovascular)
Exercise
Start with a brisk walk every day if tired
Concentrate in low impact or no impact
exercises (e.g. Elliptical Trainers)
Do what you enjoy (bicycling, roller
skating, etc)
Good for burning fat, triglycerides, blood
sugar, but it may decrease muscle mass
20 - 30 minutes 3-4 times a week is
enough for many people

68. Resistance Exercise
Exercise using weighs, machines, your own
body
Warm up by doing a light set
Lift maximum weight for muscular failure
(exhaustion) at 8-12 repetitions
One body part per week
One hour sessions 3-4 times a week
Three sets per body part
If no access to a gym, start with crunches,
push ups, and squats at home

69. Resistance Exercise Principles
Safety First - Stop if if hurts!
High Intensity - Momentary muscular
failure to stimulate growth
Recovery = Rest, nutrition, and time
2 - 3 warmup, 2- 3 heavy sets per
exercise
45 to 60 minutes per session, 3 - 4
sessions per week.
DO NOT
OVERTRAIN!

70. Resistance Exercise Principles
(continued)
Major muscle group first when energy is
highest
Do compound exercises first while
energy is up. They affect the most
tissue/mass for quickest growth
(squats, bench press)
Secondary/ancillary muscles follow
Important: Full range of motion -
recruits/builds the most muscle mass

71. Resistance Exercise Principles
(continued)
Warm up sets: 50 - 60 % of the
heavy weight you can lift 6-12
times
Heavier sets: Weight you are
capable of lifting 6 - 12 times to
momentary muscular failure
When strength increases so you
can do 12 reps, increase weight 5
– 10 lbs so you can only lift about
6-8 reps to momentary muscular

72. Best Exercise Sites
with videos, etc
www.exrx.net
www.MyFit.ca
Ipod exercise routine downloads:
http://www.menshealth.com/download/

73. Final Words
There are several life style modifications in your control
to stay healthy and in shape as you age to prevent
lean body mass and bone loss, sexual dysfunction, and
heart disease.
You do not have to accept sexual dysfunction as a
reality of aging. There are several treatment options!
Find out your free testosterone and thyroid function if
you have fatigue, sexual dysfunction, etc. Supplement
if needed. Readjust the dose if you do not achieve
optimum levels.

74. Final Words
Do not waste your money and risk liver or medication
interaction problems with unproven supplements. Support
the New York buyers’ club.
Combat loss of lean mass and increased fat with
resistance and cardiovascular exercise 3 to 4 times a week
for an hour
Diet: Avoid sweets, hydrogenated oils, high fructose corn
syrup, animal fats and consume more fruits, vegetables,
fish, lean meats, yogurt and nuts.
An informed man helps his doctor to give him the best care

75. For More Information
More details in ”Testosterone- A Man’s Guide” on
www.amazon.com
Nelson Vergel – nelsonvergel@yahoo.com
TestosteroneWisdom.com