Sexual and emotional health in men.
Males (Psychological aspects)
Males (Sexual behavior)
Males (Food and nutrition)
Sex (Psychology) (Analysis)
Stein, Daniel S.
Baer, Michael A.
Bruemmer, Nancy C.
|Publication:||Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2008 American Psychotherapy Association ISSN: 1535-4075|
|Issue:||Date: Summer, 2008 Source Volume: 11 Source Issue: 2|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
A pilot study of 20 males was conducted with a sample of healthy
males selected for normal characteristics. Each was administered an
8-week trial of a supplement using natural nutrients and pro-hormones.
Success was measured along a number of scales of independent variables
to determine an overall improvement in sex life.
Despite the many advances we have made medically and technically in this century, we lag behind in our knowledge of ourselves. This is particularly true when it comes to the advancement and understanding of our own sexuality, specifically, our poor comprehension and discomfort with the topic and discussion of sexuality. Surrounded by myths, misnomers, and misunderstanding, most men are confused and bound by False knowledge of sexuality. Our shame in regard to sexuality and exploring its dysfunction is the cause of great suffering.
We have little understanding of the complexity of the brain and the enormous role it plays in sexual function. With the demise of the myth of mind/ body separation, we can appreciate how the brain and the entire body mediate sexual function. Sexual function plays throughout the entire body with both biological and lifestyle considerations. No part of the human being is untouched by the experience. Because sex is still such a difficult, embarrassing, and taboo subject for many Americans to discuss, it continues to be a source of pain for many in this nation.
Recent discoveries in the enhancement of sexual function with new products have been a big step in alleviating sexual suffering. The discovery of such products as Viagra[R], Cialis[R], and Levitra[R] have allowed a lifestyle change for many men who thought themselves doomed to spend their days in silent suffering with Erectile Dysfunction (ED). The entry of the pharmaceutical companies into the marketplace has also come with renewed research of old natural formulas that have been existent for centuries. The revisiting of these naturally occurring substances is the topic to be considered here. The new concept of combining time-honored pro-sexual nutrients with pro-hormones is reported and discussed. They are compounded together to improve and help optimize sexual functioning in men. They do not require a prescription, as they are found in nature. Sexual functioning is a fundamental part of man's identity and how he feels about himself. It further has a great deal to do with how a man deals with intimacy and closeness in his relationships. A man's sexual health (or dysfunction) has been found to be a key factor in his capacity for maintaining healthy relationships. People with good sex lives live healthier and longer lives (Aldridge-Westoff & Stein, 2002). Optimal sexual health enhances this capacity, and is thus, an increasingly important topic.
To cover this discomfort we make jokes about sex, a very uncomfortable subject for most Americans to discuss. Intimacy is the other portion of our difficulty with our sexuality. We are equally uncomfortable with our feelings of emotional closeness and therefore have difficulty in discussing feelings. To illustrate, when Viagra[R] first came out on the market, it became the topic of humor for late night television. The jokes went on for years. Yet, this vasodilator and the other products that followed it have become incredible sellers. All one has to do is find the courage to talk to a physician about the need to employ such a medication. For many men this is difficult and maybe even impossible because of the many myths of sexuality and uncomfortable feelings in their confusion about sexuality and shame. It is extremely difficult for a man to face his physician and ask for help with his sexual dysfunction. After all, we are men, and this doesn't exist in the John Wayne School of Machismo. This also helps to explain the lack of compliance with depressed men who have unfilled prescriptions for needed antidepressant medications, or worse, filled antidepressant prescriptions with depression exacerbated by iatrogenic sexual dysfunction. Antidepressant medications inhibit sexual response up to 90%, as does the original condition of depression. Men are embarrassed to discuss this side effect with their physicians. They simply cease to take the medication, and their depression persists along with sexual health.
They do not recognize that not all antidepressants cause ED. From the age of 20, when men are at their sexual peak, they begin to decline sexually. We have trouble understanding and discussing this matter due to the many myths of sexuality we mislearn in our society. Sexual function in this culture is closely tied to our self-esteem. It is not only closely tied to our view of health but to our perception of emotional closeness and intimacy. Emotional health in men is closely tied to their capacity for maintaining sexual function. All of life is about relationships, whether it is with self or others.
More then 40 million men in the United States suffer from low levels of testosterone, leading to a decline in sexual health, self-esteem, potential sexual dysfunction, and ED (Bunch, Abraham, Wang, & Meikle, 2002). Other contributing factors include general fatigue and depression (Nurnberg et al., 2002; Okulate, Olayinka, & Dogunro, 2003: Shabsign, Zakaria, Anastasiadis, & Seidman, 2001); prolonged stress; normal aging: hypertension (Burchardt et al., 2000); chronic illness (Marumo & Murai, 2001); cardiovascular disease (Tan & Pu, 2003); obesity (Chung, Sohn, & Park, 1999), which is now epidemic in this country; and chronic illness. In addition, there are common lifestyle patterns that contribute to a decline in optimal sexual function, which include cigarette smoking, lack of adequate regular physical exercise, excessive regular alcohol consumption, poor sleep, and unmanageable stress both at home and work.
The incidence of ED in one longitudinal study of men ages 40 to 69 was 25.9 per 1,000 man-years (Johannes et al., 2000). At ages 60 to 69, it increased to 46.4 cases per 1,000 man-years. Among other factors to which the authors attributed the abysmal results were poor lifestyle and lower education. Other well-designed studies have confirmed these findings (Blanket et al., 2001).
In studies conducted cross-nationally evaluating the prevalence of ED in Brazil, Italy, Japan, and Malaysia (Nicolosi et al., 2003), the authors found that the percentages of men who could not perform sexual intercourse numbered 34% in Japan, 22% in Malaysia, 17% in Italy, and 15% in Brazil. These numbers, when adjusted for age, read as 9% for men aged 40-44 years, 12% for men aged 45-49 years, 18% aged 50-54 years, 29% for men aged 55-59 years, 38% for men aged 60-64 years, and 54% for men aged 65-70 years. They found that there was an increased risk of ED associated with diabetes, heart disease, lower urinary tract symptoms, heavy smoking, and depression. However, their study also found that ED was inversely related to education and physical activity.
Other studies have looked at the relationships between ED and depression, alcohol abuse, and panic disorders (Okulate et al., 2003). They found that among men identified as having ED, 10% were depressed, 10.3% had alcohol problems, and 0.6% had panic disorders. This study found that age and depression were good predictors of ED, but not good predictors of alcohol abuse and panic disorder. Cosgrove et al. (2002) found that patients with post traumatic stress disorder (PTSD) had decreased scores on overall sexual satisfaction and orgasmic function, and they showed trends toward less satisfaction with intercourse and erectile function, although they was no statistically significant differences in sexual desire. Results indicate that the rate of erectile dysfunction was 85% in patients with PTSD and 22% in patients without the diagnosis of PTSD. This suggests that combat veterans with PTSD experience a significantly higher rate of sexual dysfunction than do veterans without PTSD. These authors and others stress the importance of educating the public about the aging process and its relationship to male reproductive and sexual health.
This strategy would be especially effective if there were a medically plausible rationale for the efficacy of nutritional supplements in the treatment of ED. Health food stores and the Internet are filled with products boasting claims of increasing sexual performance and penile size with little evidence-based science to validate these claims. The following study was created to evaluate the effectiveness of the ingredients in the supplement and the effect on sexual functioning and desire in the non-pathological sample. The formula was medically designed to enhance optimal normal male sexual function and to support optimal sexual desire and performance, erection, and pleasure. It is held that the novel combination of pro-sexual nutrients, together with prohormone supplementation in full adult dosage, may help counter the cumulative negative effects of aging, andropanse, atherosclerosis, depression, stress, and medication on healthy males, promoting intimacy. They may help prevent the medical, social, and psychological issues associated with ED.
The supplement (currently marketed as ExtenZe [TM]) is a formulation medically designed with both prohormones (the nutritional building blocks of hormones) and pro-sexual nutrients. Some of the nutrients included have been used to promote sexual health and well being for decades, and in some cases, for centuries; however, the addition of pro-hormones to promote optimal sexual health is novel.
The medical intention was to formulate a nonprescription pro-sexual herbal and male pro-hormone supplement to increase sexual desire and to enhance sexual health, penile size, and strength of erection. The authors hypothesized that in addition to promoting sexual health, increasing penile size and strength of erection, and improving sexual performance--both the added sense of well being from more satisfying sex and the increase "in testosterone effect" from the inclusion of natural prohormones DHEA and pregnenolone would have a positive effect on desire for sex. Because the market is flooded with herbal supplements claiming results that are physically and physiologically impossible to achieve, it was our intent to document authentic, experienced results on sexual intimacy from a clinical perspective. The objective was to determine if the supplement's formula improves sexual functioning as designed by physical and perceptual self-evaluations. The following looks at non-prescription supplements and pro-hormones that affect sexual health.
Pro-Hormones: DHEA and Pregnenolone
DHEA is a pro-hormonal building block for natural testosterone, and it is the most important of all human pro-hormones. Testosterone is known as the "hormone of desire" for both sexes. Pro-hormones are critical for sexual arousal, desire, and response. DHEA levels decrease linearly with age. Production peaks in the early 20s and declines 10% every 10 years. Low levels of testosterone can lead to low sex drive and a smaller sex organ. Research shows that cortisol, the stress hormone, is elevated in major depression. DHEA has been found to counteract cortisol and improve depression. The benefits of DHEA supplements in those who are deficient include improved sense of vigor and well being, increased alertness and stamina, better memory, and enhanced sexual interest and performance (Araghinikam, Chung, Nelson-White, Eskelson, & Watson, 1996; Yen, Morales, & Khorram, 1997).
Pregnenolone, another pro-hormone, is also a vital pro-hormone building block in the cascade of molecular events which lead to testosterone, estrogen, and progesterone, in its final form, pregnenolone has powerful effects on the nervous system, similar to those of neurotransmitters (Baulieu, 1991). This enhanced neurosensitivity may reveal itself in improved genital sensitivity, thus enhancing the facility for arousal, erection, and orgasm as reflected in Quantitative Genital Neurosensitivity Analysis, a quantitative penile sensation technology, and biosthesiometry. Neurosteroid levels diminish with advancing age; pregnenolone supplementation may counter this loss.
The human body either ingests pregnenolone or manufactures it from cholesterol, and then uses it to make testosterone, progesterone, estrogen, DHEA, androstenedione, androstendiol, and all other prohormones and hormones in the steroid family. One reason for using DHEA and pregnenolone prophylactically is that the level of many of these hormones declines with age. By taking pro-hormone supplements, it is thought that their related hormonal metabolic end products may be naturally boosted to more youthful levels.
Tribistol is the active ingredient in the plant that flowers by the same name, called Tribulus Terrestris. It is an herbal pro-sexual nutrient that has been demonstrated to increase the secretion of lutenizing hormone (LH).
The research suggests that LH stimulates the release of testosterone and enhances the sexual effectiveness of natural testosterone production (Adaikan, Gauthaman, Prasad, & Ng, 2000; Li et al., 1998). It has been used for centuries in Chinese medicine to treat a variety of conditions, including premature ejaculation, low libido, and male infertility.
Tongkat Ali is a tree native to the jungles of Malaysia, Thailand, and Indonesia. All is an herbal pro-sexual nutrient that has an ancient reputation as an aphrodisiac in Malaysia and Indonesia, where it is known as "Ali's staff," a reference to its effects on male sexuality. A form of it is used to increase stamina, energy, vitality, and for sexual prowess (penile firmness and strength). Tongkat All may enhance natural testosterone and cGMP production.
When optimal testosterone is achieved, sexual health and vitality are boosted. Tongkat Ali, with its widespread pro-sexual energy and healing properties, is believed to stimulate the natural defense mechanism of the body to all kinds of insults, thus increasing the body's ability to protect itself. It is a clinically proven contributor to male sex drive and sexual stamina and is widely reported to heighten the urge for sex and to prolong sexual activity before ejaculation. Of particular interest is a 1998 report on Tongkat Ali's ability to increase sexual motivation in sexually naive male rats published by the University Sans Malaysia (Ang, 1998). This study was designed to evaluate the aphrodisiac properties of Tongkat Ali. An electric grid separated sexually inexperienced male rats from estros-receptive females on the other side of the grid. One group of virgin male rats was treated with Tongkat Ali; the other was not. Tongkat Ali caused the virgin male rats to hop across the electrical grid to mount the receptive females and to ejaculate more frequently than the non-treated controls.
Eurycoma Longifolia Jack
Eurycoma Longifolia Jack is a small tree found in the jungles of Malaysia and Southeast Asia. Natives consider every part of the tree medicine, as it acts as an herbal pro-sexual nutrient. Research has shown that Eurycoma Longifolia Jack contains several photo-chemicals that support the healthy testosterone effect levels required for optimal male sexual functioning. It is also said to promote sexual health and sex drive and to increase mental alertness (Ang & Sim, 1998).
Yohimbine is the name of the bark of the tall evergreen tree in western Africa, known as pausingystalia yohimbine. Yohimbine is an herbal pro-sexual nutrient made from natural yohimbine bark. It is the most important penile circulatory ingredient in the supplement's formula. Yohimbine HCI has been approved by the FDA as a vasodilator and for medical treatment of male impotence, whether due to vascular problems, diabetes, or psychogenic causes. It is said that the natives of West Africa used yohimbine bark extract for centuries during fertility ceremonies as a means of increasing libido, enhancing penis size, and improving sexual performance. Research has also demonstrated its use in the treatment of ED (Ernst & Pittler, 1998; Morales et al., 1987; Riley, 1994; Sonda, Mazo, & Chancellor, 1990; Vogt et al., 1997). Scientific studies on yohimbine conducted since the 1930s have confirmed that the herb has definite positive effects on aspects of sexual performance and have confirmed its ability to increase blood flow to the penis, cause erectile stimulation, and to enhance penile size. "Long term usage of yohimbine can result in erections that are firmer, larger, and longer-lasting than normal, and can encourage permanent gains in penis size" ("Yohimbine," n.d.).
L-Arginine is an amino acid present in the proteins of all life forms. It is best known as a growth hormone releaser. The decrease of growth hormone in the human body with aging is a major reason muscle mass tends to decrease, body fat tends to increase, and why, in part, there is a slower rate of skin growth (Kirk et al., 1993), which results in thinner, less flexible skin. L-Arginine is included in the supplement to enhance the effect of other penile blood flow enhancing ingredients and to complement the DHEA, pregnenolone, and testosterone-promoting sexual nutrition ingredients. Several recent studies suggest a statistically significant improvement in sexual function associated with L-Arginine's clinical use (Barbal, 1986; Clarkson et al., 1996; Isidori, Lo Monaco, & Cappa, 1981).
Nitric oxide is formed from L-Arginine in the brain through an enzymic reaction similar to that in vascular endothelial cells (Knowles, Palacios, Palmer, & Moncada, 1989). Nitric oxide now also appears to be the neurotransmitter responsible for converting short-term memories into long-term memories in the brain. This is an ability that often declines with aging. Most important is its precursory role to nitric oxide in the genitals. Nitric oxide plays a very important role in sexual function. It is an epithelial-derived relaxing factor, the chemical secreted by the lining of the human blood vessel in the penis that causes the blood vessel to relax, thus facilitating engorgement and produceing extra blood flow into the penis during the process of erection (Lerman, Burnett, Higano, McKinley, & Holmes, 1998). Adequate nitric oxide also helps to ensure that this allocation of blood flow to the penis is accomplished without undue increase in blood pressure.
Zinc is an essential mineral required for the body to manufacture optimal testosterone levels in men. Men with zinc deficiency may have a problem with sexuality, and a shortage of zinc may induce a low sperm count, loss of sexual desire, and emotional problems. Lack of zinc may also cause swelling of the prostate gland, which will in turn, slow sperm traveling up from the testes. This swelling may also diminish the release of prostatic secretions and ejaculation volume.
Low concentration of zinc in the seminal plasma of infertile male subjects is considered to be one of the factors responsible for the decreased testicular function. Zinc may also be helpful in fighting prostate infection and inflammation in older men (Ali et al., 2005).
Korean ginseng is a perennial herb. The plant, with its typically light-colored, fleshy root is found in China, Korea, and Russia. Ginseng is classified as an adaptogen and is said to promote longevity, vitality, and act as an aphrodisiac and sexual tonic. Research studies have found a slight connection between sex drive and consumption of ginseng, although a direct link and the mechanism of action are still unknown (Murphy & Lee, 2002). Moreover, some tests with land animals and ginseng have shown that Korean ginseng promotes the growth of male reproductive organs, increases sperm and testosterone levels, and increases sexual activity in laboratory animals. In general, scientists believe that the link between ginseng and sex drive is due to ginseng's effect on strengthening overall health and balancing the hormonal influence ("Korean Ginseng," n.d.).
Pilot Study: Subject Selection
Twenty males were found through a newspaper ad that solicited them for the study. Inclusion criteria included male gender, age between 18 and 65, an average sexual history, and no sexual or erectile dysfunction (ED). Participants were contacted by phone for weekly evaluations of each measured variable. The study required a commitment to participate for at least 8 weeks. Subjects were to meet in person with the primary researcher at the clinic setting at week one and eight.
Exclusion criteria included severe hypertension and medically diagnosed impotence or sexual dysfunction due to a physical/medical condition. A physician reviewed both criteria requirements.
Participants were instructed to take one tablet of the supplement daily, at the same time each day in order to achieve a more controlled day-to-day level. Each subject received 60 tablets of the formula, and follow-up availability of day and time was agreed upon. To increase the likelihood of compliance with the research design requirements, a one-year supply of the supplement was offered to each participant as an incentive to complete the study.
Subjects were given a series of 13 questions to answer each week. Criterion of questions was assessed on the three domains: 1) sexual desire/sexual energy/passion, 2) sexual power/pleasure/performance, and 3) overall : sex life improvement. (Questions appear in the index). Limited to 7-day intervals, ratings were documented utilizing a Likert scale from 1 to 10. Results were obtained during weekly telephone consultations using the same 13 questions each time.
The participants in the study reported a 99% improvement in sexual performance and satisfaction after taking the supplement formula for 8 weeks. These results provide evidence to conclude that when taking the formula, it is advisable to continue taking the supplement for at least 8 weeks before the full effect can be noted. Analysis did not show us a statistically significant improvement between the first and fourth week of taking the formula, but it did show a statistically significant improvement in increased sexual pleasure and performance by the eighth week.
Penile measurements were also documented at weeks one and two and months one and two. The study showed up to 50% improvement in flaccid and erect length. During the first interview, participants were asked to purchase a measuring tape, and the method of measurement was explained in detail for the participants. A demonstration of measurement requirements and procedures was then reviewed in private with the subject. Unfortunately, inconsistency of measurement could not be controlled using this design protocol. Despite the limitations, significant penile size enhancement in both length and girth was observed respectively in 50% and 45% of participants. Using more controlled heuristic measures in future research, these factors may yield very helpful information.
Analysis of Data
The results from the three domains had staggering similarities. Statistically significant improvement was noted in all subjective categories. Criteria for significance are a probability less than a measurement of .05. A value above .01 is highly significant. The subjects taking the supplement demonstrated statistically significant improvement in overall sexual health.
In the area of sexual desire/sexual energy/passion, the questions yielded significant results. The results were at the 99% level of difference between week one and week eight employing a t-test to demonstrate weekly improvement. Sexual fantasies and sexual thoughts increased with demonstrated statistical significance in the study participants.
In the area of sexual power/pleasure/performance, six questions showed significance at the P= .05 level. The results indicate positive changes in confidence of erection, ease of arousal, satisfaction of erection, and maintenance of erection. In the area of overall sex life improvement, the statistical gains were at the P= .001 level. There was a 990,6 improvement in overall sexual performance satisfaction after taking a supplement for 8 weeks. This is highly significant.
Sexual nutrition supplementation including both prohormones and pro-sexual nutrients can positively influence and enhance subjective perception of the sexual function in normal men. The reported differences between week one and week eight are statistically significant. Based on these self-reported results, similar larger studies with control groups are warranted. The authors recommend the inclusion of the following as based on tests to help justify the study's findings: sequential hormone analysis, serial Rigiscan[TM], serial Uroan DIR501, erection strength documentation, serial genital ultrasound confirmation of measured penile blood flow (with and without stimulation) to document the supplement's effect on penile blood flow in both flaccid and erect states, and serial quantitative neurosensory analysis (Medoc-Israel) or biothesiometry (Bio-Medical Instrument Company) to objectively document the supplement's subjective effect of enhanced penile neurosensitivity. Additionally, the supplement, ExtenZe[TM], is open to more research with larger population samples and further scientific analysis.
Improving sexual nutrition can affect the lives of millions of individuals who have abandoned a healthy sexual life and the joy of intimacy for the secret life of suffering in silence and hopelessness. In abandoning a healthy sex life, one often abandons an intimate and sharing of life that once brought emotional and psychological connection. Sexual nutrition can help to establish a healthy sexual lifestyle for the millions of men who suffer in desperate silence. This supplement with its unique combination of pro-sexual nutrients and pro-hormones may be an option for those seeking sexual as well as global good health.
Earn CE Credit Take CE tests for free online at www. americanpsychotherapy.com or see the questions for this article on page 19.
1. True or false: The inability of many Americans to discuss their own sexuality comfortably, even with their physician, assists in manifesting good mental health and longevity.
2. Which of the following is not likely to cause Erectile Dysfunction (ED) in men?
a) antidepressant medication and/or depression
b) exercise and adequate nutrition
c) low testosterone and cortisol
d) prolonged stress and obesity
3. True or false: Yohimbine HCI has been approved by the Food and Drug Administration as a vasodilator.
4. Which of the following is false concerning nitric oxide?
a) It plays an important role in memory transfer in humans.
b) It plays an important role in human sexual functioning.
c) It assists the role of blood flow to the penis.
d) It causes increased blood pressure in humans during exercise.
5. True or false: Studies of the use of ginseng have found a robust and high statistical correlation between its use and increased sexual drive in humans.
6. In the pilot study conducted in the article, overall sexual improvement was found in the subjects:
a) at 33%, a non-statistically significant level
b) at 99%, equal to a significant P score of .001
c) a two-tailed ANOVA score significant at .05
d) The study was not robust and could not be measured statistically.
Interpretation of Results
Working from a baseline established prior to week one of treatment, increases over the 8-week period are significant in all areas. An illustration of this by category follows:
* Increase in weekly sexual events = 90%
* Increase in sexual desire = 85%
* Increase in sexual fantasies = 100%
* Improvement in confidence to achieve erection = 75%
* Increase in penile sensitivity (less stimulation required) = 65%
* Increase in firmness of erections = 90%
* Increase in patient satisfaction with erections = 90%
* Increase in maintaining erection to completion of intercourse = 100%
* Increase in overall pleasure = 75%
* Increase in personal sexual performance satisfaction = 85%
* Increase in satisfaction with sex life as a whole = 80%
* Increase in overall improvement including sexual activity, vigor, and performance = 100%
Erectile dysfunction may be caused by emotional or physiological issues. Common causes for each are listed below:
The most common psychological causes:
* Anxiety (work, school)
* Guilt about sex (from religion, family, culture)
* Sexual problems are often rooted in relationship problems (power, trust, intimacy)
* Feelings about partner (can influence sexual response)
* Depression affects sexual desire.
* Sexual situation: place, time, person ... are they right?
* Anxiety about performance, size, etc.
The most common physical causes:
* Vascular conditions
* Abnormal nerve function
* Hormone deficiency
* Removal of prostate gland for cancer
* Other surgical procedure
* Peyronie's disease
* Illicit drugs
* Smoking and diet, as contributing factors
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Dr. Stein was recently honored in the Tampa Bay's Best magazine as one of the best doctors of the past 30 years. A long-time OB/GYN, he refocused his medical expertise in the way of laser surgery, when he founded the Laser Surgery Institute in 1978. Most recently, Dr. Stein has been practicing the art of sound energy. He has used this knowledge to practice cutting-edge body-sculpting techniques at the Tampa-based Stein Medical Institute. Dr. Stein also founded the first integrated Women's Medical Center in the United States and the first free-standing medical practice devoted to comprehensive, physical, and psychological evaluation to optimized sexual function, the Foundation for Intimacy, both in Tampa Bay, FL.
The full article can be read in the Spring 2008 issue of Tampa Bay's Best.
Daniel S. Stein, M.D., F.A.C.O.G. is a Board Certified Gynecologist and also a founding member of American Board of Laser Surgery. He has been a Clinical Associate Professor at the University of Florida College of Medicine and is the author of the New York Times best seller, Passionate Sex: Discover the Special Power in You. Committed to helping those less fortunate, he was the founder of organized medical care for the homeless and has had local and national television shows oriented towards consumer education. Dr. Stein also founded the first integrated Women's Medical Center in the United States and the first free-standing medical practice devoted to comprehensive, physical, and psychological evaluation to optimized sexual function, the Foundation for Intimacy, both in Tampa Bay, FL. He can be reached by e-mail at firstname.lastname@example.org.
Mike Baer, PhD, CRS, is a Life Fellow and former chair of the American Psychotherapy Association. He has been a member since 1997 and was awarded APA's Master Therapist designation in 2006. Contact him with your thoughts at email@example.com.
Dr. Bruemmer has held the position of medical director at Stein Medical Institute in Tampa, Florida since 2006. Her interests have been focused in the areas of sexual health and cosmetic and anti-aging medicine She has authored numerous articles in her fields of study and has contributed to the publication, Careers for Women in Medicine. Her most recent publication, "A Medically Designed Synergistic Combination of Pro-hormones and Pro-sexual Nutrients and Their Influence on Male Sexual Desire & Potency: Preliminary Results" was published in the online Journal of the American Association of Integrative Medicine.
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