A Dab in the Nose Gives Guys a Lift

Nasal gel may boost testosterone without shutting down sperm production.

Okay, admit it, the nose is not the place you’d think of for treating erectile dysfunction. But it works. And it may avoid a problematic side effect that’s common with other testosterone therapies, says Dr. Ranjith Ramasamy, a male reproductive medicine specialist at the University of Miami Health System.

Dr. Ramasamy is conducting the very first clinical trial to determine if the testosterone (T) replacement medicine Natesto, a gel men squirt in their nose three times a day, will boost T levels without tanking their sperm count.

Level up, and down

Turns out, that’s an issue with testosterone replacement therapies. Creams, patches, injections – you name it. High doses can shut down sperm production. In fact, Dr. Ramasamy says, testosterone boosters were once studied as a contraceptive. Problem is, it only happens in about 60 to 70 percent of cases. Which made it a pretty unreliable means of preventing procreation.

But a lot of men have exactly the opposite perspective. They’re hoping to up their, um, testosterone, because they want to make babies. So, a sperm factory shutdown is a bad thing.

The answer, though, may be as plain as the nose … well, you know.

Actually, it makes sense. The mucus membrane in the nose makes it an ideal drug receptor. (Think Miami Vice.) Medicine goes in, and into the bloodstream, quickly. That means it takes effect fast – in smaller doses.

“It’s so short-acting you have to use it three times a day,” Dr. Ramasamy says. “Because it’s so short acting, it still preserves the production of hormones from the pituitary gland which are responsible for sperm production. … What has not been shown is whether this affects fertility and sperm production or not.”

The down side of the down side

About one out of every 10 men experience low testosterone levels. Especially as they age. And when testosterone goes down, so do they – in more ways than one. There’s the obvious one, of course. But a drop in the manly hormone can also make you feel down in the dumps.

Other effects: osteoporosis, impaired cognition, lack of energy, and a low sex drive. And, of course, erectile dysfunction.

“Importantly,” Dr. Ramasamy says, “it can also affect sperm production. So, if you have low testosterone you could also have infertility.”

Wait! What?

Yes. There’s a Goldilocks Zone. Low levels can kill your swimmers. And too high a dose of testosterone replacement therapy can too.

The UHealth Natesto study is still recruiting participants. Dr. Ramasamy wants 40, between the ages of 18 and 55, with verifiable low testosterone. He’s got 10 signed up already. And, yes, they’re all excited.

“The patients feel the effects right away, as opposed to some of the other preparations where they have to wait a few days, sometimes even a few weeks before it starts working,” he says. “They’re very happy. No one wants to come off the drug.”

If you want to take part in the trial, call or email UHealth Dr. Manuel Leyba Molina at (305) 243–4873 ext. 1176 or m.molina.leyba@miami.edu