SUPERmarket PHARMACIST

A pharmacist's look at the supermarket and beyond

Category: safe sex

Where my pill at?

Are we on the verge of a new male contraceptive?

The demand is there, coming from both men and women, although there is still that concern that men could not be trusted to take a pill every day. Research in the area of male contraceptives is underfunded compared to the more attractive and lucrative areas related to form and function. Enhancing libido and genitalia attract many more dollars than looking for a male contraceptive. Besides, don’t women already have that taken care of?

I first wrote about non-barrier male contraceptives in a Pharmacy Times article in October of 1995, predicting that a male contraceptive pill was coming soon, or, “at least by the next millennium.” The new millennium is here and there may be some new options beyond the condom for men willing to take the responsibility of baby prevention into their own hands, as it were. That reminds me of the poor guy whose only date was with his right hand… he always got Valentine’s Day confused with Palm Sunday.

You can read the original article and other predictions on this page.

The Chinese and the Brazilians have considered gossypol, a cottonseed component, as a male contraceptive. At first things looked pretty successful as the gossypol pill provided a very high degree of contraception, reportedly by blocking enzymes necessary for sperm to mature. Problems arose when frequent hypokalemia and rates of permanent infertility proved unacceptably high. Brazil almost got the gossypol pill, Nofertil (subtle Brazilians!) on the market at about the same time my PT article appeared. The FDA considers it a toxic substance and spends some time and money making sure it does not turn up in animal feed. It’s still being looked at as a kind of chemical vasectomy for its ability to cause permanent infertility.

In India, they have been working on a reversible contraceptive for men that involves a direct injection into the scrotum. Vasalgel (TM), a polymer, is injected into the vas deferens, preventing sperm from traveling beyond the epididymis. A product called RISUG (TM), Reversible Inhibition of Sperm Under Guidance, has been used by Indian men for over 15 years. Although the R stands for reversible, the reversing process has only been tried on animals, not “officially” on humans. The hope is that the newer polymer Vasalgel is more easily reversed and has been licensed for study in the US. Other polymers have been used in China and elsewhere to plug the vas deferens.

The search for a male hormonal birth control pill is ongoing but may have been abandoned. Most hormonal choices that may limit or stop the production of viable sperm are not good candidates for oral use, either being quickly destroyed by stomach acid and digestive enzymes or simply not being absorbed into the bloodstream. That means the needle is most likely guys, although their may be something in a couple non-hormonal drugs that seem to reduce male fertility.

Dibenzyline (phenoxybenzamine), for pheochromocytoma and Mellaril (thioridazine), a behavioral drug both seem to have a peculiar effect on male orgasm. Relax guys, you’ll still have an orgasm, but it will be a cum-free cum. Here’s the rub: Many drugs, notably α-adrenergic antagonists, have effects on contractility of the vas muscles and thus normal ejaculation. It’s a common side effect of these drugs. Normally, sperm and seminal fluid are propelled through the vas by the orchestrated contraction of both longitudinal and circular muscles. It’s quite a trip, starting in your balls and passing up and behind your bladder, right through your prostate, up the shaft of your penis and into the loving environment provided by your partner. Anyway, phenoxybenzamine and thioridazine are particularly good at blocking the contraction of the longitudinal muscles and allowing the circular muscles to contract. The net effect is to close down the highway. We’re trying to take advantage of a side effect here, so much research still needs to be done. Yet studies are ongoing to find more specific agents that will have targeted effect with few side effects. This is also an area being examined to find a drug for premature ejaculation. The calcium channel blocker, nifedipine. is also being looked at because it was observed that men taking it had altered sperm that have a diminished capacity to latch onto the egg.

It’s illuminating to see that there are a huge number of articles (mine included) in the past few decades promising a male contraceptive pill and still nothing has reached the market. Perhaps we are chasing unicorns.

Foods for Sexual Health: A+B

Mankind has long been fascinated by the idea of certain foods as aphrodisiacs. That stems, of course, from mankind’s endless fascination with sex. The very word aphrodisiac derives from the goddess of love, Aphrodite. Word on the ancient streets was that Aphrodite considered sparrows to be sacred because of their “amorous nature.” The heathens responded by grinding the poor little birdies into their love potions. We’ve come a long way since then, so please don’t try that at home. Let’s keep our focus on things that we can find at the market.

Prehistoric horny humans began experimenting with foods that resembled genitalia or were seeds or eggs to see if they could be even hornier or make somebody else hot for them. If it looked. smelled, tasted or felt like a sexual organ, it was worth trying as an aphrodisiac. Often foods became known as treatments for loss of libido, impotence or infertility simply because they were nutritious. Undernourishment was quite common in the old days and good nutrition is a primary path to sexual health.

In many cultures there are still strong beliefs that sexual potency can be enhanced by eating the genitals of our animal brethren. 5 snake wineThere is actually a “Five Penis Wine” sold in China, as well as a “Five Snake Wine” both of which contain five of the named item. Five is considered a lucky number in China, but not so lucky for snakes or animals missing a penis. The availability of Viagra is actually helping save endangered species since it works so much better than dried tiger penis or powdered rhino horn. Even today, many “macho vitamins” sold in Mexico purport to contain powdered or extracts of bull testicles. I do not recommend any of these animal products.

Let’s take a look at foods with a reputation that we can find in our local markets. Foods that we are actually likely to eat and even enjoy. I’ll try to stick to the alphabet and will post in groups of reasonable size, for size does matter when it comes to blogs.

Before we get started on the sexy stuff, I should mention that the ancient Greeks warned against dill, lettuce, watercress, rue, lentils and water lilies as anti-aphrodisiacs. Hmmm, maybe I’ll skip that salad. “Hold the pickle, hold the lettuce,” doesn’t seem like an unreasonable request, especially if you hope that somebody will hold your pickle or caress your lettuce later.

Both ancient Greeks and Romans claimed that sucking on Aniseeds was said to increase desire. I found them flavorful but that’s about it. Taste like licorice. I only chewed a few, though, so perhaps I under-dosed myself. Mukhwas, that seedy mixture offered after the meal at many Indian restaurants, features Aniseeds. Although that mixture is purportedly to aid digestion, we’re talking about the folks who brought us the Kama Sutra, so what better way to start the post prandial activities than with fresher breath and a libido kicker. Anise oil has been used as a treatment for lice. Go figure.

Asparagus is thought of as a sensual food, mostly due to its phallic shape, and there may be something suggestive to feeding your lover these green stalks. It makes for potent urine but no discernible pharmacological effect. The pungent odor imparted to urine is due to thiols which may appear in the urine very quickly after eating asparagus. Interestingly, only about 40% of humans have the gene that allows them to detect this odor. If altered urine aroma is a turn-on for you, then by all means, eat your asparagus.

Arugula, frequently found in upscale salads is a pungent green whose seeds are sometimes called “rocket” seeds. You get the image? Arugula was a popular and sexy for ancient Romans. It was said to be a favorite of a god of fertility, Priapus, from whom we get the medical term for one of those erections that last longer than four hours! I find the robust taste very enjoyable and much more likely to make me feel lusty than a plain lettuce salad.

The Aztecs called the avocado tree “Ahuacuatl” which translates as “testicle tree.” They do tend to hang in pairs. During avocado harvest time Aztecs would lock up their virgin daughters as a safeguard. They are delicious with a sensuous texture. Avocados are very nutritious and a very good source of potassium (~7 mEq/fruit) but are high in saturated fats (>10gm/fruit). I recall the Texas Tornado song where the amorous young Texan wanted to “make guacamole all night long” with his lover.

Bananas have a marvelous phallic shape and make excellent training tools when teaching about proper condom use but offer little, other than providing potassium, B vitamins and suggestive oral maneuvers. The non-verbal communication as one sexily eats a banana has been the beginning of many wonderful relationships. As a rule of thumb, there is about one mEq of potassium per inch of banana. You can develop your own Freudian theories for any dreams or fantasies that you might have that involve bananas.

Mass quantities of sweet basil are reported to boost sex drive and fertility. I haven’t tried mass quantities of it, but I’d be willing to try a warm pesto body rub! In other cultures basil is revered for its sensual powers. Mexican brujas will use basil in love potions that are used to keep one’s lover from straying. Basil is sacred to Indian gods such as Krishna and Vishnu and in Italy, where it is also called kiss me Nicholas, basil has been used for many love-related purposes. Young women would often dust themselves with basil, hoping to drive the man of their desire crazy with lust. Basil has been used as a sign of availability, either as a hair ornament or in a small herb pot placed on the windowsill.

I love brussel sprouts! They are the kings of the vegetables when it comes to nutrition, and they are especially good sources for many of the necessities for sexual health. Many fertility specialists recommend brussel sprouts to improve both male and female fertility. As a favorite for increasing sperm count, I swear my “boys” hang a little heavier after a good helping of these tasty green orbs (or maybe I just need to get laid). Loaded with crucial nutrients like zinc and folic acid, these tiny cabbages come highly recommended. Great stuff for baby-making! Improved sperm count, healthy womb, folate and more for a healthy baby.

I should mention butter, if only because there are numerous reports of people using butter for a sexual lubricant, either when coupling or during individual attempts at self pleasuring. As a pharmacist, I would not recommend butter for any activity that results in exposure to sensitive mucus membranes. External use is likely OK as a natural and edible lubricant. Is this where the expression “I want to butter you up,” comes from? There are many versions of sex butters available but these are usually based on coconut and other oils. I wonder if these so-called “finishing butters” are of any value? What, exactly, are we finishing? There is also a challenging sexual position called the butter churner. You can discover that one on your own. I cannot recommend any other kind of Butterfinger than the candy bar! I prefer my butter on popcorn or toast.

It’s fun to revisit this article that I wrote many years ago and have now updated for the blog. Yes, when I say I tried the food in question, I really did, although it may have been quite some time ago. I have many good memories from many of these foods. I’ll be back with more of the alphabet soon.

Fenugreek Rears its Head

Recently, PharmD candidate Hannah Shorb found a product on our shelves called Vitali-T-Aid, labeled as a drug free dietary supplement. This product had some interesting phrasing on the front label: Helps Increase Libido (with an asterisk) with clinically studied Testofen, Supports natural increases of free testosterone in men (asterisk) and Helps boost sex drive & performance (yes, an asterisk). The asterisk, leads you to the usual disclaimer that none of this has been evaluated by the FDA. As a dietary supplement, there is minimal regulatory oversight and the product does not need to adhere to pharmaceutical standards. Also notice that Testofen is “clinically studied” which is essentially a meaningless statement without identifying the study findings.
Let’s break it down shall we?

Vitali-T

Vitali-T

Nutrition Facts
Serving Size : 2 Capsules
Serving per Container : 30
Amount Per Serving:

Testofen 600 mg
This is Fenugreek! If you have been following the blog, you know this was the main ingredient in Milky!, the lactation support product. Not sure what it is doing in here other than no less than the Natural Medicine Comprehensive Database cites reports of increased testosterone levels if 500mg is taken daily for 8 weeks (and you exercise!). Hannah found, however, data that showed that it decreases plasma androgen and lowers sperm concentration. In animal studies, seminiferous tubules and testicular interstitial tissue were damaged and the weight of the testes was decreased. This phenomenon of shrinking balls is seen with anabolic steroid use. When something that mimics testosterone is added to the body the testicles see no need to produce testosterone so they shut down and shrivel away, turning grapes into raisins. No change in strength or endurance was seen in the studies. Whatever fenugreek does in the male body, the results are a mixed bag, pardon the pun.

Male Wellness Blend 100 mg contains:

Saw Palmetto Berry Powder
Saw Palmetto is a popular prostate supplement and is antiandrogenic, that is, it works against masculine hormones. That is helpful for enlarged prostate and in controlled trials erectile dysfunction, ejaculatory dysfunction and reduced libido were all reported. So what the hell is this doing in this product???

Astragalus Root Powder
This may actually do some good in sufficient doses. It dilates blood vessels, so more blood flow, increases sperm motility, which is good if pregnancy is your target, and is diuretic, which may help if peeing like a racehorse makes you feel more manly. However, the dose is quite small per serving.

Phytosterol
Phytosterols may actually reduce production of testosterone and dihydrotestosterone. Again, very counter-productive. Why is it here? 

Asian Ginseng Root Powder –  
There is some evidence of small effects for increased libido. Ginseng is a popular memory supplement and just having a slight boost to your mental acuity could be a turn on.

Tribulus Fruit Extract –  
This is a good source of saponins which may be good for your sperm health according to animal studies, but has no effect on testosterone levels. Again, if making a baby is your goal…

L-Arginine USP
This one is all about blood flow. 4 to 6 grams a day are shown to improve sexual function in men with organic erectile dysfunction when taken for 6 weeks. Since there is only some fraction of 100mg in each dose here, it is unlikely that it will help. Notably, arginine is one of the key ingredients in “Dream Cream” which is sold to “enhance female sexual sensation” and is applied directly to the lady parts. Arginine does lead to higher levels of nitric oxide which is needed to relax smooth muscle in erectile tissue resulting in better blood flow. A guy might be better off to skip this tiny amount in these capsules and just have a dream cream party for two, rubbing the arginine cream all over each other’s erectile parts. I’m excited already!

This stuff goes for about $40 and has many ingredients in conflict with one another. As with most of my recommendations, I prefer to select individual ingredients, not some shotgun formula like this one. Most of the effect would derive from the effectiveness of the advertising on the label. If you believe you are one studly human then you may act like one. I like to think that the brain is the sexiest organ of all. A little whipped cream could be fun too!

No Balloon? No Party.

As a young pharmacy intern, one of my first encounters with somebody embarrassed buying condoms happened at Laverdiere’s Drug Store. A young man had been hovering near the pharmacy check out counter and finally, when other customers had departed and he had only me to deal with, he quickly grabbed a box from the condom display and brought it up to buy his box of three original Trojans. I could see he had a dollar bill clutched in his hand and when I rang it up and told him the total he looked confused, worried, and sad all at the same time.
“That will be a dollar and three cents,” I told him.
He stammered back, “it says ninety-nine cents!.”
“Well there’s four cents for the tax,” I replied, and now he looked downright terrorized.
“If you have to hold them on with tacks, forget it!” he cried and started to beat a hasty retreat.

I was able to coax him back to the counter and give him some solid advice on proper condom use and kicked in the three cents so he could go on his merry way.
The scenario is apocryphal, of course, and comes from an old pharmacy joke that has probably been around as long as condoms and taxes. Truly though, I have counseled many a young man on condom use and other ins and outs of safer sex.

Early attempts at condoms or some sort of penile protection were usually cloth based, linens and silk mostly. This reminds me of the even older joke about the traveling salesman who revisits a lass that he had frolicked with on his last circuit through town only to find that she had a fair-haired young son about whom he remarked, “He sure is a fine young lad.” The woman shot back, “He should be fine, he was strained through a silk handkerchief.”

We tend to give the Romans credit for the first use of the more effective goat bladder condom. An Italian doctor, Gabriel Falloppio, is believed to have taken sheaths of lamb gut, tied one end with a ribbon, and anchored on the erect penis with another ribbon. “Look! A present for you!” These were often rinsed out and reused and can be seen hanging to dry in some late 16th century artwork.

Today we have a wide assortment of condoms available, offering a variety of sizes, shapes, colors, flavors and scents. Package claims even stretch into the realm of providing an enhanced sexual experience. Some focus on sexual pleasure with promises of arousal, intense pleasure, double ecstasy, and even intensified charged orgasmic pleasure! Wow! I must admit that I have not used a condom in many years and had no idea they were electrically charged nowadays!

We do not have electric condoms yet, although there is a vibrating ring with its tiny little battery, so we’re getting close. The condoms in question use a “intensified lubricant” and strategically designed and placed “ribs” or ridges to provide the charge. “Price check on Charged Orgasm condoms on register three!”

This all started when I was unlocking the condom case one morning and I noticed the huge variety of condoms (and even vibrating rings!) that we had in stock, all sporting a variety of sexy claims. I wondered how they did it. Chemicals must be used that create these sensations and so I asked my students to have a look at the ingredients and report what types of things were used in or on condoms to support the package claims.
What if somebody had an allergic reaction to a condom? Would they know what caused it? The ladies began a passionate pursuit of new knowledge…

This turns out to be a daunting task. It’s a secret! Not much info is provided beyond whether the condom is latex or not, have nonoxynol-9 as a spermicide, and then simply state if a lubricant is present. Or in the case of the Climax Control versions, that benzocaine, an anesthetic, is used. There is a “Fire and Ice” Trojan which I suspect may use castor oil (!) for warming and menthol (!) for cooling, although I have no way to verify that. I did find hydrogenated castor oil listed as an ingredient in some personal lubricants.

We were able to find that various things may be added to the latex during the vulcanization process, but that is proprietary information. We were able to learn from secondary sources that condom manufacturers sometimes use the milk protein, casein, and the lack of casein supports the claim of “Vegan Certified.”

Sir Richard

Sir Richard

We found that parabens may be used. Parabens are another one of those chemicals commonly used in our cosmetics and personal hygiene products, ostensibly to prevent bacterial growth. Parabens have been found in breast tumors, although no causal relationship has been established. Parabens are thought to be endocrine disruptors (remember the Triclosan blog?) and have estrogenic activity, although, according to the FDA, “they have been shown to have much less estrogenic activity than the body’s naturally occurring estrogen.” Great. I’d be concerned about soaking my dick in estrogen every night! OK, OK, maybe not every night.

Glycerin, a hydroscopic sugar alcohol, is a relatively safe lubricating liquid with a variety of uses, most relating to its hydrating effect. Being a sugar alcohol, it is somewhat sweet and edible. However, there are numerous reports from women of increased frequency of yeast infection when exposed to glycerin found on condoms.

So here’s the rub. The FDA addresses condom labeling under the general device labeling regulations with addendum for expiration dating and warnings about latex allergy when appropriate. There is no regulatory compulsion to disclose anything about other additives or chemicals used in the vulcanization process, lubricants, or anything they care to squirt into that little foil pouch.

So its up to you to cover your own ass, so to speak. Choose wisely, grasshopper. I would recommend the KISS principle here: Keep It Simple, Stupid, you don’t need a chemical bath for your penis to achieve intense pleasure, nor should you expose your lover to unknown risks.

Here are just a few of the varieties that we have in stock:

condoms

condoms

Trojan sports the biggest and longest product line. See it here.

Durex is also in the game in a big way.

Sir Richard promises fewer chemicals and for every condom they sell to you they promise to give one to a poor person in a developing country.

Research assistants: Hannah Shorb, PharmD candidate Midwestern University, Glendale and Thao Truong, PharmD candidate University of Arizona

Today’s SCOTUS Ruling – My Take

The contraceptives at issue before the court were the emergency contraceptives Plan B and Ella (Emergency Contraceptive Pills ), and two IUDs.

NIH, FDA, and ACOG all define pregnancy as beginning with implantation
Takes about 6 days for a fertilized egg to begin to implant
Intervention within 72 hours cannot result in abortion
ECPs are not effective if a woman is already pregnant

However, Justice Samuel Alito wrote in his majority opinion that forcing companies to pay for methods of women’s contraception to which they object violates the 1993 Religious Freedom Restoration Act. He said the ruling is limited and there are ways for the administration to ensure women get the birth control they want. He went on to write that this only affects “closely held” companies whose owners “have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients.”

Notice the quotes and notice the contradictory use of the terms contraceptive and abortifacients in the same sentence. Proof positive that these justices did not gain an understanding of the science involved here. The whole situation illustrates the fact that much of our population would rather cling to the folklore of the past than to try to understand scientific and medical knowledge.

“The common belief that the major mechanism of action of IUDs in women is through destruction of embryos in the uterus (i.e., abortion) is not supported by the available evidence.” – NIH

Widespread use of emergency contraception could prevent an estimated 1.7 million unintended pregnancies and 800,000 abortions each year.
(Glasier & Baird, 1998)

Peace, Love, Freedom

How do you make a hormone?

No, it’s not the old joke. A patient asked me about her estrogen tablet. Her current brand was being discontinued and her doctor was considering Premarin for her. Premarin, you should know, comes from PREgnant MARes urINe. She was not thrilled with that concept.

First, lets take a look at Premarin. Water soluble estrogens were first noticed in pregnant mares’ urine in 1930. By 1933, a commercial product called Emmenin was available, but this was made from human urine and so was rather costly (perhaps we will speak of pee drinkers another time). Premarin was launched in 1942. Just about this time some other “hormonal” activities were taking place…

A botany professor, Russell Marker, was intrigued by the variety of plants that contained hormones similar to human ones. After a brief stint here in the Southwest testing cacti with disappointing results, he read a journal article that told of Mexican yams that yielded high levels of hormones. Before you could say “hola amigo” he was off to Mexico to harvest yams. He was able to extract a progestin from that first batch of yams and attempted to sell it to drug companies back in the States. Notably, Searle and Merck were already in the hormone business, but used animal starting products. They were not interested, so Dr. Marker started Syntex (merging “synthetic” and Mexico). According to “The Pill on Trial” by Paul Vaughan, Marker never saw profits from this venture and returned to academia.

Syntex scientists continued to refine the extraction process and eventually synthesized the progestin, norethindrone, which is still found in many oral contraceptives. Searle also had a progestin, northynodrel. These two agents were investigated at the Worcester Foundation in Shrewsbury, Massachusetts by Drs. Charles and Kistner and were found to shut down ovulation in rabbits. Much of this research was funded by Margaret Sanger, noted women’s rights activist and founder of the American Birth Control League, which eventually became Planned Parenthood. Other money came from Karl McCormick heir to the fortune left by Cynthia, inventor of McCormick’s Reaper. After the animal studies were completed the Worcester Foundation made a pill that combined estrogen with northynodrel and began human subjects testing.

The Planned Parenthood Federation of America commissioned Dr. Gregory Pincus and Dr. John Rock to develop a simple and reliable form of contraception in 1950. These early human trials of Enovid (Searle’s brand name containing 10mg of estrogen) are difficult to examine without meeting with allegations and controversy. With much less regulation than today, the drug was tested on about 6,000 women in Puerto Rico. The high dose did result in effective contraception, but also caused much nausea and vomiting. Psychiatric disturbances, debilitating strokes and as many as 5 deaths have been alleged as occurring but unreported. Remember, those pills had 10mg of estrogen, today’s pills have 20mcg to 30mcg, so those early subjects were taking about 400 times the modern dose.

Searle’s Enovid-10 was introduced to the U.S. market in 1960. About a year later, Syntex licensed their product to Johnson and Johnson which sold it as Ortho Novum. The formulations were constantly tinkered with and the amount of estrogen per pill plummeted.

But, how do you make a hormone? Today, manufacturers synthesize various progestins and the only link to a natural product that I could find in that process is that the alcohol used as a solvent comes from sugar beets. The estrogenic precursor no longer comes from yams. The ethinyl estriadol found in todays pills is synthesized from a soy bean extract. Chemistry! That’s how you make a hormone! Premarin reamins viable in the marketplace with over $260,000,000 in annual sales.