Virility ranks at the top of most men's
lists of prized possessions -- and maintaining normal testosterone levels is essential to protecting it. Age and bad luck may put you at a disadvantage, but what you put in your body can also affect how it performs.

Testosterone Levels Naturally Wane With Age
"After age 35, men lose 1 percent to 2 percent of testosterone levels per year," said Dr. Lyle Lundblad, president of Midwest Institute of Urology in Minneapolis.
Some 4 million men have low testosterone levels, but only an estimated 200,000 receive treatment.
Symptoms of low testosterone include fatigue, depression, osteoporosis, muscle deterioration, decreased libido
and erectile dysfunction. "By the time they get to my office they have sweated the decision for months. For most men, libido problems aren't easy to talk about," Lundblad said.
Once other risk factors, such as smoking, stress, and alcohol or drug use, are ruled out, Lundblad said most older men with low testosterone require testosterone replacement therapy. Testosterone replacement treatments
come in injection, patch and gel forms,and must be prescribed by a doctor.
Supplement Use Affectts Testosterone Production
It's not just old age creeping up on you
that can affect testosterone levels.
Supplements men use to bulk up can also have consequences in the bedroom. "Body-building supplements can sometimes have an influence on how testosterone is produced in the body," Lundblad said.
For example, supplements containing creatine and androdione sometimes suppress testosterone production. "These supplements cause a shift in fluid retention so their muscles bulk up. Some [men] develop erectile dysfunctions, but that depends on how long and how much they have been taking," Lundblad said.
Over the last 10 years, Lundblad said there has been an increase in early male menopause and low sperm count. "We know a lot of foods have excessive estrogen," he said. "That causes low sperm count [and] problems with virility, libido and the general feeling of wanting to be involved sexually."
A minority of men -- estimated at 10 percent to 15 percent -- suffers from psychological problems that can lower sperm count and reduce the size of erections, Lundblad said.
"We also do nighttime sleep studies that help us evaluate if a problem is organic or psychological," he said. "Normal guys have five to seven erections per night. Anything less than that, we start to explore counseling as one treatment."
Other evaluations include checking for high cholesterol, which can interfere with blood flow to the penis, and assessing thyroid glands to determine if diabetes is present.
"Only once we have assessed all possibilities can we prescribe effective treatments," he said.
Are Herbal Remedies an Answer?
Some medical doctors and herbalists regularly recommend herbs and other botanical or homeopathic medicines.
In a study published in the New England Journal of Medicine, the herb yohimbe was found to increase libido and the frequency of ejaculation. Yohimbe is thought effective for some types of impotence, especially of vascular, diabetic or psychogenic origins. It also can improve the quality and staying power of erections, usually without increasing sexual excitement. Yohimbe has side effects that can lead to dizziness, nervousness and anxiety.
Lundblad has found that the herb saw palmetto can help some of his patients.
"I prescribe saw palmetto for enlarged prostate, but we are seeing that can
have some effect on testosterone levels in the body," he said. It also helps to
enhance the actions of other herbs. Saw palmetto helps maintain the prostate for proper hormone balance, which is needed for sexual function, especially in older men.

Horsetail is especially useful if impotence is due to prostatic enlargement or improper nutrition of the genitourinary tract. An optimally functioning prostate gland not only produces and delivers semen, but is also part of the biochemical and mechanical processes involved in achieving an erection, explain Frankie Avalon Wolfe, Ph.D., and Louise Tenney, M.H., in "The Complete Idiot's Guide to Herbal Remedies." In addition, horsetail is high in selenium -- a nutrient some older men lack.
For men with low testosterone levels, Korean and Siberian ginseng may be able to enhance virility and is thought to be a remedy for infertility. Helpful herbs include ginger, prickly ash bark, chickweed, sarsaparilla, garlic, turmeric and pumpkin seeds, according to Wolfe and Tenney.

For a more natural remedy, look at your diet. Diets high in vitamins, minerals and antioxidants from fresh fruits and vegetables help maintain vascular integrity and sufficient blood flow to maintain normal erections. Vitamins C and E with selenium, niacin, zinc and essential fatty acids can aid in the production of sperm and seminal fluid, and help the normal functions of the
prostate.

Although evidence has shown some herbs to be helpful in some cases natural remedies aren't as effective for medical problems, such as impotence, infertility or erectile dysfunction, as conventional drug therapies, medical experts say.
Some herbs, in fact, may cause infertility or genetically damage sperm. A study at Loma Linda University suggests that the side effects of such herbs as St. John's wort, echinacea and ginkgo biloba might include blocking conception and the possibility of genetic damage to sperm.

Work with your doctor to find out what treatment is right for you.