By Dr. Jim Ferguson

My Christmas essays for 2017 were written in weeks past. So, if you missed them or other essays, the Knoxville Focus has a fine website and archive of previous issues, including my pontifications. Just go to, click on archives and then select the week you missed. Finally, go the bottom of the page and select my name or that of another fine columnist.

The Holiday season brings early deadlines for columnists. This allows The Focus staff to “put the paper to bed” earlier and to spend time with their families. And understandably, people are more interested in family, friends and, in the case of Christmas, the Reason we celebrate during the winter solstice. In antiquity, the winter solstice was important and commemorated the time days began to be longer (at least in the northern hemisphere). Pagans celebrated a time when the sun “reappears” and rises higher in the sky each day. Or is it the annual reappearance of the Son?

Since this week is foreshortened, I suspect that fewer people will read this column or others. And since The Focus is a family friendly paper, it’s just as well that fewer read this column which is meant for mature audiences –  or for wrapping fish.

Because there’s been a deterioration of morality in our culture, I shouldn’t be surprised by the plethora of advertisements for “male enhancement” or ED (erectile dysfunction) treatment. I remember being taken aback when feminine products began to be advertised during the Super Bowl. Now, Viagra ads have been added to ads for “male enhancement” nutraceuticals and “low-T clinics.”  Intimacy is an important aspect of humans and married life. And sexual dysfunction fosters poor self image and marital discord. I am a firm believer that proper therapy depends on a proper diagnosis. So, I have concerns that drive-through clinics focus on one aspect of physiology rather than nuanced patient care. I’m also concerned about mail order “medicinals” so powerful that users “should show caution with their use in the bedroom.” P. T. Barnum once spoke to such unrealistic expectations.

Human sexuality is a complicated and sacred gift. You would think it obvious, but these days I must assert that women and men are different. Women respond differently than men and need emotional connection to their partner for intimacy. Men are aroused by visual imagery. Understanding these differences is crucial. Apparently, predatory men of the ruling class never learned their coursework in Courting 101.

When a man is aroused neural excitation causes the release of a chemical called cyclic GMP. Rising levels of this chemical within the penile vasculature cause the release of nitric oxide promoting penile arterial vasodilation and contraction of venous outflow channels. This results in an erection. As cyclic GMP is metabolized by an enzyme called phosphodiesterase-5 (PD-5), levels fall resulting in declining nitric oxide levels and detumescence. Drugs like Viagra and Cialis are

PD-5 inhibitors and act to augment nitric oxide levels.

Similar physiology occurs in females, but the arousal state in females is more complicated and first involves emotional connection with her partner, then choice and situation must follow and finally physiological arousal can proceed. This explains why “female Viagra-like” agents are not very effective.

Vascular disease occurs as we age and diabetes is increasingly common in obesity. Both of these common conditions are associated with ED. Importantly, Viagra-like medications are contraindicated with some cardiovascular drugs. In that case other modalities including a vacuum tumescence device, penile injections with “triple mix” medications or a surgical implant may be indicated. All of these therapies require a comprehensive evaluation and thoughtful patient care – and the word care is integral to any remedy.

Recently,  “selective androgen receptor modulators” (SARMs) have arrived on the scene. These agents are sold on the internet as “performance enhancing substances.” These chemicals are thought to bind to androgen (testosterone) receptors and function like anabolic steroids. The latter have been used to build muscle and augment athletic performance, but have been banned because of liver and heart disease as well as psychiatric issues of aggression known on the street as “roid rage.”

A study of SARM agents in the November 28, 2017 issue of JAMA (Journal of the American Medical Association) found that only half of the products tested even contained SARM class agents and 40% contained other unapproved drugs. The study also found that labeling of SARMs was very unreliable. As a sidebar you should be aware that medications sold in a licensed pharmacy and carry the USP label must conform to US Government standards regarding labeling and purity. There are no guarantees of nutraceuticals purchased in, for instance, a health food store if there is no USP label.

The Spanish explorer Juan Ponce de Leon searched for the mythical Fountain of Youth capable of “reversing the aging process and curing illness.” He never found it because it doesn’t exist. Contained in the human genome is our specie’s life limit of approximately one hundred and ten years. With technology, antibiotics, clean water, adequate food, vaccinations and modern medicine, humans are living closer to that limit. Research is ongoing to extend those limits, but we are not there yet and may never arrive at immortality this side of the cross.

I believe in maximizing health, but I don’t believe in another Fountain of Youth known as “Bioidentical Hormone Replacement Therapy.” The focus of this therapy is to restore hormone levels to those of youth. Let me point out that, for example, I believe in using thyroid hormone to augment a failing thyroid gland and treat hypothyroidism. However, is it appropriate to restore my testosterone levels to those of an eighteen year old? Would it be wise to give a woman in her seventies estrogen? The notion of natural aging is at the heart of the question. Are hormone changes in my functioning sixty-six year old body a natural phenomena or are they reflective of a medical deficiency warranting treatment?

I have lived long enough to see things come with great hope and then see them go with great disappointment. I will say up front that endocrinology is not my specialty, and one can always find someone wiser than me or oneself. But for more than forty years I have operated by Ferguson’s axiom #11: “Don’t be the first on the block to try a new remedy or last in the neighborhood.”      Food for thought…