Male Maintenance

Men’s health encompasses a number of factors typically related to aging. Issues like low testosterone, poor sexual health, and reductions in muscle mass are often interconnected, but there is also lower urinary tract health, namely benign prostatic hyperplasia that can impact men’s quality of life as they get older. Scientific literature and innovations in new product development continues to grow to target this massive consumer population hoping to restore their vigor.

Sexual Health

Poor sexual function is often associated with age-related declines in testosterone levels, also known as late onset hypogonadism (LOH). One study that surveyed a population sample of 3396 men between the ages of 40 and 70 at eight European centers observed that “symptoms of poor morning erection, low sexual desire, erectile dysfunction (ED), inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level.” Researchers noted that the three sexual symptoms in particular had a syndromic association with decreased testosterone levels.¹

It’s important to note, however, that ED shares risk factors with cardiovascular diseases and may even be a marker of cardiovascular mortality and morbidity.² In fact, another study on the same population found that 50% of the men reported one or more comorbidities with hypertension, obesity, and heart diseases being the most prevalent. That study showed that as a function of age, sexual health declined while concomitant morbidities increased.³ There is even a name for the type of atherosclerosis that causes ED, peripheral artery disease (PAD). Vascular diseases such as PAD are likely the cause of ED in 50-70% of men who experience it.⁴ Therefore, strategies that target cardiovascular health may be beneficial to reduce one’s risk of developing symptoms such as ED.

That said, potential solutions exist to target symptoms of poor sexual function. A proprietary blend of standardized Punica granatum fruit rind and Theobroma cocoa seed extracts marketed as Tesnor by Gencor (Austin, TX) was found in a recent study to significantly improve sexual function in 40-70 year old men with mild to moderate ED. These results were based on total and domain scores of the Derogatis Interview for Sexual Functioning-Self Reporting Male questionnaire, and the International Index of Erectile Function-5.⁵

In a previous study, Tesnor was found to improve aging males’ symptoms (AMS) scores that included significant reductions in perceived stress while also increasing free and total testosterone.⁶ Therefore, the ingredient’s benefits have broader implications for men’s overall well-being, including mental health.

“In my opinion, at least with increased testosterone, there’s an increase in confidence,...[of] your ability to achieve what you need to do, whether that’s professionally or personally,” says Christopher Bailey, Gencor’s director of scientific affairs. “With that confidence, it means that you’re less likely to have stress.”

Muscle Health

There is a strong correlation between age-related declines in testosterone and frailty in men related to declines in muscle mass, also known as sarcopenia. Declines in muscle mass can lead to declines in motor and physical function that is associated with an increased risk of falls and fractures in older men, and therefore a significant decline in quality of life.⁷ Therefore taking measures to maintain muscle mass and continued physical fitness is an important aspect of men’s health. Supplements may aid men in this task, with some research indicating that they may positively impact muscle mass and testosterone levels

A couple studies on a standardized blend of East Indian Globe Thistle (Spaeranthus indicus) and Mango Tree Bark (Mangifera indica) called TestFactor, from PLT Health Solutions (Morristown, NJ) demonstrate benefits to both muscles and testosterone. One study in which 40 18-40 year old males received either placebo or 540 mg of the extract for 56 days showed that supplementation resulted in significant improvements in baseline bench press, leg press, handgrip strength, number of repetitions, and time to exhaustion.⁸ This same study also found significant increases in free testosterone in men taking the extract. In another study, 90 men between the ages of 19 and 29 were assigned to take either 435 mg of the extract, 850 mg of the extract, or placebo while doing resistance exercise training (RET) for 56 days.⁹ Results showed that those taking the extract saw better improvements in bench-press and leg extension compared to placebo, as well as significant increases in free and total testosterone.

The combination of certain herbal solutions and exercise may play an important role in combating age-related sarcopenia. Testosterone may only be one factor driving the decline of muscle mass, with some research indicating that it may also be the result of inflammatory cytokines and mitochondrial-derived problems. “Especially, age-induced mitochondrial dysfunction triggers the production of reactive oxygen species (ROS) by mitochondria, impedes mitochondrial dynamics, interrupts mitophagy, and leads to mitochondria-mediated apoptosis,” writes Yoo et al. “Aerobic exercise provides at least a partial solution to sarcopenia as it ameliorates mitochondria-derived problems, and resistance exercise strengthens muscle mass and function. Furthermore, combinations of these exercise types provide the benefits of both.”¹⁰

Lower Urinary Tract Health

Benign prostatic hyperplasia (BPH) is when the prostate becomes enlarged. Located beneath the bladder, the urethra passing through the center of the prostate, and when the prostate becomes enlarged, it presses against the urethra impeding the flow of urine. This results in common symptoms such as frequent or urgent urination, getting up throughout the night to urinate, weak urine stream, and not being able to fully empty the bladder.¹¹ These symptoms negatively impact the quality of life of males over the age of 40, and if the blockage becomes substantial, can cause more severe complications. Medications exist to treat BPH, but there are promising results that suggest herbal solutions such as saw palmetto may also alleviate symptoms.

A recent review of literature published in Uro argues that while scientific literature in the U.S. has not supported the use of saw palmetto to help patients with BPH due to poor results, when you look at the global body of peer-reviewed literature, there is substantial evidence to indicate that this herbal solution may be efficacious and safe to use.¹² An important factor when picking a saw palmetto ingredient is the composition of fatty acids, which significantly impacts their effectiveness. The berries of saw palmetto contain 10-15% lipids, but extracted oils are rich in total fatty acids, free fatty acids, fatty acid esters, fatty alcohols, and sterols.¹³ According to the U.S. Pharmacopeia, to validate saw palmetto identity, it should have a minimum of 80% total fatty acids, with specific ratios of lauric acid concentration to nine other fatty acid concentrations.¹⁴

An example of such an extract of saw palmetto (USPlus from Valensa International; Eustis, FL) was recently investigated in a study designed by urologists. In that study, 46 patients with lower urinary tract symptoms secondary to BPH were given 320 mg of the extract per day for 12 weeks. Results showed that 12 weeks of supplementation resulted in significant improvements in International Prostate Symptom Score (IPSS) and quality of life scores in those with moderate baseline IPSS scores.¹⁵ These encouraging results should be validated by larger studies, but nevertheless demonstrate the potential of saw palmetto benefiting men dealing with BPH, significantly improving quality of life.

References

1. Wu FCW, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N. Engl J Med. 2010; 363(2): 123-135. doi: 10.1056/NEJMoa0911101 
2. Corona G, Maggi M. The role of testosterone in male sexual function. Rev Endocr Metab Disord. 2022;23(6): 1159-1172. doi: 10.1007/s11154-022-09748-3 
3. Corona G, Lee DM, Forti G, O’Connor DB, et al. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J Sex Med. 2010;7(4 Pt 1): 1362-1380. doi: 10.1111/j.1743-6109.2009.01601.x
4. Erectile Dysfunction and Vascular Disease. WebMD. September 9, 2023. Accessed November 22, 2024. https://www.webmd.com/erectile-dysfunction/vascular-disease-ed
5. Srivastava MK, Sigh G, Kodur RR, Yalamanchi AA. Combination of Punica granatum Fruit Rind and Theobroma cacao Seed Extracts Enhances Sexual Function in Aging Males in a Randomized, Double-blind, Placebo-controlled Study. Int J Med Sci. 2025; 22(2);383-397. doi: 10.7150/ijms.99958 
6. Pandit SL, Yaligar D, Halemane M, Bhat A. A proprietary blend of standardized Punica granatum fruit rind and Theobroma cocoa seed extracts mitigates aging males’ symptoms: a randomized, double-blind, placebo-controlled study. Int J Med Sci. 2022; 19(8): 1290-1299. doi: 10.7150/ijms.73645
7. Shigehara K, Kato Y, Izumi K, Mizokami A. Relationship between Testosterone and Sarcopenia in Older-Adult Men: A Narrative Review. J Clin Med. 2022; 11(20): 6202. doi: 10.3390/jcm11206202 
8. Rokkam MP, Gora O, Konda MR, Koushik A. A proprietary blend of Sphaeranthus indicus flower head and Mangifera indica bark extracts increases muscle strength and enhances endurance in young male volunteers: a randomized, double-blinded, placebo-controlled trial. Food Nutr Res. 2023;67. doi: 10.29219/fnr.v67.8972
9. Salter D, Swamy S, Salis KM, Deep DK, Nadig P. A botanical extract blend of Mangifera indica and Sphaeranthus indicus combined with resistance exercise training improves muscle strength and endurance over exercise alone in young men: a randomized, blinded, placebo-controlled trial. Front Nutr. 2024;11. doi: 10.3389/fnut.2024.1393917
10. Yoo SZ, No MH, Heo JW, Park DH, Kang JH, Kim SH, Kwak HB. Role of exercise in age-related sarcopenia. J Exerc Rehabil. 2018; 14(4): 551-558. doi: 10.12965/jer.1836268.134
11. Mayo Clinic. Benign prostatic hyperplasia (BPH). September 24, 2024. Accessed April 4, 2025. https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
12. Strum SB. Serenoa Repens (Saw Palmetto) for Lower Urinary Tract Symptoms (LUTS): The Evidence for Efficacy and Safety of Lipidosterolic Extracts. Part III. Uro. 2021;1(3): 155-179. doi: 10.3390/uro1030017
13. Strum SB. Serenoa repens (Saw palmetto) for Lower Urinary Tract Symptoms (LUTS): The Evidence for Efficacy and Safety of Lipidosterolic Extracts. Part I. Uro. 2021; 1(3): 118-138. doi: 10.3390/uro1030015 
14. Chughtai B, Bhogani N, Zorn KC, Elterman D. Variability of Commercial Saw Palmetto–Based Supplements for the Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms. JU Open Plus. 2023; 1(8): e00037. doi: 10.1097/JU9.0000000000000040 
15. Winograd J, Lama J, Codelia-Ajum A, Bhojani N, Elterman DS, Zorn KC, et al. Measuring the efficacy of Serenoa repens (USPlus) extract with mobile uroflowmetry. The Canadian Journal of Urology. 2024; 31(6): 12053-12059. PMID: 39675037