Acupressure Points
Note: Some illustrations show acupressure points on one side of the body only.
Acupressure points of the abdomen and chest.
Acupressure point at the bottom of the foot.
Acupressure points of the inner leg.
Acupressure points of the lower leg and foot.
Acupressure points of the outer arm and hand.
Acupressure points of the inner arm.
APPENDIX B
How Do You Find a Doctor Who’s
Trained in Natural Medicine?
Your choice of personal physician is one of your most important and potentially game-changing lifestyle decisions, but if you’re looking for a doctor who offers natural medicine, you may be perplexed by your options. The popularity of natural health care has given rise to many “integrated” clinics that offer combinations of conventional pharmaceutical medicine and natural alternatives. Some may provide useful services, but unfortunately not all are what they seem.
The key question is no longer how you can find a doctor who offers natural therapies, but one who was actually trained in them. Anyone with a license to practice medicine can offer natural therapies, without ever having taken a single college course in them. Buyer beware: no government agency regulates such offers or protects you from misleading claims about natural health.
To be savvy about this, you need to understand the important distinction between licensed naturopathic physicians and conventional doctors. It’s all about the education: naturopathic medical students study the same basic sciences as conventional medical students, but their education diverges sharply when it comes to the study of therapeutics—methods of treating all types of conditions—reflecting vastly different philosophies of health and disease. While conventional medical students learn to use mainly pharmaceutical drugs and surgery, their naturopathic counterparts study a wide range of natural alternatives that include nutritional science, herbal and botanical medicine, hydrotherapy, massage therapy, counseling, and other therapies.
You might think conventional medical schools have become open to alternative medicine in recent years, but research shows the curricula of most have changed surprisingly little; the focus is still on pharmaceutical treatments, with few if any requirements in alternative medicine. (If alternative courses are offered, they may be only electives.) As a result, no matter how well-intentioned conventional doctors may be, they aren’t adequately trained to provide natural therapies. As Mark Hyman, M.D., concedes, “I, like almost every other doctor in the country, was trained to be a clinical pharmacologist. … I was trained to dispense medication.”
Naturopathic schools continue to stand alone as the only medical programs requiring enormous amounts of coursework—more than 700 hours—in therapeutic nutrition and naturopathic therapeutics. Considered among the most demanding of any type of medical training in the United States, they blend rigorous study of natural therapies with much of the best that Western medical science has to offer. This makes naturopathic physicians—by definition, the only doctors whose training is truly “integrated”—uniquely qualified to offer you the full range of alternative therapies, backed by a solid foundation in the sciences.
In the United States, the only way to be sure your doctor had this kind of extensive natural-health training is to find a licensed naturopathic physician. It’s important to verify that your doctor graduated from one of the naturopathic schools listed below, since they’re accredited by the Council on Naturopathic Medical Education—the gold standard when it comes to naturopathic training, recognized by the U.S. Secretary of Education as the national accrediting agency for programs leading to the doctor of naturopathy (ND) degree. (In some states, which don’t yet license naturopathic physicians, anyone can claim to be a “naturopath” without legitimate training.)
—To find a licensed naturopathic physician in your area: Contact the American Association of Naturopathic Physicians (www.naturopathic.org). If you are in North America, make sure your naturopathic doctor graduated from one of these schools:
—To find a qualified acupuncturist or practitioner of Chinese herbal medicine: Contact the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org), or check your state’s acupuncture board.
APPENDIX C
Resources
Note: Many of the products listed below, as well as some other products mentioned in this book, are available at: www.SteelsmithVitamins.com. Page numbers listed for NCWH refer to our previous book, Natural Choices for Women’s Health (Three Rivers Press, 2005).
—Antioxidant formula: Steelsmith Antioxidant Formula.
—Black-cohosh and wild-yam suppositories: Cimicifuga-Dioscorea and Vitamin E Vaginal Suppositories by Earth’s Botanical Harvest (available through natural-health-care practitioners who carry them).
—Bone formula: Steelsmith Bone Formula.
—Chinese herbal wash: Yin-care by Yao Company (www.yincare.com).
—Chlorella: BioImmersion, Inc. (www.bioimmersion.com), or Chlorella by Sun Chlorella (www.sunchlorellausa.com). Chlorella is also available from other companies at many health-food stores.
—Eating an alkaline-forming diet: in NCWH.
—Flax and Fish Oils: Barlean’s (www.barleans.com) carries both flax and fish oils, and oil blends specifically for women and men.
—Friendly bacteria (for dietary cleansing): Theralac by the company of the same name (www.theralac.com; also available at some health-food stores).
—Friendly bacteria vaginal suppositories: Earth’s Botanical Harvest Acidophilus Vaginal Suppositories by Earth’s Botanical Harvest (available through natural health-care practitioners who carry them), or Gy-na-tren, over-the-counter vaginal acidophilus suppositories by Natren (www.natrenpro.com).
—Herbal aphrodisiacs: Hot Plants for Her and Hot Plants for Him by Enzymatic Therapy (www.enzymatictherapy.com), or Women’s Libido and Male Libido by Gaia Herbs (www.gaiaherbs.com). These herbal aphrodisiacs are also available at some health-food stores. Libido Booster for Her and Libido Booster for Him are available through Pacific Herbs (www.pacherbs.com).
—Laboratory testing: Genova Diagnostics (www.gdx.net) and Meridian Valley Lab (www.MeridianValleyLab.com) for comprehensive hormone tests.
—Liver lipotropic formula: Lipotropic Complex by Integrative Therapeutics (www.integrativeinc.com), or Vita Lipotropic by Eclectic Institute (www.eclecticherb.com). Vita Lipotropic is also available at some health-food stores.
—Making castor oil packs: Pages 319–320 in NCWH.
—Multivitamin: Steelsmith Multi-Vitamin.
—Other herbal products:
—Pelvic self-massage: Ending Female Pain, Isa Herrera (BookSurge Publishing, 2009).
—Rice-based protein powder: ClearVite by Apex Energetics (www.apexenergetics.com).
—Treating UTIs naturally: in NCWH.
—Vaginal douche powder: Tanafem by Intensive Nutrition (www.intensivenutrition.com).
—Vitamin E vaginal suppositories: Vitamin E Vaginal Suppositories by Earth’s Botanical Harvest (available through natural-health-care practitioners who carry them).
APPENDIX D
Outline of Meals and Supplements
During Your 21-Day Dietary Cleanse
(for Your Great Sex Detox)
The following is a day-by-day outline of the meal and supplement portions of your three-week cleanse in Chapter 2. (Some supplements recommended can be found in Appendix C; others, as described in Chapter 2, are available at health-food stores.)
As you can see, your daily protocols change over the course of the 21 days, most notably in the number of magic smoothies you’ll have daily. Depending on personal preference, you can vary your meal menus, snacks, and the way you take your flax oil, but it’s essential to follow these guidelines regarding the number of magic smoothies you have each day and the particulars of your supplement routine.
—Days 1-3. Breakfast: One magic smoothie, and two lipotropic-formula pills, two chlorella pills, one capsule of antioxidant formula, two multivitamin tablets, and one antibug herbal pill.
Midmorning snack: Rice cake with almond butter.
Lunch: A large multicolored salad with skinless chicken breast or salmon, brown rice or quinoa, and a side of steamed vegetables like broccoli or kale. Add one tablespoon of flax oil to your salad dressing, or pour it over your steamed vegetables. Take at least one billion organisms of friendly bacteria, and one antibug herbal pill.
Midafternoon snack: Macadamia nuts and walnuts (a maximum of five of each).
Dinner: Vegetable bean soup with steamed vegetables, or brown rice or quinoa with fish and vegetables. Take two lipotropic formula pills, two chlorella pills, one capsule of antioxidant formula, two multivitamin tablets, and one antibug herbal pill. All of your dinners, throughout your 21-day plan, should be light, and eaten early enough that you won’t be too full when you go to bed.
—Days 4–7. Breakfast: One magic smoothie, and repeat all of the supplements you took with breakfast on days 1 through 3.
Midmorning snack: An apple with almond butter.
Lunch: Salad or steamed vegetables with chicken or beans, or brown rice or lentils topped with nuts and seeds. Add one tablespoon of flax oil to your meal, and take at least one billion organisms of friendly bacteria and one antibug herbal pill.
Midafternoon snack: Coconut yogurt (dairy-and soy-free), or a handful of walnuts or sunflower seeds.
Dinner: One magic smoothie and two lipotropic-formula pills, two chlorella pills, one capsule of antioxidant formula, two multivitamin tablets, and one antibug herbal pill. If you’re still hungry, have a salad or steamed greens with chicken or salmon.
—Days 8–15. Breakfast: One magic smoothie, and repeat all of the supplements you took with breakfast on days 1 through 3.
Midmorning snack: Rice cake with almond butter or avocado.
Lunch: One magic smoothie, and one tablespoon of flax oil (either in your smoothie or in capsule form), at least one billion organisms of friendly bacteria, and one antibug herbal pill. If you still feel hungry, have a small salad topped with chicken or turkey; however, it’s best to have only magic smoothies for lunch, and as little solid food as possible, during days 8 through 15.
Midafternoon snack: Walnuts and seeds.
Dinner: One magic smoothie, and repeat all the supplements you took with dinner on days 4 through 7. If you’re still hungry, have a small salad with chicken or salmon; but again, it’s preferable to have only magic smoothies for dinner, with as little solid food as possible, during days 8 through 15.
—Days 16–18. For these three days, repeat the protocol you followed during days 4 through 7.
—Days 19–21. Repeat the protocol you followed for days 1 through 3.
APPENDIX E
Testing Your Hormones
To test your hormones, you can request that your doctor order laboratory tests. If the chart in the “Evaluating Your Hormones” section of Chapter 4 indicates that you have hormone imbalances, testing can give both you and your doctor direction on how to create optimal hormonal health. The following tests give you the most valuable information about your hormone levels:
—Comprehensive hormone testing. Sometimes referred to as a comprehensive hormone profile, comprehensive hormone testing is the ultimate way of assessing your levels of estrogen, progesterone, DHEA, testosterone, and cortisol. (The test measures your thyroid hormone, too, but if it shows that your thyroid-hormone level is abnormal, you’ll want to follow up with the thyroid-hormone test described below.) If you’re in your menstruating years, this test should be done on day 21 of your menstrual cycle to provide adequate information about your progesterone level.
The most reliable types of comprehensive hormone testing are saliva tests and 24-hour urine collection tests. These aren’t generally considered “standard” hormone tests, so you may need to find a licensed naturopathic physician (see Appendix B) or other qualified holistic doctor to order them for you. Some laboratories provide saliva tests that give you information on your hormones over your entire menstrual cycle, rather than a single day only. This can be especially useful if your cycles are irregular.
Saliva and 24-hour urine tests are dependable because they measure the levels of unbound (“free”) hormones in your saliva, or the levels of hormones in your urine—the best way to get a clear reading of your hormone levels. Blood tests are also available for comprehensive hormone testing, but less accurate because the hormones in your blood are bound to proteins (which means these tests don’t show you how much free hormone is actually in circulation).
—Individual-hormone saliva testing. Any of the six hormones explored in Chapter 4 can be tested separately with an individual-hormone saliva test. If you want accurate information on your level of a particular hormone, and you don’t need the comprehensive profile, this may be your best bet. As with comprehensive hormone testing, you can use this method to gauge your thyroid-hormone level, but if it shows abnormal results, you’ll want to assess further with the thyroid-hormone test below.
In the case of saliva testing for cortisol, you need to repeat the test four times over the course of a day—for example, at 6 A.M., noon, 6 P.M., and midnight. One saliva test that measures cortisol, known as an Adrenal Stress Index, also measures your progesterone and DHEA.
—Testing your estrogen metabolism. All estrogen in your body—whether produced by your own body or taken as supplemental estrogen—is converted by your liver into either “friendly” or “unfriendly” forms. It’s important to know how well you’re converting estrogen: friendly forms decrease your risk of estrogen-related conditions like breast cancer, breast cysts, heavy periods, and premenstrual syndrome, but high levels of unfriendly forms are linked with increased risks of estrogen-related cancers. To assess how much estrogen you have and to measure your levels of friendly and unfriendly estrogen, I recommend a 24-hour urine collection test known as an estrogen metabolism test. This is essential if you’re taking synthetic or natural hormones, and invaluable if you’re a menstruating woman concerned about your hormone balance.
As you can see from the diagram below, the two predominant estrogens in your body, estradiol and estrone, can convert into one another, and into various other forms. Estrone is less friendly than estradiol because it has the potential to convert into two unfriendly hormones. The estrogen metabolism test monitors your levels of the friendly and unfriendly estrogens, as shown in this diagram.
Conversion of estrogens in your body into “friendly” and “unfriendly” forms.
If your estrogen metabolism test reveals that you’re converting too much estrogen into an unfriendly form, you can take many steps to support healthier estrogen metabolism. See Chapter 4 for tools and tips, including nutritional supplements and dietary changes, for promoting your friendly estrogen production.
—Testing your thyroid hormone. Standard laboratory blood tests can evaluate your thyroid-hormone status; in this case, blood testing is more accurate than saliva or urine testing. As Chapter 4 points out, you have more than one thyroid hormone, and your TSH (thyroid stimulating hormone) is typically tested to determine your thyroid-hormone level. If this test shows your TSH level is high, you’re diagnosed with low thyroid hormone; if it shows your TSH level is low, you’re diagnosed with excessive thyroid hormone.
Other tests that measure different forms of your thyroid hormone, including T4, T3 (your active thyroid hormone), and Reverse T3, can give you a more complete picture of your overall thyroid-hormone level. The most helpful tests, in addition to the TSH test, are referred to as the Free T4 test, the Free T3 test, the Reverse T3 test, and the T3 Total test. It’s a good idea to have all of these done, as well as two other tests to measure your thyroid antibodies—an antimicrosomal antibody test, and an antithyroglobulin antibody test. The combined results of all these tests can tell you a lot about what’s going on with your thyroid hormones, and the antibody tests can also detect whether you have an autoimmune condition called Hashimoto’s thyroiditis, which can cause serious problems for your thyroid gland, resulting in low thyroid hormone.
Another tool that may be helpful in assessing your thyroid-hormone status is known as a basal body temperature test. You can easily do this test at home by taking your temperature before you get out of bed in the morning with a basal thermometer (available at many drugstores). If you’re in your menstruating years, take your temperature on the second, third, and fourth mornings of your cycle; if you’re menopausal, take it on ten consecutive mornings any time of month. If your basal body temperature is consistently below 97.8 degrees Fahrenheit, you may have low thyroid-gland function or a low level of thyroid hormone in circulation.
As explained in Chapter 4, if laboratory testing shows normal results but you have persistent symptoms of low thyroid hormone, a licensed naturopathic physician can offer a more thorough assessment and help clear up whether or not you have the condition known as subclinically low thyroid hormone.
The saliva and urine tests listed above, which may run from $100 to $350, typically aren’t covered by insurance, but blood tests commonly are. For laboratories that provide hormone testing, see Appendix C.
APPENDIX F
How to Use Bioidentical Hormones
As you discovered in Chapter 4, transdermal (through the skin) application of bioidentical hormones is more effective, healthier, and safer than taking them orally in pill form because it allows hormones to be absorbed immediately into your bloodstream. If you take hormones as transdermal oils or creams, they bypass your liver, circulate through your body, and go directly to your target tissue—before they’re transported to your liver to be broken down. Thus, you need to take only the amount you actually require. Since hormones in pill form have to be taken at much higher doses in order to achieve the same effects, transdermal oils or creams result in far less hormone in your body. It’s always best to use the lowest possible dose of any hormone to achieve your desired therapeutic goal.
In the case of progesterone, in addition to the transdermal oil or cream, and the oral pills known as oral micronized progesterone (such as Prometrium), there’s a third form—a sublingual pill, sometimes referred to as a troche, which is absorbed under your tongue. The sublingual pill is generally preferable to the oral one, but transdermal applications are still your best bet. Every woman is unique, however, and it’s sometimes wisest to stick with whatever method works for you.
An extra advantage of transdermal application is that this method allows you to have your hormones blended by a compounding pharmacy into a “cocktail” to suit your specific needs. Or they can be prepared individually, making it convenient to take them separately and adjust your dose of a given hormone at any time.
Where on your body should you apply your hormones? In the form of transdermal oils or creams, they can be applied to any thin-skinned area of your body, such as your inner arm or thigh—but even on those areas, the hormones have to pass through relatively thick dermis before being absorbed into your bloodstream. For much better absorption, you can apply them directly to the mucous membranes of your vulva or vagina; place the recommended amount on your fingertip, and gently massage it into your vulvar or vaginal tissues.
Choosing the best “base” for your transdermal hormone application is also important. Natural bioidentical hormones that you apply transdermally can be put into a variety of oil or cream bases by compounding pharmacies; when your physician orders your prescriptions, you can request certain bases. Knowing what to choose can have consequences for your health, especially if you apply hormones frequently to your delicate vulvar and vaginal tissues. Let’s look at some commonly used bases, beginning with your best options:
—Oil bases. Two of the safest and most popular bases for transdermal hormone applications are olive oil and jojoba oil. You can conveniently apply a few drops of the mixture to your vulva or vagina each day. These bases usually contain minimal unwanted chemicals or other ingredients, and are well tolerated by most women. Other options for oil bases include grape-seed oil and emu oil (derived from the fat of the Australian emu bird).
—NataCream. Another good choice, this cream base—all the components of which are of vegetable origin—is free of ingredients that may be found in other products, such as solvents, chemical impurities, dioxine, and ethylene oxide. NataCream is available from Key Compounding Pharmacy in Kent, Washington.
—PLO gel. This cream base is frequently used for transdermal hormone applications, is readily absorbed, has a low risk of tissue irritation, and works well for many women. It contains soya lecithin, isopropyl palmitate, sorbic acid, and poloxamer 407. The first two of these ingredients are fairly benign, but the Environmental Working Group (EWG) lists the last two as moderate hazards (although they’re not found in high amounts in PLO gel).
When choosing the bases for your transdermal hormone applications, you should avoid certain types commonly used by compounding pharmacies, as they contain compounds that could compromise your health. Since healthy oil and cream bases are readily available, it’s easy to steer clear of those with questionable ingredients. The following bases are not recommended for your hormone applications:
—Velvachol. You should avoid Velvachol because of its high content of parabens—chemical preservatives and known environmental toxins that mimic estrogen (which means they could potentially increase your cancer risk) and can accumulate in the fatty layer of your skin. A study reported in 2004 in the Journal of Applied Toxicology found increased concentration of parabens in breast tumors, and subsequent research confirms that parabens are not only estrogen-mimickers but can also interfere with your hormone levels. You should also steer clear of Velvachol because it contains petrolatum, a petroleum-based ingredient; it’s best to avoid using petroleum products on your body.
—MBK fatty acid. MBK fatty acid isn’t recommended, because it contains PEG-8 distearate and hydrogenated vegetable oil. The EWG rates PEG-8 distearate as a moderate hazard with possible links to toxicity, and hydrogenated oils are chemically synthesized trans-fatty acids that shouldn’t be ingested or used on your body.
—Vanpen. Vanpen should be avoided because it contains the chemical butylated hydroxytoluene, also known as BHT. According to the EWG, BHT is a moderate hazard linked with toxicity and endocrine-system disruption; other sources indicate that it’s toxic to the immune system and human skin, may have nerve toxic effects, and may contribute to the development of cancer cells. Animal studies have found that it can increase the risk of cancerous tumors.
APPENDIX G
Safe Sex, Naturally
The number of sexually transmitted infections (STIs) is greater than many people realize. In addition to HIV and herpes, they include human papilloma virus, chlamydia, hepatitis B, hepatitis C, trichomoniasis, gonorrhea, and syphilis. Some can be treated with natural techniques, others require pharmaceutical drugs, and some have no cure. Most can cause serious health consequences with wide-ranging symptoms.
STIs appear to be on the rise with the increased use of drugs like Viagra. Since Viagra became available in 1998, studies show sharply increased STI rates among the post-midlife population (the drug’s most frequent users). A 2008 British study reported that the rate had more than doubled between 1996 and 2003 among people 45 or older—a significantly higher increase than in those under 45. Another study conducted in 2000 in Washington State found that the rate of gonorrhea had risen more than 18 percent among those middle-aged and older, again a higher increase than among younger people. Although these studies weren’t focused specifically on Viagra, and researchers attribute the findings in part to other factors, much speculation remains about the extent to which the problem is compounded by the popularity of Viagra and similar drugs.
The safest way to avoid STIs is to be in a committed monogamous relationship—defined as one in which neither you nor your partner has any sexual activity outside the relationship. This means your exchange of bodily fluids is “private”; in a sense, you share an intimate mucous-membrane barrier that protects both of your immune systems by excluding certain aspects of the environment outside of your relationship. As long as this barrier remains in place, it’s extremely unlikely that any STI will get through.
If you’re in a new relationship, communication and trust are essential. You need to know as much as possible about your new partner’s sexual history before having sex. But since unknowns are inherent in new relationships—even with the best efforts to communicate, you may not have ultimate certainty about your partner’s sexual history—the following steps are recommended for safe sex:
—Educate yourself. Be aware of how HIV, herpes, and other STIs are transmitted. For example, learn what herpes outbreaks look like; you or your partner may have herpes without knowing it. Get tested for HIV, and request that your partner be tested, too.
—Examine your bodies. Carefully inspect yourself and your partner for cuts, blisters, sores, or other breaks in the skin anywhere on your bodies—especially in or around your mouths, hands, and genitals—which can present opportunities for STI transmission. If either of you has openings in your skin on these areas, refrain from sex until they’re healed.
—Use condoms. Avoid lubricating the penis before putting on a condom, which can cause it to slip off during sex. Make sure condoms stay in place during sex by feeling the “ridge” at the base of the penis with your hand. Withdraw your partner’s penis from your vagina soon after sex—a time that condoms are apt to come off—with one of you holding the condom’s base in place.
—Use lubrication and avoid chafing. Lubrication prevents vaginal or penile abrasions that can lead to infections. Use water-based lubrication with latex condoms; oil-based lubrication can dissolve latex. Whether you use condoms or not, avoid anything that might cause chafing, such as excessive thrusting when your vagina feels dry.
APPENDIX H
Natural vs. Synthetic Birth Control
Some people might wonder what natural sex has to do with birth control. Wouldn’t it be natural to simply let nature run its course? The answer is both yes and no. Pregnancy is a natural consequence of sex without birth control, but it’s also a natural impulse, exercised by people throughout the ages, to control whether pregnancy happens. Depending on your personal philosophy, you may feel preventing birth is as natural as promoting it.
If you use birth control, the method you choose can be important for your overall health. As with everything else, you want your birth-control method to compromise your well-being as little as possible. Although birth-control pills have become commonly used, they interfere with your natural hormonal balance by using synthetic hormones to prevent you from ovulating. As explored in Chapter 4, your hormonal balance is crucial to your health and sexuality. Birth-control pills also put you at risk for side effects that include irregular menstrual bleeding, depression, headaches, dizziness, breast tenderness, weight gain, and other symptoms.
There are various methods of using synthetic hormones to prevent pregnancy, but don’t be fooled by the fact that they may not be referred to as “the Pill.” All rely on more or less the same approach of meddling with your natural hormone levels, and can have similar symptoms. They include hormone patches like Ortho Evra, estrogen and progestin injections like Lunelle, and progestin injections like Depo-Provera.
Natural birth-control methods may seem less convenient than synthetic hormones in the short run, but they’re likely to be much better for your health in the long run. And a combination of two or three natural methods can be highly effective in preventing pregnancy. Let’s look at some pros and cons of common natural methods, including some that may be considered seminatural because they involve spermicide (also included are some nonnatural methods that provide alternatives to synthetic hormones):
—Periodic abstinence. With periodic abstinence, you simply refrain from having sex when you’re most likely to conceive. You can use a basal thermometer or other methods to gauge your monthly time of peak fertility. (For more information, see Taking Charge of Your Fertility, by Toni Weschler.) Periodic abstinence allows for unrestricted sex any time of the month except around your ovulation, but if used by itself, it’s not one of the more dependable ways of preventing pregnancy.
—Condoms. The pros of condoms include their ability to help protect you against STIs. The cons include decreased sensation for you and your partner and possible allergic reactions to latex. Female condoms are available, although they’re less effective for birth control than male condoms.
—Cervical cap. You can insert a cervical cap up to two hours before sex; to be effective, it has to be used with spermicide.
—Diaphragm. As with a cervical cap, a diaphragm can be inserted up to two hours before sex, and works effectively when combined with spermicide. If not fitted properly, diaphragms may increase your likelihood of urinary tract infections.
—Intrauterine device (IUD). Inserted by a physician and sometimes left in place for several years, an IUD can have the advantage of convenience. But for some women it may increase menstrual cramps, bleeding, and the risk of pelvic inflammatory disease. In some situations, IUDs may also result in perforation of the uterus.
—Tubal ligation and vasectomy. These methods allow for spontaneous sex without concern for birth control. If in the future you want to become pregnant, however, either method requires additional surgery, which may not be effective.
APPENDIX I
Natural Testosterone for Men:
Recommended Doses, Methods of
Administering, and Follow-up Testing
For most men, including men with ED or low libido due to low testosterone, the usual starting dose of natural testosterone is 50 to 75 mg daily; this can be adjusted to 100 mg daily, depending on a man’s response and test results. A man should always use the smallest amount needed to achieve the desired effects. The goal is to return to his own natural testosterone level, not to oversupply his body with testosterone or produce the controversial levels some athletes seek, using testosterone-like substances, to enhance performance. (Natural testosterone treatment shouldn’t be confused with the use of synthesized anabolic steroids, often taken by bodybuilders in doses many times the normal levels of testosterone.) Let’s examine treatment methods for using natural testosterone:
—Gels and creams. The most common method in the United States, gels and creams allow a man to apply testosterone to his scrotum or anal mucosa on a daily basis. The advantages of this method are convenience of application and good transdermal (through-the-skin) absorption for most men. In addition, a man can ask his doctor to order gels or creams through many compounding pharmacies that make them. The disadvantages of gels and creams: they may cause skin irritation in some men, and you should avoid direct skin contact with areas where your partner applies them for two hours after application (since contact might affect your own testosterone level).
—Patches. Testosterone-releasing patches are typically applied daily to a man’s scrotum, abdomen, or side. The advantages: they’re relatively convenient, and available from many compounding pharmacies. The disadvantages include poor absorption in some men, visibility of the patches on the skin, and skin irritation that many men experience. Transdermal patch products that deliver natural testosterone include Androderm and TestodermTTS.
—Pills taken orally. Pills aren’t the best way of delivering testosterone into a man’s body. When testosterone is taken in pill form, most of the hormone first passes through his liver, potentially causing liver stress and damage.
Two to three months after beginning any method of treatment, a man’s total testosterone, free testosterone, and estrogen should be retested to make sure his testosterone level is within normal range. His symptoms should also be monitored for signs of improvement. In addition, it’s recommended that he have another SHBG (sex hormone binding globulin) test, as well as a new blood test that measures dihydrotestosterone (DHT) and its breakdown products, called a testosterone metabolites profile. (This test, which also measures how well a man is breaking down testosterone, can be valuable in preventing potential problems associated with taking testosterone. It’s available through Meridian Valley Lab; see Appendix C.)
In some cases, men who discontinue treatment find that their testosterone levels remain normal without additional treatment—in other words, they don’t return to their pretreatment lows—as if temporary treatment was all they needed to jump-start their natural testosterone-producing ability. The reason for this isn’t well understood, but it’s worth noting that a man may not need to continue testosterone treatment indefinitely. He may want to suspend it occasionally, to see if his symptoms are resolved.
APPENDIX J
Are You at Greater Risk for HIV and Other
STIs If Your Partner Is Circumcised?
As Chapter 7 indicates, statistics suggest that you’re less susceptible to sexually transmitted infections, including HIV, if your partner is intact. The United States has the highest medicalized circumcision rate in the industrial world—and one of the highest HIV transmission rates. In Europe, where the vast majority of men are intact, the HIV infection rate is far below that of the United States. Researchers point out that the foreskin’s natural lubrication and mobility reduce vaginal and penile dryness, chafing, and abrasion during sex, decreasing chances of infections for both partners. According to Intact America, circumcised men may be 50 percent more likely to infect their partners than men who are intact.
Circumcision certainly doesn’t prevent the spread of HIV and other STIs; both circumcised and intact men can contract and transmit them. The proven, effective prevention methods are safe sex (see Appendix G), abstinence, and education programs about risky behaviors. Even in recent years, the media has echoed erroneous claims that circumcision prevents HIV—a notion that may increase HIV risk by creating a false sense of security among circumcised men (already less apt to use condoms due to reduced penile sensation) and undermining safe-sex practices.
APPENDIX K
How Foreskin Restoration Works
Most foreskin-restoration methods involve devices worn on a man’s penis, allowing its skin and tissue to be pulled downward over the glans with moderate, steady tension. Some devices, attached with tape or “tapeless” methods, use weights or elastic straps; others use “dual tension” traction devices requiring neither weights nor straps. (A cottage industry has developed to meet the growing demand, with manufacturers becoming increasingly inventive.) If a device is worn daily for a long enough time, the skin and tissue gradually stretch, eventually covering the glans.
Foreskin restoration relies on skin- and tissue-expansion principles often used by plastic surgeons. It works because gradual stretching stimulates mitosis (cell division or reproduction); the total number of cells increases, resulting in new skin and tissue. Done properly, any technique should be gentle, and not cause pain. The key is patience and long-term commitment, but the time needed varies from one man to the next. You may hear claims that some men achieve a foreskin within months, but for most it’s a matter of years before they’re satisfied with the results.
What often does happen within the first few months is that a man notices distinct changes in the sensitivity of his glans as it sheds its layer of keratinized cells—the early effects of its being consistently covered by skin and tissue, after all the years of unnatural exposure to clothing. This surge of new sensation can be powerful confirmation that he’s on the right track and an encouraging preview of what’s in store if he follows through with his restoration.
Foreskin restoration has centuries-old roots, but the modern movement can be traced to the early 1980s, when it began catching on in the United States. Jim Bigelow’s groundbreaking 1992 book The Joy of Uncircumcising! sold 18,000 copies in its first printing—it can be conservatively estimated that upwards of 50,000 men have practiced restoration—and a newer edition of Bigelow’s book, which remains the classic on the subject, is available.
Two important caveats need to be added about foreskin restoration. First, doctors aren’t trained in restoration, and may discourage it, since many are pro-circumcision. (Doctors often present expectant mothers, for example, with circumcision’s supposed “benefits” while failing to accurately disclose its risks and consequences.) Foreskin restoration is self-help and requires a willingness to act autonomously. Second, although it can result in a penis that looks surprisingly like it has a natural foreskin, restoration won’t replace all that’s lost to circumcision. The thousands of specialized nerve endings that were removed, for instance, won’t grow back after restoration. (Nevertheless, some sensitivity can be regained; as Chapter 7 points out, men who practice restoration report increased capacity for sexual pleasure—as well as strongly positive emotional reactions.)
You can learn more about foreskin restoration from the National Organization of Restoring Men (www.norm.org).
APPENDIX L
Recommended Reading:
Great Texts for Great Sex
Cass, Vivienne. The Elusive Orgasm. Emeryville, CA: Marlowe & Company, 2007.
Herrera, Isa. Ending Female Pain. Charleston, SC: BookSurge Publishing, 2009.
Komisaruk, Barry, Carlos Beyer-Flores, and Beverly Whipple. The Science of Orgasm. Baltimore, MD: Johns Hopkins University Press, 2006.
Northrup, Christiane. The Secret Pleasures of Menopause. Carlsbad, CA: Hay House, Inc. 2008.
Steelsmith, Laurie, and Alex Steelsmith. Natural Choices for Women’s Health. New York: Three Rivers Press, 2005.
