Playing with Fire
On this episode, guest Camille describes herself as a late bloomer that was always concerned about being romantically involved.
She attributes some of her reticence to being raised in a family that didn’t hug, cuddle, or verbally express love often. Later experiences encouraged her to openly express affection with her parents, but as a young person, Camille remembers thinking neither of her parents was suited to intimate talks about sex, love, and romance.
Listen to “126: [Personal Story] – Playing with Fire – Camille” on Spreaker.
When Camille Meets David
Even when Camille knew boys found her attractive, she felt crippled by extreme shyness. She explains that things changed when she met her future husband, David. Because he was as awkward as she was, she felt they were perfectly matched. Though they were only 14, she claims they saw no reason to avoid sexual activity. She shares the journey of their relationship and experiences with other partners. She tells us about the regrets she gathered through those experiences including being objectified for her looks. After experiencing the world, Camille decided to honor David and their relationship by continually seeking a deeper intimacy with him.
As a Christian who doesn’t support abortion, Camille is ashamed to admit that as a teen she planned to abort any pregnancies that might occur. While young, Camille believes she was too cavalier about the magnitude of what happens during an abortion, and she expects many people are the same today. She warns that abortion is a traumatic experience for a woman’s body that can even cause post-traumatic stress.
Their relationship hit a hiccup early on as David desired sex more than she did, and she would often reject him. After realizing that she could make herself physically available to her husband with the aim of pleasing him, she found that this form of self-giving allowed true intimacy to flourish because it removes sex from the raw pursuit of physical pleasure and transforms it into a means of communicating and developing love and caring.
Teaching Kids About Sex
Camille explains that her views about intimacy were influenced by a course she took called Moms of Men. She wanted to raise her children to respect and avoid objectifying women. She also learned to teach her sons to avoid relationships that can’t lead to marriage, because when you date or have sex with people, part of you always stays with that person, making it impossible to give your whole self to your future spouse.
Camille also learned from Pope John Paul II’s Theology of the Body, which taught her that sex is something that God intended men and women to experience, and that it’s good to talk about it openly. She believes that talking about sex is helpful in rearing children because it encourages kids to communicate with their parents about sex and love and it helps parents guide their children towards wise sexual decisions.
Resources for Camille:
Dr. McKenzie explains both sexes produce testosterone however it’s much more prevalent and important in men. Serena informs us that puberty is driven primarily by testosterone. She notes that testosterone production increases exponentially in men during puberty, peaks around age 30, and subsequently declines. From driving growth and facilitating sexual function to retaining bone density and cognitive function, Dr McKenzie describes testosterone as a hormone with lifelong importance in men’s health.
Listen to “125: Testosterone – Dr. Serena McKenzie” on Spreaker.
Causes of Low Testosterone
Serena tells us the most direct cause of low testosterone, clinically diagnosed as testicular hypogonadism, occurs when the pituitary gland produces insufficient hormones to trigger adequate testosterone production. But she explains that many cases of low testosterone are caused by obesity, diabetes, insomnia, sleep apnoea, a sedentary lifestyle, smoking, excessive alcohol consumption, and other varieties of poor self-care. She also mentions that many clinicians understand lower testosterone levels as a natural result of aging, and not as a condition requiring treatment.
Symptoms of Low Testosterone
Dr. McKenzie admits that most of her patients present with sexual dysfunction. She often finds problems such as low libido, trouble gaining or sustaining an erection, fatigue or depression. One symptom she describes that points directly to hypogonadism is a measurable decrease in testicular size. She mentions the loss of non-sexual erections as indicative of low testosterone. She points out that these symptoms can also be caused by vascular disease or pituitary dysfunction, but she reassures us that true cases of testosterone dysfunction can be diagnosed fairly easily by physicians.
Low is Low?
To diagnose hypogonadism, Serena explains that labs look for reproducible testosterone levels below 300 or 350. The doctor explains that testosterone levels vary from day to day and hour to hour, which is why testing a man’s testosterone more than once is necessary for a correct diagnosis. She admits that some practitioners will skip this second test, which can lead to inappropriate diagnoses. She explains that most men should have testosterone levels between 200 and 900 for full sexual health, but the exact levels vary for different individuals.
Treating Low Testosterone
Dr. McKenzie believes that it’s important to assess lifestyle variables and consider alternative treatments like testosterone stimulation before rushing into testosterone replacement. For many men, correcting poor self-care, addressing relationship problems, and learning to foster romance in their relationships can solve their sexual and energy complaints. She remarks that these treatments are especially useful for younger men because hormone replacement shuts off the body’s natural ability to produce testosterone, which can prevent men from fathering children or require lifelong testosterone supplementation after treatment.
But for men with primary testicular failure or pituitary dysfunction, Dr. McKenzie acknowledges that testosterone treatments will be a necessity for the rest of their lives. Men whose testicular tissue has been damaged by chemotherapy or alcohol abuse may also need continual testosterone treatments to maintain sexual function.
Serena describes a market that has produces 15 to 20 different methods of administering testosterone for patients, including injected doses of testosterone, injectable pellets, transdermal gels, sprays, and pills, but she says insurance usually decides the form of treatment.
Risks of Different Treatment Types
Dr McKenzie prescribes transdermal gels and lotions most often. For those, she warns that it’s important for men to wash their hands after application and for them to allow the gel or cream to dry after application, otherwise accidental transmission of testosterone to partners or pets may occur.
She implies that most other methods are even safer, though high-dose injectable varieties of testosterone have been shown in some studies to increase the risk of blood clots, making heart disease important for prescribers to consider.
Testosterone Abuse and Misuse
Serena believes that testosterone is a wonderful substance, but she recommends it only be used with a clinician’s oversight. Because of testosterone’s ready availability online, she meets many men who buy themselves testosterone and are puzzled by the substance’s tendency to reduce, rather than increase, libido in healthy men.
Producing Testosterone Again
For men who don’t need lifetime testosterone treatment, Dr. McKenzie explains that results vary when treatment is discontinued. She says that some men—usually those who did not require treatment—produce adequate levels of testosterone immediately after treatment stops. Other men must wait for three to six months for their testicles to resume testosterone production, a time period that she warns can cause men to feel the depression, fatigue, and other symptoms associated with low levels of testosterone. She says that people who recover more slowly may require testosterone stimulating therapies to regain sexual function or fertility treatments if they intend to conceive a child. She also warns that a few men never regain their fertility or sexual function after undergoing testosterone treatments.
Finding Treatment for Sexual Dysfunction
Dr. McKenzie admits that medical treatment for sexual problems can be difficult to find. She describes some doctors as being disinterested in hearing about their patients’ low libido and sexual problems.
To meet the needs of this under-treated population, Serena tells us that pop-up sexual health clinics began to appear. Because pop-up clinics often provide inadequate or inappropriate treatment, she explains that more clinicians began to understand the need to provide sexual health services to their patients. Thanks to these changes, Serena shares the encouraging news that getting medical help for sexual problems is becoming easier every day.
A healthcare worker since 1992, Dr. Serena McKenzie is an evidence-based, holistic primary care physician with expertise in sexual medicine, healthy aging, and the pelvic floor. She is certified as a sexual medicine fellow (IF) through the International Society for Women’s Sexual Health (ISSWSH), as a nationally certified Menopause Practitioner (NCMP) through the North American Menopause Society (NAMS), and as a sex counselor through the American Association of Sex Educators and Therapists (AASECT). Using a multi-disciplinary approach that assesses her patients holistically, Dr. McKenzie helps her patients treat sexual dysfunction at every stage in life.
Links for Dr Serena McKenzie:
Bridging Sex Therapy and Sexual Medicine
Today’s show is going to delve into talking about sex with both your therapist and your physician, potentially, and how that collaboration can benefit your struggles can make a difference.
Listen to “124: Bridging Sex Therapy and Sexual Medicine – Dr. Pebble Kranz and Dan Rosen” on Spreaker.
I interview Dr. Pebble Kranz and Dan Rosen. He is a sex therapist, and she is a family practice physician. Both of them have had extensive training in sexual health and sexual treatment, and they started a clinic together.
What we talk about applies to you if you have some sexual struggles, because it is essential that your providers be communicating and collaborating and that you are getting the best of both worlds.
Dan Rosen became licensed as a Clinical Social Worker after attending NYU’s school of social work. He became a Certified Sex Therapist in 2014 and chaired the AASECT Ethics Advisory Committee from 2016-2018.
He has been providing local training for psychotherapists and medical residents since 2008 as well as teaching sex therapy as an instructor at the University of Buffalo 2016-2017.
While the European Society of Sexual Medicine does not credential social workers, Mr. Rosen participated in the same training program as Dr. Kranz benefiting from the truly global perspective on sexuality and sexual health. Integrating sex therapy with psychodynamic psychotherapy, treatment of sexual abusers, EMDR, CBT, IFS, and couples counseling has been uniquely rewarding.
Now, as a member of the Rochester Center for Sexual Wellness team, Dr. Kranz and Dan are bringing this global perspective on sexual health to Western New York.
Dr. Kranz is Board-certified as a family physician and trained at the University of Rochester Family Medicine Residency Program with an area of focus in the psychosocial aspects of primary care.
Family medicine appealed to her as a specialty because of its whole-person, whole-family, and whole-community approach to medical care. Family medicine residents at the University of Rochester train alongside marriage and family therapy trainees and are explicitly taught to work systemically and to collaborate with mental health providers.
Dr. Kranz’s prior medical training included almost no information on sexual function and dysfunction, nor did it expose me to a range of interventions for treatment. All along, her patients made it clear that this was an important part of their lives.
She completed a fellowship through the European Society of Sexual Medicine. Dr. Kranz now participates in both the medical school and residency curricula to improve exposure to sexual medicine. She and Mr. Rosen opened the Rochester Center for Sexual Wellness in 2017, providing comprehensive assessment and treatment for sexual concerns in individuals and couples of all genders.
Rochester Center for Sexual Wellness: https://rochestercenterforsexualwellness.com/
The organizations mentioned:
KinkAware Professionals: https://www.ncsfreedom.org/resources/kink-aware-professionals-directory/search-kap
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