Among Bill Clinton’s post-White House ventures, one of the more striking is his campaign to reverse trends in childhood obesity. It’s been remarkable for its ambition, and for the scope of its potential benefits. But perhaps most of all, it’s been remarkable to see someone of Clinton’s typically diet-oblivious gender speak publicly about laying off the cheeseburgers.

Diets aren’t just for women – Men diet too

Since his quadruple heart bypass surgery in 2004, the former McDonald’s-lover-in-chief has been strikingly candid about his relationship to food — candid not just for a former world leader, but candid for any man. “I was a fat band boy,” he writes in My Life (a hefty volume, ironically, weighing nearly three-and-a-half pounds).

In the book, he discusses his weight fluctuations and admits to experimenting with a kind of homespun precursor to the Atkins diet. This past October, he told the New York Times that he weighs himself daily. Famously America’s “first black president,” Clinton might well become America’s first female ex-president.

Indeed, the vast universe of dieting has been a kind of private (and grim) clubhouse for women. A realm of Jenny Craig and egg whites, Weight Watchers and fat-free yogurt, it’s historically been glimpsed by men only from across the dinner table. But increasingly, the unfairer sex is beginning to find a corner in that realm all its own.

“Men are becoming more conscious of health, and with that, weight,” says Betsy Klein, a registered dietician in Miami. “Being overweight is becoming such a marker for diabetes and heart disease.”

Diet and masculinity

Of course the health risks of a bad diet are just part of men’s motivation for changing how they eat — we also care about how we look.

“Males of all ages are being affected by our highly body-conscious culture now,” says registered dietician and exercise physiologist Samantha Heller. “Body dysmorphia — an unhealthy view of the body — is also increasing in men as well as women.” She said that for men, these issues manifest differently than with women. “They tend to work out a lot, and many turn to anabolic steroids. And more and more, they’re dieting while they do this.”

Or at least they’re doing something while they do this. Venturing into territory traditionally reserved for women isn’t always easy for men, and they tend to couch their involvement in it differently — starting with the language they use.

“They don’t always call it ‘dieting,’” Heller says. “‘Dieting’ and ‘slim’ don’t resonate well with men. Their goals are more to feel strong and masculine. Not only does the term dieting sound feminine, but dieting also causes them to worry they’ll lose muscle mass in the process.”

“Fine with me that they don’t like that word,” Klein says, “I don’t either. To me, dieting implies a beginning and an end, as opposed to the full lifestyle change that they need.”

So what ideas do put men in front of healthier plates? Visions of brawniness, it would seem. As Klein, Heller, and a multibillion-dollar dietary supplement industry attest, it’s an interest in bodybuilding, stamina, and other hallmarks of masculinity that really get guys to be food-conscious. If the way to a man’s heart is through his stomach, the way to his stomach is apparently through his biceps.

The male comfort zone — How men choose diets

“Men are drawn to diets that promise to make them better at sports or to increase their energy,” Heller says. “The supplement market is geared toward men who want more mass and less fat. Problem is those protein shakes don’t do anything. We get plenty of protein. Exercise is all that will build muscle. There’s no way around that.”

Indeed, men don’t always know what they’re doing in the diet department. And to be fair, there are simpler departments to navigate. Men will order a piece of grilled fish and think they’re being healthy, Klein offers as an example. “The fish may be a wise choice,” she says. “But the sauce or marinade will get you.”

Thwarted by such complexities, many men seek refuge in more well-marked terrain. The Atkins diet, Heller said, is particularly popular with men.

“They’re more comfortable with [Atkins'] all-or-nothing thing for some reason. And a steak is more masculine than a chicken salad. But it’s not a healthy diet in the end,” she says.

Of course that last point is endlessly disputed. A recent Stanford study threw a little ammunition to the Atkins advocates. In a year long study comparing four popular diets, overweight women lost the most weight on Atkins and had slightly better cholesterol and blood pressure levels.

Though the women-only study also has implications for male Atkins dieters, the lead author, Stanford researcher Christopher Gardner, says neither sex should take the results as a total vindication of the popular diet.

“This is just a 12-month study,” he says. “As a health professional, I’d be concerned about what a high-saturated fat, high-protein diet would mean over the course of a lifetime.”

Gardner argues that refined carbohydrates are the most important foods for both women and men to avoid. White bread, white rice, soda, starchy junk food — it’s these, he suspects, that are responsible for the increase in the country’s caloric intake over the last couple decades. Good carbs such as fruit, vegetables, oatmeal, brown rice, and whole wheat breads and pastas, on the other hand, shouldn’t be neglected.

Tips for men on diets — How to avoid diet pitfalls

Just knowing the score on different foods isn’t always enough. In tailoring nutrition lessons for me, Klein zeroes in on some common vulnerabilities even among those who know cookies from kale.

“Travel is an issue for a lot of men because many are often away from home because of work,” she says. “Learning how to eat healthy on the road is important. On planes, I say to bring four or five packages of instant oatmeal — they’ll give you the hot water. Also, boxes of dry cereal. Cheerios, but not Honey Nut Cheerios.”

Klein also advises travelers to book their hotel rooms on the sixth floor and walk up. Another tip: Get the taxi to drop you off a mile from where you’re staying and hoof it the rest of the way.

Back at home, men are also world-class breakfast-skippers — terrible habit, Klein says. “We go into a kind of starvation mode when we sleep, so if you wait until lunch to eat again, the body thinks, ‘Hey, I’d better save this as reserves. Who knows when this guy’s going to eat next?’ So it gets stored as fat. Take five minutes to have a high-fiber cereal or even peanut butter on whole wheat toast. Small changes make big differences.”

One last directive from Klein, who says Americans eat way more than we need: Cut those portions in half. It’s the quickest change a man can make in his eating habits — even if it is hard to swallow.

Has the “free love” generation lost its mojo?

If you talk to baby boomer gals, it seems the answer is yes. Indeed, as millions of women enter perimenopause and then transgress to menopause and beyond, many say they check their sex drive at the door – and most are not happy about it.

“I don’t think a day goes by when at least one patient – and usually more – complain that their sex drive is dropping off and want to know what they can do about it,” says Laura Corio, MD, a gynecologist and clinical instructor at Mt. Sinai Medical Center in New York City.

Clinically known as HSDD (hypoactive sexual desire disorder) Corio says she doesn’t think more women are affected now than in the past, but she does believe more are coming forward — prompted, at least in part, by the success male potency drugs like Viagra.

“The man gets a prescription for Viagra and he’s ready to rock and roll while she’s thinking ‘Hey, where’s my pill?’ If she’s not ready to jump in the old van and join him for a ride, there can be real problems,” says Corio.

Discovering What’s Wrong

While male sex drive is easy to define — and relatively easy to restore — that’s often not the case for women. Because the female sex drive is multifactorial, the desire to make love is not only influenced by physical issues, but emotional ones as well.

“Part of the desire to make love is clearly physical, but part is also emotional – depression can make a difference, so can any emotional issue in a woman’s life; female sex drive is very multidimensional,” says Glenn D. Braunstein, MD, an endocrinologist and chair of the department of medicine at Cedars Sinai Medical Center in Los Angeles.

While emotions are frequently behind a loss of sex drive in younger women, doctors say it is frequently the agingprocess itself that’s at when desire changes in women over age 45.

“The very fact that a woman is no longer ovulating regularly, or not ovulating at all, automatically takes her sex drive down a few notches,” says Steven Goldstein, MD, professor of ob-gyn and NYU Medical Center in New York City.

Nature’s Design for Sex

Indeed, as many women are aware, Mother Nature built in a natural increase in the desire for sex beginning just prior to ovulation, and lasting several days afterwards — not coincidentally, the only time of the month conception is possible.

Stop ovulating, says Goldstein, and you automatically lose that regularly scheduled boost in your sex drive that has been present since puberty — and you’re probably going to notice.

“There’s nothing wrong with you; it’s just the way nature works,” says Goldstein.

Moreover, around menopause, when there is also less estrogen circulating in your body, that too can bring your sex drive down for the count.

“Estrogen is a mood elevator, it works in the brain to maintain interest in sex, but it also works at the level of the genitals, helping to increase sensation and just making sex more pleasurable,” says Corio.

Without it, she says, not only can desire take a dive, vaginal tissue begins to dry and shrink. As a result, intercourse can become uncomfortable, or even painful. Problems with desire, say experts, are easy to understand.

“Who wants to make love when making love hurts?” asks Goldstein.

Moreover, he says, avoiding sex because of pain only leads to more pain. The old “use or lose it” theory really does apply.

“From a strictly physical standpoint, the less sex you have the more painful it is when you try to have it,” he says.

Put the Sizzle in Sex

While estrogen levels are important, the latest research shows that the male hormone testosterone also plays a role in a woman’s sex drive. Though present in only tiny amounts, some doctors say it’s the seasoning that makes her sex drive sizzle.

Moreover, when levels become erratic, as they do at midlife, that sizzle can fizzle fast.

“There are a lot of physical reasons a woman can experience a decrease in sexual desire. But for many women who are otherwise healthy, a drop in testosterone that occurs at midlife is the reason,” says Braunstein, who is one of the nation’s leading researchers on testosterone treatment in women.

Complicating matters further, studies show that sometimes the very treatments women take to control midlife symptoms — such as HRT or low-dose birth control pills — can actually disrupt desire by robbing the body of testosterone.

“When these hormones are taken orally, they are metabolized by the liver, which in turn puts out a protein that binds to testosterone, causing a deficiency,” says Braunstein. This, he says, can also be true for younger women using birth control pills for contraception.

And while in younger women the answer may be to simply switch brands of birth control pills, in women over 40, Braunstein says, adding tiny amounts of testosterone back into the body is the solution.

But not everyone agrees. Goldstein says the jury is still out on whether it really can help or even if it’s safe. And last year the FDA advisory panel ruled that the testosterone patch for women needed more safety data before approval is granted.

Still, many doctors do prescribe testosterone “off label” — frequently turning to drugs like Estratest, a combination estrogen-testosterone prescription approved for hot flashes and other menopause symptoms. But if you’re at all worried about taking estrogen, experts say this is not the drug for you.

Finding Your Mojo Again

Admittedly, there are far more options for men seeking to rediscover their libido than there are for women trying to find theirs. In fact, despite rumors — and even some early clinical evidence — that Viagra can encourage both genders to jump in the van and head for the all-night love fest, studies show it had disappointing results in women.

That said, the picture is not as grim as one might think. Experts consulted suggest talking to your doctor about the following:

• A blood test for low thyroid function and iron deficiency anemia, two common disorders that can affect sex drive.
• Discuss whether or not you may be suffering from low-level depression — which can affect libido. If you are already taking an SSRI antidepressant drug, discuss switching to another type of medication, which won’t dampen sex drive.
• Localized estrogen therapy. Placing estrogen directly into the vagina soothes vaginal tissue, and allows the secretions necessary for comfortable sex and possibly even an increase in sexual desire, says Goldstein. Unlike oral estrogens that carry some cancer risks, he says estrogens applied locally to the vagina are generally safe. They are available as suppository tablets, creams, or “rings,” which sit inside the vagina and give off small doses of the hormone over time.
• Compounded testosterone cream. Many compounding pharmacies (they make medicines from scratch) offer testosterone creams and gels, but you’ll need a doctor’s prescription. Corio says they can be applied to the vagina to increase sensation, or to the clitoris to increase orgasm.
• Vitamin E. When used locally in the vagina it can help rehydrate tissue and may possibly increase sensation. No need for a prescription here; Corio says just stick a pin in a vitamin E capsule and apply to the vagina several times a week, even if you’re not having sex. And be sure to use a lubricant when you are having sex – either vitamin E or a commercially prepared product such as K-Y Jelly or Astroglide.
• Zestra. A small, placebo-controlled trial published in the Journal of Sex and Marital Therapy in 2003 showed that when used as a genital massage oil, this proprietary blend of botanicals (including borage seed and evening primrose oils, Angelica root and vitamins C and E) provided a statistically significant increase in arousal, desire, genital stimulation, ability to orgasm, and pleasure, in 20 women with or without sexual desire problems. The treatment also worked equally well on women using SSRI antidepressant medicines.
• ArginMax. In a study of 77 women, a controlled double blind study found the nutritional supplement ArginMax increased sexual desire and satisfaction in more than twice the number of women taking placebo. The research was published in the Journal of Sex and Marital Therapy in 2001.

Before using of supplements, you should first have a discussion with your doctor as side effects or drug interactions can occur.

Don’t Be Driven by Declining Sex Drive

As frustrating as a lagging libido can be for some women, for others, it can simply be a rite of passage to a quieter, gentler time. In fact, Goldstein says that for many women, and their partners, a lessened sex drive is not a problem and is often replaced by other intimate and bonding experiences.

As such, Goldstein reminds us that a reduced need for sex and a declining drive are not medical problems — and if they don’t cause you distress, there is no need to seek treatment.

“Just because your sex drive is different, doesn’t mean there is something wrong or that you have to try and fix it. If less sex isn’t bothering you, your partner, or your relationship, then take heart — you are maturing in the way nature intended,” says Goldstein.

Irregular or abnormal ovulation and menstruation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren’t ovulating, a condition known clinically as anovulation.

Although anovulation can usually be treated with fertility drugs, it is important to rule out other conditions that could interfere with ovulation, such as liver disease, diabetes, problems with the ovaries, and abnormalities of the adrenal, pituitary, or thyroid glands, which produce important hormones.

Getting Pregnant When You Have Ovulation Problems

Once your doctor has ruled out other medical conditions, he or she may prescribe fertility drugs to stimulate your ovulation.

The drug contained in both Clomid and Serophene (clomiphene) is often a first choice because it’s effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken orally instead of by injection. These drugs block the effects of estrogen throughout the body.

This leads to an increase in the production of certain hormones — luteinizing hormone (LH) and follicle stimulating hormone (FSH) — that bring about ovulation. These drugs induce ovulation in about 80% of women with anovulation and, of that number, about 50% will become pregnant within six months. Up to 10% of women on Clomid will have a multiple gestation pregnancy — usually twins. (In comparison, just 1% of the general population of women delivers twins.)

The typical starting dosage of clomphene is 50 milligrams per day for five days, beginning on the third, fourth, or fifth day after your period begins. You can expect to start ovulating about seven days after you’ve taken the last dose of clomiphene. If you don’t ovulate right away, the dose can be increased by 50 milligrams per day each month up to 150 mg. After you’ve begun to ovulate, most doctors suggest taking Clomid for no longer than six months. If you haven’t gotten pregnant by then, you would try a different medication.

These fertility drugs sometimes make the cervical mucus “hostile” to sperm, keeping sperm from swimming into the uterus. This can be overcome by using artificial insemination to fertilize the egg.

Depending on your situation, your doctor may also suggest other fertility drugs such as Gonal-F or other injectable hormones that stimulate follicles and stimulate egg development in the ovaries. These are the so-called “super-ovulation” drugs. Most of these drugs are administered by injection just under the skin. Some of these hormones may overstimulate the ovaries (causing abdominal bloating and discomfort), thus, your doctor will monitor you with frequent vaginal ultrasounds and blood tests to monitor estrogen levels. About 90% of women ovulate with these drugs and between 20% and 60% become pregnant.

Polycystic Ovary Syndrome (PCOS)

A common ovulation problem that affects about 5% to 10% of women in their reproductive years is polycystic ovary syndrome (PCOS). PCOS is a hormonal imbalance that can make the ovaries stop working normally. In most cases, the ovaries become enlarged and appear covered with tiny, fluid-filled cysts. Symptoms include:

• No periods, irregular periods, or irregular bleeding
• No ovulation or irregular ovulation
• Obesity or weight gain (although thin women may have PCOS)
• Insulin resistance (an indicator of diabetes)
• High blood pressure
• Abnormal cholesterol with high trigylcerides
• Excess hair growth on the body and face (hirsutism)
• Acne or oily skin
• Thinning hair or male-pattern baldness

Getting Pregnant When You Have PCOS

If you have PCOS and you’re overweight, losing weight is one way to improve your chances of pregnancy. Your doctor also might prescribe medication to lower your insulin levels, since elevated insulin levels — caused by your body’s inability to recognize insulin — has been found to be a common problem among many women with PCOS. Chronically elevated insulin levels can also lead to diabetes.

Clomid is often used initially to start ovulation. If that doesn’t work, your doctor may prescribe hormones that you can inject at home each day. Your doctor will monitor your blood levels and likely do ultrasound imaging tests of your pelvic area. Women who use the hormone injection method develop multiple follicles and run a slight risk of multiple pregnancy if they conceive. They have a 30% risk of ovulating with multiple eggs.

A procedure known as in vitro fertilization, or IVF, is another potential treatment for women with PCOS.

The Stress Factor

For couples struggling with infertility, it’s a particularly cruel fact: Not only can infertility cause a lot of stress, but stress can cause infertility. It’s known to contribute to problems with ovulation. For many people, the longer you go without conceiving, the more stress you feel. Fears about infertility may also lead to tension with your partner, and that can reduce your chances of pregnancy even further. After all, it’s hard to have sex if one of you sleeps on the couch.

While it’s a fact that coping with infertility is stressful, that doesn’t mean you have to give into it. If your doctor can’t find a medical cause for your ovulation problems, consider finding support groups or a therapist who can help you learn better ways to cope with the anxieties that come with infertility.

The American Society of Reproductive Medicine offers these tips for reducing stress:

• Keep the lines of communication open with your partner.
• Get emotional support. A couples’ counselor, support groups, or books can help you cope.
• Try out some stress-reduction techniques such as meditation or yoga.
• Cut down on caffeine and other stimulants.
• Exercise regularly to release your physical and emotional tension.
• Agree on a medical treatment plan, including financial limits, with your partner.
• Learn as much as you can about the cause of your infertility and your treatment options.