As long ago as the nineteenth century it was known that certain medicines could damage the testicles. Felix Roubaud, a famous French physician, described how in treating tuberculosis with iodine vapours he had observed four cases of progressive sexual impotence. He found ‘a marked wasting of the testicles’. Saltpetre was also found to be harmful, the use of bromide compounds affected mainly sexual desire, while camphor inhibited the ‘sensitivity of the sexual system’. Nowadays it is anti-cancer medication in particular that has a bad name in this respect. Other drugs that can adversely affect the production of sperm cells are salazopyrine (used for inflammation of the intestine), indomethacine (rheumatism), ranitidine and cimetidine (stomach complaints), nitro — furantoine (urinary tract infections), spironolacton (a diuretic), allo- purinol (gout), cyclosporine (an anti-rejection agent in transplants) and various hormonal preparations. Gossypol is a natural component of cotton seed oil, which in some parts of China is used in the kitchen. Strikingly, in those regions male fertility was clearly reduced. The Chinese plant Tryptergium wilfordii can also cause reduced fertility.
As mentioned in the previous chapter, men with metastatized prostate cancer are mostly given medication to reduce testosterone to what is called ‘castration level’ (surgical castration is scarcely if ever carried out today). Even for elderly men this remains quite an onerous procedure. Partly because of their often advanced age most prostate cancer patients are no longer able to achieve a firm and lasting erection. The hormonal therapy results in hot flushes, comparable with menopausal symptoms in women. In addition there is the risk of osteoporosis and the accompanying increased danger of fractures.
Erotic fantasies are stimulated by testosterone, and therefore one would expect them to peter out. But that is by no means always the case: the memory has stored many of these fantasies. This phenomenon
is sometimes called cinema erotique interieur. In such cases erotic caresses by an understanding partner can therefore do wonders. No one should underestimate the fulfilment and satisfaction this can bring, particularly in old men close to death. Knowing one is suffering from incurable prostate cancer and still feeling some life in one’s sexual organs can provide a much-needed boost.
Alcohol has a toxic effect on the functioning of the testicles, and in the case of chronic abuse less testosterone is produced and the liver is less and less capable of breaking down oestrogen (men produce small quantities of this female hormone). In contrast to men, in women sexual excitement usually increases under the influence of alcohol. Why is that?
In both sexes sexual interest and sexual arousal are related to the testosterone level in the blood. But with women things are more complicated: in their case the production of the male sex hormone (in the adrenal gland, in fat tissue and in the ovaries) varies with the menstrual cycle: the testosterone level is highest in the fertile period around ovulation. Researchers have discovered that a relatively small amount of alcohol (two glasses of beer or wine) is sufficient to cause the testosterone level to rise. The effect is found only around ovulation if no contraceptive pill is used. In the case of women who stop taking the pill the effect is all the greater because with the contraceptive pill the testosterone level remains relatively low throughout the cycle.