A lot of men don’t realize it but low testosterone causes problems in relationships. Low T Is Not a ¨He¨ problem It’s a ¨We¨ Problem
When we talk about low testosterone, men always hog the limelight. But in reality, the sex life, in general, takes a huge hit for both the partners involved! Testosterone is a sex hormone responsible for a man’s overall energy and mood levels. Lower testosterone not only decreases his sexual drive but also takes a toll on his emotional levels. As a result, the relationship of a couple goes through a rollercoaster of ups and downs.
Let’s dive in and learn more about low testosterone, the signs to look for, how it affects your relationship with your partner, and ways you can deal with it.
What are Testosterones and Its Role in Men’s Health?
Testosterone is a male-defining hormone and an anabolic steroid that is responsible for the development of male attributes. It is crucial for fueling their sex drive and for building the muscle mass.
It is primarily produced by the testicles and plays a key role in several male attributes like sperm productivity, male libido, body hair, sperm production, and its motility. This hormone regulates a man’s fat distribution and also maintains their bone density. Medicine Net Site. (Reviewed 2016, May 13). Medical Definition of Testosterone. Retrieved from https://www.medicinenet.com/script/main/art.asp?articlekey=5747
Testosterone peaks during adolescence and naturally declines after the age of thirty. While the normal levels start to drop with age, low testosterone may also relate to a serious medical condition.
What is Normal T?
The normal array of testosterone lies within 300 ng/dL and 1050 ng/dL. But as the levels start declining with age, it can easily fall below the range.
The levels above or below the normal range are considered to be out of balance. WebMD Site. (Reviewed 2016, August 31). Low Testosterone: How Do You Know When Levels Are Too Low? Retrieved from https://www.webmd.com/men/features/low-testosterone-explained-how-do-you-know-when-levels-are-too-low#1
What Are the Common Causes of Low “T?”
Studies show that from the age of forty, the levels of testosterone starts declining in males by 1% every year.
The process of testosterone production is a complex chain of action that is regulated by Hypothalamus. It regulates GnR hormone that stimulates the pituitary to form the LH along with the follicle hormone. Luteinizing hormone regulates Leydig cells to produce the testosterone.
As men age, the process becomes slower, and the majority of testosterone gets excreted by the kidneys. It’s not just the slow production process of testosterone that causes low ‘T,’ but diseases like diabetes, hypogonadism, obesity, and low thyroid function are also related to the decrease in testosterone levels.
Major Testosterone Killers
Certain food items that are known to lower the testosterone levels in the body. Products with Glycyrrhizic acids and licorice are the most likely food items that kill the “T” levels.
High consumption of processed food and excessive alcohol consumption also lead to a decline in the testosterone levels. Inappropriate lifestyle with poor sleeping habits, high nicotine intake, and exposure to stressful condition also lowers the testosterone levels.
Read more about testosterone killers.
Signs of Low Testosterone
Low testosterone is a condition where the body does not produce enough hormones and cause various symptoms like decreased sex drive, erectile dysfunction, fat gain, balding, and infertility.
Some people relate low testosterone levels with being cranky or tired, but there are many signs that are associated with it. It includes-
- Sleep Disturbances
- Brain Fog
- Persistent Fatigue
- Decreased Libido
- Low Erections
Side-Effects to Having Low “T” for Men
Dropping levels of testosterone will not merely cause a sexual problem but is also associated with mood swings, weight loss, and poor concentration level. These conditions are usually overlooked.
Other effects of low “T” include reduced sex drive, weakness, depression, hair loss, loss of muscle mass, erectile difficulties, low semen volume, and redistribution of the body fat.
How Does a Man’s Low “T” Affect a Woman?
If your guy feels exhausted all the time, his sex drive is diminishing, or perhaps he is losing focus on work, then low testosterone is to be blamed.
It is normal for a man to have low testosterone production but it usually results in low libido, erectile dysfunction, and lack of sex drive. This vital male hormone also impacts the psyche, which resultantly affects his energy and mood levels.
How Low “T” Affects Relationships?
Men with the low testosterone are often found to be depressed, anxious, and easily irritated. Studies show that although the partners are sexually desirable, men with low testosterone are not able to initiate the sexual interactions.
The mood changes and sexual difficulties start affecting both the people in a relationship. Low “T” affects every aspect of your life and here is how it affects your relationship.
Difficulty in Concentrating
Low testosterone levels lead to lack of concentration. Maybe you require help with a DIY project for the weekend or assistance with some house chores, but his lack of attention causes frustration and the both of you end up having unwanted arguments.
Decreased Sex Drive
If your husband has a low sex drive, it’s normal to feel unwanted, rejected and confused. Insecurities can distance you from your partner and can also get you both upset on the smallest of things.
Low T causes men to feel depressed and more irritable. They might have less motivation to socialize or work together that may lead to fights in your relationship.
Tips For Coping With the Intimacy Issues
Many couples face this challenge but fail! The reason you ask?
Most couples fail to communicate openly about their sexual needs. A sexual challenge is an incredibly difficult topic of discussion for a husband. A lot of egos is wrapped in a husband’s ability to fulfill his wife sexually and hence talking about the same might feel ego crushing to some.
As a wife, we need to understand what low testosterone means and how it affects our husband. Arming ourselves with this knowledge will not only make the conversation easier but will also help us stay positive and work towards a journey that would truly strengthen the marital bond.
Read more about low testosterone.
2. The Stress of Being a “Man.”
We women always claim that the men have it much easier in life, but do they really?
Men pride themselves on being the Prince Charming to our fantasies, The Hercules to all the heavy lifting, even a psychiatrist at times. With all roles and responsibilities bestowed on men, there is very minimal space for showing any kind of weakness or emotions.
Furthermore, men are taught from young to invest so much ¨down below” that when their ability to please and satisfy is impaired, it hits them very hard, both emotionally and mentally. The stress and anxiety of failing in the bedroom become a question of their manliness.
3. Me Before You
When our sexual life goes downhill, we start feeling neglected sexually and emotionally. Overwhelmed by to the sudden detachment and flooded by feelings of rejection, we are shaken at a personal level. This silence starts eating into your marriage. Often we put our needs and emotions first and fail to understand what our husbands are going through. Many women start feeling unwanted and insecure, feeling like they have lost the charm of interest their man sexually.
Believe me, that is a hit not just for one´s ego but emotionally, physically and spiritually. It is extremely important in every marriage to keep that wanting and desire alive because it is simply irreplaceable. But at the same time, identifying the nature of the problem should be the very first step to go about any challenge.
Majority of men with low testosterone would normally report still finding their partners sexually desirable but no longer have the drive to initiate any sexual engagements.
Wondering, how you can address this challenge effectively? Sticking to each other and working on your marriage can overcome these issues. Also, here are some other tools that can help you survive this intimacy neglect and get your sex life back on track:
Both you and your partner need to have open communications and understand that this is no one’s fault. Questioning your self-worth or jumping to conclusions like “he has lost interest in me;” or “I am not that attractive anymore” will only make things worse. The best way to address any problem is to know the nature of the problem and understanding what it means. Low testosterone level is a physical issue rather than a psychological one. By no means is the decreased sex drive a reflection of your beauty or the strength of your marriage.
Pay Attention to Physical Health
A good lifestyle with a well-balanced diet and a regular workout routine goes a long way toward addressing any health challenge. Furthermore, Herbal supplements like Tongkat Ali and Ginseng, which are scientifically proven to boost sex drive and facilitates hormonal balance can also help in maximizing the effects of your medical treatments.
As a wife, encourage your husband in maintaining a healthy lifestyle and better yet, join him on this journey. After all, no man is an island, and all this effort is for the both of you! Understanding that lower testosterone and the subsequent decrease in sex drive is a physical aspect and knowing that there’s a solution would motivate him even more to overcome the issue.
We all want a miracle solution to any and every problem we have. But magic is limited to the world of fiction and reality is not always pleasant. Remember, just like any other health challenge; hormonal imbalance will also take time to overcome. Working at it persistently will surely bring you closer to the results.
What Is the Truth About Normal “T” Levels?
Most men do not tend to function to a “normal” level of testosterone and yet seem to be doing fine.
As mentioned above, the normal range of testosterone is between 300 ng/dL and 1050 ng/dL. While it is a steep range to be defined as normal, these levels keep on changing continuously based on diet, age, and lifestyle.
Normal for each is termed as average over the course of a few months to a year to determine where the average actually falls.
Read more about normal testosterone levels.
Effective Ways to Boost Testosterone Naturally
Testosterone is known as an essence of masculinity; it’s the hormone that is responsible for muscular physique, aggression, high libido and sex drive.
The natural levels of testosterone hit around 30-35 years of age, and after this age, a slow decline starts. There are only some men who can maintain an optimum level of testosterone around the age of 40-60.
Now if you are in this age, the question is, how do you raise your testosterone naturally?
Here are some of the best testosterone boosting guides that will walk you through several diets and other ways to enhance it.
1. The Man Diet
A healthy diet is important to have a great lifestyle, but this guide will help you have a focused diet to boost the testosterone levels naturally.
It includes sustainable recipes and also will help you to kick start your testosterone boosting lifestyle.
It is a step by step guide that focuses on the recipes to maximize your body’s ability to produce the testosterone.
Juicing for manhood consist 17 recipes that will eliminate the limp libido syndrome and will boost your T levels.
But, no matter what we try, testosterone levels are going to decline. All we can do is slow down things by bringing some changes in our lifestyle and eating habits.
Step Up Your Workout Routine
Exercise can help men with low testosterone levels. Exercising elevates the testosterone levels temporarily. Age, weight, workout timing and overall fitness level determine the efficacy of exercising in boosting “T” levels. For instance, exercising helps overweight men increase their testosterone levels by helping them shed extra pounds.
In general, all types of exercises can help boost the production of testosterone hormones. But high-intensity sweat sessions and weightlifting seem to have the highest effects on improving “T” levels.
However, exercise alone cannot help. A well-balanced diet is equally important in effectively coping with the issue.
Read more on how to boost testosterone naturally.
Food to Boost Your Testosterone Levels
Testosterone is all about virility and vitality. Men who are as young as 30 years old show the signs of low testosterone.
You can boost your T levels through various natural ways, but along with those, you can also consider potential testosterone boosting foods.
- Oysters: They contain Zinc that helps you increase the muscle growth, physical endurance, and the levels of “T.”
- Broccoli: By increasing the number of cruciferous vegetables in your diet, the body gets rid of estrogen thus increasing the testosterone.
- Garlic: Garlic contains the chemical diallyl disulfide that stimulates the body to release hormones leading to increasing the testosterone production. Oi, Y., Imafuku, M., Shishido, C., Kominato, Y., Nishimura, S., & Iwai, K. (2001). Garlic supplementation increases testicular testosterone and decreases plasma corticosterone in rats fed a high protein diet. The Journal of Nutrition, 131(8):2150-6. DOI: 10.1093/jn/131.8.2150
- Eggs and Tuna: These both are rich in Vitamin D content are considered as essential for optimal testosterone levels.
- Honey: Honey contains mineral boron, is rich in nitric oxide, and is the key to open up blood vessels that cause erections. Gholami, M., Abbaszadeh, A., Khanipour, K. Z., Anbari, K., Baharvand, P., & Gharravi, A. M. (2018). Honey improves spermatogenesis and hormone secretion in testicular ischaemia-reperfusion-induced injury in rats. Andrologia, 50(1). doi: 10.1111/and.12804, Tatli, O., Karaca, Y., Turkmen. S., Gulgen, G. S., Sahin, A., Eryigit, U., … Gunduz, A. (2016). The effect of mad honey on testosterone levels of male rats. Bratislavske Lekarske Listy, 117(11):677-680. doi: 10.4149/BLL_2016_130, Gambelunghe, C., Rossi, R., Sommavilla, M., Ferranti, C., Rossi, R., Ciculi, C., … Rufini, S. (2003). Effects of chrysin on urinary testosterone levels in human males. Journal of Medicinal Food, 6(4):387-90. DOI: 10.1089/109662003772519967
If you are looking for the best way to increase the “T” levels, combine these food items with Tongkat Ali supplements.
Get more food choices at the Top 10 Foods to Increase Testosterone.
Intermittent fasting is another natural way to increase testosterone to high levels. It refers to refraining from calories intake for a brief amount of time. The process uses a fasting window for calorific abstinence, followed by an eating window during which you can consume your daily calories.
Wondering how this will help?
Testosterone levels plummet after eating regardless of consuming fats, carbs or proteins. As such, having multiple small meals throughout the day only leads to further decrease in “T” levels with every meal. Intermittent fasting is also the easiest way to burn body fat, and weight loss again helps in balancing “T” levels.
Must Try Herbal Supplements For Low T Levels
- Tongkat Ali: Tongkat Ali root extract is used extensively for its aphrodisiac properties. It is known to decrease the production of Prolactin that leads to an increase in the Testosterone levels. Herbolab’s concentrated Tongkat Ali supplement with just 3% Eurycomanone is the most promising supplements that effectively boost testosterone levels in men. Tambi, M. I., Imran, M. K., & Henkel, R. R. (2012). Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia, 44 Suppl 1:226-30. doi: 10.1111/j.1439-0272.2011.01168.x, Ismail, S. B., Wan, W. M., George, A., Nik Hussain, N. H., Musthapa Kamal, Z. M., & Liske, E. (2012). Randomized Clinical Trial on the Use of PHYSTA Freeze-Dried Water Extract of Eurycoma longifolia for the Improvement of Quality of Life and Sexual Well-Being in Men. Evidence Based Complementary and Alternative Medicine, 2012:429268. doi: 10.1155/2012/429268
- Ashwagandha: This herbal remedy is a rare find. Unlike many other supposed herbal t-boosters, Ashwagandha has the scientific proof to back it up. In several studies, it was found to protect cells that help in the production of testosterone from oxidative damage. The result was a direct increase in testosterone levels. Ahmad, M. K., Mahdi, A. A., Shukla, K. K., Islam, N., Rajender, S., Madhukar, D., … Ahmad, S. (2010). Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertility and Sterility, 94(3) 989–996. DOI: 10.1016/j.fertnstert.2009.04.046, Belal, N.M., El-Metwally, E. M., & Salem, I. S. (2012). Effect of Dietary Intake Ashwagandha Roots Powder on the Levels of Sex Hormones in the Diabetic and Non-Diabetic Male Rats. World Journal of Dairy and Food Sciences, 7 (2): 160-166, 2012. DOI: 10.5829/idosi.wjdfs.2012.7.2.1109
- Maca: Maca is an herbaceous plant that contains a compound p-methoxybenzyl isothiocyanate, which is known have aphrodisiac and fertility-improving qualities. Regular consumption of Maca enhances both sexual appetite and performance. Ohta, Y., Yoshida. K., Kamiya, S., Kawate, N., Takahashi, M., Inaba, T., … Tamada, H. (2016). Feeding hydroalcoholic extract powder of Lepidium meyenii (maca) increases serum testosterone concentration and enhances steroidogenic ability of Leydig cells in male rats. Andrologia, 48(3):347-54. doi: 10.1111/and.12453 Herbolab offers the most potent Maca supplement, which interacts with sex hormones and helps regulate, support and balance the hormonal system.
- Korean Ginseng: Korean Ginseng is a plant that is associated with improving erectile dysfunction and increased alertness. Jang, D. J., Lee, M. S., Shin, B. C., Lee, Y. C., & Ernst, E. (2008). Red ginseng for treating erectile dysfunction: A systematic review. British Journal of Clinical Pharmacology, 66(4):444-50. doi: 10.1111/j.1365-2125.2008.03236.x, Salvati, G., Genovesi, G., Marcellini, L., Paolini, P., De Nuccio, I., Pepe, M., & Re, M. (1996). Effects of Panax Ginseng C.A. Meyer saponins on male fertility. Panminerva Medica, 38(4):249-54. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9063034?dopt=Abstract The new fermented Korean Red Ginseng by Herbolab is a clinically effective sexual enhancer. It contains maximum ginsenoside concentration at 12%, which further adds to its efficacy.
- Creatine: The creatine supplementation does not increase the testosterone levels but is known to exert the effects by converting it into an active form.
- Boron: Boron is a supplemental micronutrient that impacts the Vitamin D levels leading to an increase in free testosterone levels.
- D-Aspartic Acid: It is a natural amino acid that increases both LH and FSH that results in enhancing the “T” levels.
- Zinc: Known as an aphrodisiac, it is an essential mineral that is involved in the chemical processes of the body. The regular consumption of Zinc helps you to recover from high-intensity exercise and boosts testosterone levels. Netter, A., Hartoma, R., & Nahoul K. (1981). Effect of zinc administration on plasma testosterone, dihydrotestosterone, and sperm count. Archives of Andrology, 7(1):69-73. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7271365
- Vitamin D: It is a fat-soluble vitamin that functions as a steroid hormone leading to a boost in testosterone and improvement in sperm quality. Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., … Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3):223-5. doi: 10.1055/s-0030-1269854
The top 4 supplements that include Ashwagandha, Maca, Korean Ginseng, and Tongkat Ali are being sold by Herbolab and here is why they have the best of them:
Herbolab Tongkat Ali: At Herbolab, our Tongkat Ali extract has been concentrated 200 times, which means that it takes 200 gms of Tongkat Ali for the finished product. It takes 4.8kg of Tongkat Ali to make one bottle of Herbolab’s final product. We have the highest standardized Tongkat Ali in the market as we make use of 3% eurycomanone content and the proprietary extraction technology.
Our No. 1 Recommendation: Tongkat Ali
Herbolab’s Tongkat Ali supplement can help improve your overall health and well-being. While it focuses on erectile dysfunction and sexual health, Tongkat Ali also contains chemical compounds that boost the testosterone levels.
Herbolab takes a scientific approach to extract the well-known benefits of Tongkat Ali. The powerful bioactive compounds and saponins available in Tongkat Ali are effectively extracted for the supplements using cutting-edge extraction techniques. Therefore, the supplements is highly effective in dramatically increasing testosterone production and boosting libido.
The tongkat ali supplement by Herbolab is one of the most effective supplements available in the market. It offers 3% eurycomanone content, which is impressively equivalent to 200 grams of raw tongkat ali extract. The supplement offers a concentration of 200 to 1 and helps boost testosterone levels naturally, without any side effects.
Benefits of Herbolab’s Tongkat Ali
The main benefits of Tongkat Ali include:
- An increase of male fertility †: As this root extract boosts testosterone levels; it is also known to improve the sperm quality, which thereby treats male fertility issues.
- Increased libido †: Known for its aphrodisiac qualities, it also helps to deal with low levels of libido.
- Helps in muscle gain and fat loss †: Due to the increase in T levels that Tongkat Ali gives you, it also helps you to gain muscle mass and lose the extra fat.
The people those who have been consistently consuming Herbolab’s Tongkat Ali were found to have stronger ejaculations, lasting erections, and high sex drive. †
Here are more non-sexual health benefits of Tongkat Ali
Standardized Tongkat Ali Supplements
When it comes to buying a Tongkat Ali supplements, the quality of the raw material and extraction process are the key determining factors of its potency. The extract ratios are in the form of 1:50, 1:100, and 1:200.
Tongkat Ali by Herbolab has the highest extract ratios like 1:200. It also contains a component, namely, Eurycomanone that can easily be identified by a lab technique called HLPC.
You can learn more about Standardized Tongkat Ali or buy any of our high potency herbal supplements here.
† Results may vary.
References [ + ]
|1.||↑||Medicine Net Site. (Reviewed 2016, May 13). Medical Definition of Testosterone. Retrieved from https://www.medicinenet.com/script/main/art.asp?articlekey=5747|
|2.||↑||WebMD Site. (Reviewed 2016, August 31). Low Testosterone: How Do You Know When Levels Are Too Low? Retrieved from https://www.webmd.com/men/features/low-testosterone-explained-how-do-you-know-when-levels-are-too-low#1|
|3.||↑||Oi, Y., Imafuku, M., Shishido, C., Kominato, Y., Nishimura, S., & Iwai, K. (2001). Garlic supplementation increases testicular testosterone and decreases plasma corticosterone in rats fed a high protein diet. The Journal of Nutrition, 131(8):2150-6. DOI: 10.1093/jn/131.8.2150|
|4.||↑||Gholami, M., Abbaszadeh, A., Khanipour, K. Z., Anbari, K., Baharvand, P., & Gharravi, A. M. (2018). Honey improves spermatogenesis and hormone secretion in testicular ischaemia-reperfusion-induced injury in rats. Andrologia, 50(1). doi: 10.1111/and.12804|
|5.||↑||Tatli, O., Karaca, Y., Turkmen. S., Gulgen, G. S., Sahin, A., Eryigit, U., … Gunduz, A. (2016). The effect of mad honey on testosterone levels of male rats. Bratislavske Lekarske Listy, 117(11):677-680. doi: 10.4149/BLL_2016_130|
|6.||↑||Gambelunghe, C., Rossi, R., Sommavilla, M., Ferranti, C., Rossi, R., Ciculi, C., … Rufini, S. (2003). Effects of chrysin on urinary testosterone levels in human males. Journal of Medicinal Food, 6(4):387-90. DOI: 10.1089/109662003772519967|
|7.||↑||Tambi, M. I., Imran, M. K., & Henkel, R. R. (2012). Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia, 44 Suppl 1:226-30. doi: 10.1111/j.1439-0272.2011.01168.x|
|8.||↑||Ismail, S. B., Wan, W. M., George, A., Nik Hussain, N. H., Musthapa Kamal, Z. M., & Liske, E. (2012). Randomized Clinical Trial on the Use of PHYSTA Freeze-Dried Water Extract of Eurycoma longifolia for the Improvement of Quality of Life and Sexual Well-Being in Men. Evidence Based Complementary and Alternative Medicine, 2012:429268. doi: 10.1155/2012/429268|
|9.||↑||Ahmad, M. K., Mahdi, A. A., Shukla, K. K., Islam, N., Rajender, S., Madhukar, D., … Ahmad, S. (2010). Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertility and Sterility, 94(3) 989–996. DOI: 10.1016/j.fertnstert.2009.04.046|
|10.||↑||Belal, N.M., El-Metwally, E. M., & Salem, I. S. (2012). Effect of Dietary Intake Ashwagandha Roots Powder on the Levels of Sex Hormones in the Diabetic and Non-Diabetic Male Rats. World Journal of Dairy and Food Sciences, 7 (2): 160-166, 2012. DOI: 10.5829/idosi.wjdfs.2012.7.2.1109|
|11.||↑||Ohta, Y., Yoshida. K., Kamiya, S., Kawate, N., Takahashi, M., Inaba, T., … Tamada, H. (2016). Feeding hydroalcoholic extract powder of Lepidium meyenii (maca) increases serum testosterone concentration and enhances steroidogenic ability of Leydig cells in male rats. Andrologia, 48(3):347-54. doi: 10.1111/and.12453|
|12.||↑||Jang, D. J., Lee, M. S., Shin, B. C., Lee, Y. C., & Ernst, E. (2008). Red ginseng for treating erectile dysfunction: A systematic review. British Journal of Clinical Pharmacology, 66(4):444-50. doi: 10.1111/j.1365-2125.2008.03236.x|
|13.||↑||Salvati, G., Genovesi, G., Marcellini, L., Paolini, P., De Nuccio, I., Pepe, M., & Re, M. (1996). Effects of Panax Ginseng C.A. Meyer saponins on male fertility. Panminerva Medica, 38(4):249-54. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9063034?dopt=Abstract|
|14.||↑||Netter, A., Hartoma, R., & Nahoul K. (1981). Effect of zinc administration on plasma testosterone, dihydrotestosterone, and sperm count. Archives of Andrology, 7(1):69-73. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7271365|
|15.||↑||Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., … Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3):223-5. doi: 10.1055/s-0030-1269854|