It’s a man’s sex issue, but not the kind you see commercials for on TV. That’s because there’s no prescription pill approved for it, so there’s nothing for big pharma to advertise.

Yet this condition affects an estimated 10% to 18% of men in this country. We’re talking about problems not with erections but with ejaculation.

Doctors call it “ejaculatory dysfunction”—a condition that can include inability to ejaculate, decreased volume of ejaculation, decreased force of ejaculation, and/or delayed time to ejaculation. (Premature ejaculation, the tendency to orgasm too quickly, is a different sex problem, with different solutions.)

Medical researchers thought that ejaculatory dysfunction could be solved by giving men testosterone. But as you’ll see below, it’s not that simple. To find the secrets of true sexual healing for ejaculatory dysfunction, we turned to Laurie Steelsmith, ND, LAc, a naturopathic physician and acupuncturist in Honolulu and author of Great Sex, Naturally. Her solutions treat the whole man.

TESTOSTERONE FAIL

Researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center studied 66 men with ejaculatory dysfunction who had clinically low testosterone—less than 300 ng/dL, measured at two different times for accuracy. All of them got a topical ointment that was either a placebo or 2% testosterone.

The result was a bust.

After 16 weeks, the men who got the hormone didn’t fare significantly better than those who got the fake stuff. There was a slight improvement in some men whose blood testosterone levels rose above 300 ng/dL, but the overall result was not statistically significant. That was disappointing because, unlike with erectile dysfunction—the inability to get or maintain an erection—there’s no effective drug for ejaculatory dysfunction.

The results didn’t entirely surprise Dr. Steelsmith. She hasn’t seen great results when she’s prescribed testosterone to men with low levels of the hormone and ejaculatory dysfunction—although she has seen the “male hormone” help restore sexual confidence and interest in men with low testosterone, so it sometimes plays a role in her treatment plans.

“In Western medicine, we are always looking for a single cause to explain disease, but that often misses the big picture,” says Dr. Steelsmith. “Testosterone therapy alone doesn’t work because it doesn’t treat why a man may have lower testosterone in the first place. A comprehensive approach is what is needed.”

A CONDITION WITH MULTIPLE CAUSES—AND SOLUTIONS

Doctors have identified many factors, in addition to low testosterone, that can cause or contribute to ejaculatory dysfunction. Medical factors include (among others) a history of infections (especially in the urinary tract), prostate surgery, nerve problems such as those caused by diabetes (diabetic neuropathy), pelvic injuries and birth defects. Psychological factors may include depression, anxiety (including worries about sexual performance) and poor body image. Relationship problems can be part of the problem, too. Then there are side effects of medications (including certain antidepressants, blood pressure pills, diuretics and others) and, finally, drinking too much alcohol. In Dr. Steelsmith’s experience, the root of ejaculatory problems is different for each man.

The first step toward healing, as with all complex chronic conditions, is a careful medical history to help identify what are the most important factors for that individual—and then addressing them. Dr. Steelsmith doesn’t rule testosterone out, but even when she prescribes it, it’s only one intervention in a larger plan to treat the underlying causes. (The men who are most likely to benefit from testosterone, she says, are those who are born with birth defects that lead to low testosterone levels.)

Dr. Steelsmith prescribes a treatment plan aimed at creating overall health and vitality. There’s not a simple fix…one that tumbles out of a prescription bottle…so it may not be what some of her patients want to hear. But she’s found that when they commit to a truly holistic approach, they get better and enjoy sex more.

TREATING THE WHOLE MAN

Dr. Steelsmith employs traditional Chinese medicine (TCM), which holds that ejaculatory dysfunction is often caused by a kidney yang qi (male vital force) deficiency. “This means that a man has exhausted his vital force, or yang/male energy,” she says. “This can occur from having an excessively stressful lifestyle, overeating, overdrinking alcohol, lack of restorative sleep and exhaustion.”

The first step toward restoring kidney yang qi is to kick bad habits and adopt healthy ones. “Choose a heart-healthy lifestyle, give up smoking and don’t drink alcohol in excess, and have more time to rest and rejuvenate.”

She also practices acupuncture, inserting needles in acupoints that help kidney yang energy and balance the qi. She often uses moxibustion, in which TCM herbs are burned and used to heat the acupuncture needles to “warm the qi.”

Psychological counseling is also part of her approach. “Having a sexual partner who is sympathetic and truly understands is critical,” says Dr. Steelsmith. Working with a therapist can help you and your partner communicate better and cope with whatever relationship issues may have developed around the issue. Sexual healing, like dancing, takes two.

The easiest part of Dr. Steelsmith’s plan is probably taking the supplements she often prescribes to support pelvic health and sexual functioning. Below are four that she’s found helpful—two TCM herbs and two amino acid supplements.

“The Chinese herbs are energetically hot, and they warm up the kidney yang energy—which in TCM is the underlying cause of low ejaculatory issues,” says Dr. Steelsmith. From a Western medicine standpoint, many of these herbs are vasodilators.

One important caveat: Don’t just go out and start taking these—and especially, don’t take all four at once. Some may interact with medicines or other supplements you might be taking. For example, vasodilators can lower blood pressure—so if you have low blood pressure, that can be dangerous, and if you have high blood pressure, your doctor may need to adjust your medications. Before you start taking any of these supplements, it’s important to work with your own health-care professional.

DR. STEELSMITH’S GO-TO SUPPLEMENTS FOR EJACULATION PROBLEMS

Tribulus terrestris, a botanical used in both TCM and Ayurvedic medicine, increases vasodilation (widening of blood vessels), which helps bring blood to the pelvic area, including the penis.

• Panax ginseng, also a vasodilator, builds kidney yang energy and supports the adrenal glands, which can help you cope better with stress.

• L-arginine is an amino acid that can boost levels of nitric oxide in the blood vessels to help with vasodilation.

• L-citrulline is an amino acid that converts to L-arginine in your body and may be even more effective at vasodilation than L-arginine.

Finally, Dr. Steelsmith encourages the men she treats to learn tantric sexual practices, which emphasize enjoying the sexual journey rather than reaching orgasm. “Many of these practices include not ejaculating as a way to preserve kidney yang energy,” she explains. “But it can also help men shift their goal away from ejaculation toward the sexual energy and pleasure they experience while having sex—to have sex in a more conscious and sensitive way toward themselves and their partner.” If you’re interested in learning more, she recommends the book Jewel in the Lotus: The Tantric Path to Higher Consciousness by Sunyata Saraswati and Bodhi Avinasha.