Do Women Have Low T? The Role Of Testosterone in Women

July 28, 2014

Testosterone is the male hormone produced in the testicles that is responsible for sex drive or libido. Women also make testosterone in their ovaries. After menopause the amount of testosterone is decreased and will affect a woman’s sex drive and libido.
Testosterone, widely and misleadingly understood to be the “male” hormone. Men produce 10 times more testosterone than women, but in their early reproductive years women have 10 times more testosterone than estrogen coursing through their bodies. And many experts now believe that it’s the loss of testosterone, and not estrogen, that causes women in midlife to tend to gain weight, feel fatigue and lose mental focus, bone density and muscle tone — as well as their libido. Testosterone is a woman’s most abundant biologically active hormone. Adequate levels of testosterone are necessary for physical and mental health in both sexes.



Benefits for Women
 
Women, before, during and past menopause, and sometimes as early as in their mid-30s, invariably have low testosterone levels. Not all women will experience its wide variety of symptoms, like low libido, hot flashes, fatigue, mental fogginess and weight gain. For those who do, and who seek to avoid taking synthetic oral hormones (shown by National Institutes of Health findings to pose an increased risk for breast cancer, heart attack, stroke, blood clots and dementia), bioidentical testosterone (whose molecular structure is the same as natural testosterone) has been shown to be safe and effective.

Some testosterone is converted by the body into estrogen — which partly explains why it is useful in treating menopausal symptoms. For those at high risk for breast cancer, or who have had it, that conversion can be prevented by combining testosterone with anastrozole — an aromatase inhibitor that prevents conversion to estrogen. Nonetheless, testosterone has been shown to beneficial for patients with breast cancer. Preliminary data presented at the American Society of Clinical Oncology have shown that, in combination with anastrozole, testosterone was effective in treating symptoms of hormone deficiency in breast cancer survivors, without an increased risk of blood clots, strokes or other side effects of the more widely used oral estrogen-receptor modulators tamoxifen and raloxifene.

Other benefits cited for testosterone therapy include:

Relieving symptoms of menopause, like hot flashes, vaginal dryness, incontinence and urinary urgency.

Enhancing mental clarity and focus. Researchers at Utrecht University in Holland recently found that testosterone appears to encourage “rational decision-making, social scrutiny and cleverness.”

Reducing anxiety, balancing mood and relieving depression combined with fatigue. Dr. Stephen Center, a family practitioner in San Diego who has treated women with testosterone for 20 years, says the regimen consistently delivers “improvement in self-confidence, initiative and drive.”

Increasing bone density, decreasing body fat and cellulite, and increasing lean muscle mass. Testosterone is the best remedy available for eliminating midlife upper-arm batwings.

Offering protection against cardiovascular events, by increasing blood flow and dilating blood vessels, and against Type 2 diabetes, by decreasing insulin resistance.

Countering the Myths

Some women believe, also incorrectly, that testosterone therapy will produce “masculinizing” traits, like hoarseness and aggression. While the hormone may cause inappropriate hair growth and acne in some women, those side effects can be remedied by lowering the dose.

Testosterone therapy has been approved for a variety of conditions in women as well as men in Britain and Australia. But while the U.S. Food and Drug Administration has approved of testosterone for use in men whose natural levels are low, the agency has not sanctioned it for women, for any reason.

How Treatment Works

Women can take testosterone as a cream, through a patch or in the form of pellet implants, which have the highest consistency of delivery. Synthesized from yams or soybeans, and compounded of pure, bioidentical testosterone, the pellets, each slightly larger than a grain of rice, are inserted just beneath the skin in the hip in a one-minute outpatient procedure. They dissolve slowly over three to four months, releasing small amounts of testosterone into the blood stream, but speeding up when needed by the body — during strenuous activities, for example — and slowing down during quiet times, a feature no other form of hormone therapy can provide.

To determine a patient’s dosage, some doctors measure testosterone levels in the blood.

Side effects of the insertion procedure, which are rare, include infection, minor bleeding and the pellet working its way out or being extruded. Some patients notice improvements within a day or two; others do not perceive benefits for a couple of weeks.

Bottom Line: Since implantation is a surgical procedure, and the pellets are manufactured by a variety of pharmaceutical compounders, who may have varying safety standards, it’s important for women to consult with an experienced, board-certified physician about treatment. Ask your doctor if you feel you are having symptoms related to low testosterone and see if testosterone replacement would be right for you

Low testosterone in men shouldn’t be ignored

July 28, 2014

Low testosterone in men shouldn’t be ignored

Posted on July 11, 2014 at 5:21 PM
Meg Farris / Eyewitness News
Email: mfarris@wwltv.com | Twitter: @megfarriswwl

NEW ORLEANS – Beginning around the age of 30, men start losing one percent of an important hormone each year.

And doctors say it is important to replace it for quality of life and long term health.
Jerry Tolbert played basketball in the Air Force. In golf, he usually hits a few strokes over par, but in his mid 50s, something changed.

“As men we don’t like to talk about those things. Just seems like it’s something about that you keep to yourself,” said Tolbert.

Jerry was going through andropause. His testosterone levels were declining, like menopause in women. The hormone testosterone is responsible for sex drive and performance, muscle and bone mass, energy, mood, thinking and metabolism, helping decrease fat storage. So when he didn’t feel like himself, he turned to urologist Dr. Neil Baum.
“If your testosterone level is low, it is good medicine to raise it to normal,” explained Dr. Baum, a urologist at Touro. He says with other medical conditions, such as blood pressure, glucose and thyroid levels, doctors don’t hesitate to help patients bring those to normal.

Dr. Baum says when levels of testosterone drop, men can fall asleep after meals more easily, have low sex drive, energy and motivation, along with muscle and fitness loss and mood changes such as irritability and depression.

So with a simple blood test to diagnose low-T along with symptoms, he uses injections or creams or even tiny pellet implants to replace what the body no longer makes.

Dr. Baum wants to make it abundantly clear, this is not about taking a lot of testosterone to make you super human like some of the professional athletes do. This is simply about replacing what your body no longer makes to bring you up to normal.

He says a recent study raising concerns about testosterone replacement and risks for heart attacks and strokes, was poorly done, even including women in the study.

“The study is really flawed from so many different areas and now a new study came out that demonstrates that replacing testosterone improves the cardiac function improves, decreases the risk of stroke and it may be cardio-protective instead of cardio-dangerous,” he added.

Now at 67 years old, Jerry feels normal and his clothes fit better.

“I had this midriff bulge, that’s going away now. It’s not as bad as it was,” said Tolbert about his midsection since he began hormone replacement therapy.
Going years with low testosterone can increase risk for hip and spine fractures, diabetes and heart disease as well as cognitive declines, loss of sex drive, sexual performance and overall energy.

Doctors do not recommend oral hormone replacement at all, or replacement for men not finished having children.

Prostate Cancer –Management of Low Risk Disease*

July 27, 2014

Prostate cancer remains one of the most common cancers in men with 250,000 new cases each year and causes nearly 40,000 deaths each year. Like most other cancers there are shades of gray and not all cancers need to have treatment. This blog will discuss the use of androgen deprivation therapy and when it might used in men with advanced prostate cancer.

There’s nothing like an elevated prostate specific antigen (PSA) test result to strike fear into even the most unflappable and courageous of men. That’s because elevations in PSA in the blood can point to the presence of prostate cancer. On the other hand, elevated PSA can also indicate prostatic enlargement or inflammation of the prostate. However, an elevated PSA test result, combined with a digital rectal exam and a 12-core prostate biopsy to remove small pieces of prostate tissue from the gland, will provide a very good idea as to whether a man has cancer or not.

About 40 to 50 percent of the 241,000 men expected to be diagnosed with prostate cancer this year will have a suspicious PSA score and a Gleason score of 6 out of 10, which is based on the prostate biopsy. A Gleason score of 6 is an indicator of a very favorable or low-risk disease, a disease that is treatable and curable — if, in fact, a man chooses to treat it.

Facing treatment decisions. Once a man has a prostate cancer diagnosis, he then has to choose what type of treatment he wants, which can include surgery or radiation therapy; men with low-risk cancer can also opt for active surveillance, or close monitoring without any immediate treatment. However, these men have to have a digital rectal exam and PSA test and possibly a repeat biopsy on a regular basis.

The good news is that low-risk prostate cancer — meaning low grade and low stage with a PSA below 10 ng/mL — grows slowly, if at all. Therefore, a man should be sure to discuss with his doctor whether he really needs to undergo any therapy to treat his cancer. That’s because in the majority of cases the answer will be “not now.”

What we have learned over the years with low-grade cancer is that sometimes the best option is no treatment whatsoever. And that includes treatment with androgen deprivation therapy, or ADT.
Earlier this summer, I came across a study in JAMA Internal Medicine that reminded me that many men with low-risk prostate cancer are still being offered primary ADT to treat their cancer, something that we would not recommend at Johns Hopkins. The reason: ADT offers no survival benefit for men with low-risk cancer and it causes significant side effects, including osteoporosis, diabetes and decreased libido.

Androgen deprivation therapy (ADT)–also called hormone deprivation, or hormonal or androgen ablation–is effective at turning off the body’s supply of male hormones, which prostate cells need to grow and develop. When the supply is shut off by drugs or by removing the testes, a portion of the cancer dies, tumors generally shrink, and PSA levels drop.

It’s androgens, or male hormones, that stimulate the growth of prostate tumors. The two most common androgens are testosterone and dihydrotestosterone (DHT). Since the Nobel Prize-winning discovery by Dr. Charles Huggins of the University of Chicago that prostate tumors depend on these hormones to grow, reducing androgen levels or blocking the action of androgen (androgen suppression) has become the standard of care for men with cancer that has spread beyond the prostate (metastasized) to the bones and other organs. There has also been increasing interest in using it in men whose PSA level has begun to rise after treatment with surgery or radiation (“biochemical recurrence,” an early sign that the cancer has not been eradicated).

Most urologists typically wait until there is evidence of metastatic disease before starting with ADT. There is an exception, however, and that is when we see a rapid PSA doubling time (less than six months) — because this provides indirect evidence of micrometastic disease that will develop in the next few years.

While ADT plays a significant role in the treatment of advanced prostate cancer, it has no role in the treatment of older men with low-risk cancer. Yet primary ADT is nevertheless being prescribed for one in eight men over age 65 diagnosed with localized prostate cancer.

The JAMA article. In the JAMA Internal Medicine study conducted by Grace L. Lu-Yao, Ph.D., a cancer epidemiologist at the Rutgers Cancer Institute of New Jersey and professor of medicine at Rutgers Robert Wood Johnson Medical School, more than 66,000 older men with low-risk prostate cancer were followed for up to 15 years. Dr. Lu-Yao reported that those men who received ADT lived no longer on average when compared with men who did not receive the therapy.

Prescribing ADT for these low-risk patients may decrease the high anxiety level that a patient may have due to his cancer diagnosis, however, it is necessary to note that such treatment may carry more risk than benefit. ADT helps reduce anxiety by quickly dropping PSA levels into the undetectable range, so the doctors may feel that they are doing something positive for their patients. However, ADT may not really be in the patient’s best interest due to complex side effects. The doctor should really be talking to patients with low-risk disease about pursuing active surveillance, not ADT.

There are serious potential risks associated with ADT, including coronary heart disease, and the associated high costs of the medications, the use of primary ADT should be limited to patients in the high-risk cancer group who are not suitable for, or opt not to receive, primary therapy — surgery or radiation — that has the potential to cure.
The side effects associated with ADT. In general, hormonal therapy will cause significant side effects after several months of treatment. Long-term side effects of ADT may include one, some or all of the following:
• Anemia
• Coronary heart disease
• Decreased energy
• Decrease in mental acuity
• Depression
• Diabetes
• Erectile dysfunction
• Hot flashes
• Loss of muscle mass
• Osteopenia
• Osteoporosis

Bottom Line: Many men with prostate cancer who have low risk disease or who have recurrence after treatment with radiation or surgery. This is usually detected by a rising PSA after treatment for prostate cancer that is confined to the prostate gland. These men should have a discussion with their urologists and discuss if androgen deprivation therapy is really in their best interests and that the benefits vs. the side effects are worth the treatment with androgen deprivation therapy.

*This blog was modified from the Johns Hopkins Newsletter, July 2014

PSA Elevation After Treatment For Prostate Cancer

July 24, 2014

Prostate cancer represents the second most common cancer in men following lung cancer. Prostate cancer will be diagnosed in nearly 250,000 men annually and causes nearly 40,000 deaths each year. If you already have had prostate cancer treatment, changes in PSA levels can tell whether treatment is working.

After surgical removal of your prostate, your PSA levels should be undetectable. After radiation therapy, the PSA levels should drop and remain at low levels.
Signs that your cancer has returned may include one of these:
Three consecutive PSA rises above the lowest level over time
Confirmed rise of more than 2 ng/mL from your lowest level

The key is monitoring your PSA levels over time. A rapid rise suggests rapid cancer growth and the need for treatment. A very slow rise of the PSA can often be watched.
But PSA levels can also be somewhat confusing. For example, they can go up and down a bit for no reason. The PSA test is not precise, and minor changes from test to test are to be expected.
Low rises of PSA levels can’t predict your longevity or symptoms when you have cancer. But high or rapidly rising PSA levels can suggest future problems.
That’s why doctors take other factors into account when evaluating your situation. Talk with your doctor to get a better idea of what to expect, so the numbers don’t add to your anxiety.

Advanced Prostate Cancer and PSA Levels Over Time
If you have advanced prostate cancer that has spread outside the prostate, your doctor will be looking less at your actual PSA levels than at whether and how quickly PSA levels change.
Doctors use changes in PSA levels over time (called PSA velocity) to tell how extensive and aggressive your cancer is.

Your doctor won’t just look at one PSA reading at a time. He or she will confirm it with multiple tests over many months, especially after any radiation therapy. That’s because you can have a temporary bump in PSA levels for about one to two years after radiation treatment.
To determine how aggressive your cancer is and whether further treatment makes sense, your doctor may also consider your:
PSA levels before cancer
Grade of cancer or the Gleason score. The higher the Gleason score, the more aggressive the cancer.
Overall health and life expectancy
PSA Levels and Treatment for Advanced Prostate Cancer
Your symptoms and how long it takes for your PSA levels to double (PSA doubling time) affect decisions about how soon to try treatment such as hormone therapy.
Your doctor will look at how quickly or slowly PSA rises before deciding on which treatment to suggest. You may need continued monitoring before moving to a new treatment. Your doctor may suggest waiting for a while to delay the appearance of treatment-related side effects. Discuss with your doctor how to weigh these considerations.

PSA levels may also be useful in checking if your treatment for advanced prostate cancer is working after you have had:
Hormone therapy
Chemotherapy
Vaccine therapy
Treatment should lower PSA levels, keep them from rising, or slow the rise, at least for a while.
Doctors monitor PSA regularly based on the type of treatment you had first. For example, after hormone therapy, PSA should drop to a lower level quickly, i.e., within weeks. It may fall further over time as you continue hormone therapy.

Combined with symptoms and other tests, PSA tests can also show if it’s time to try another type of treatment.

Bottom Line: PSA is an imprecise test for diagnosing and monitoring prostate cancer. If the PSA rises quickly after treatment, whether it is surgery, radiation, or hormone treatment, this is of concern and you may need to have additional treatment. Speak to your doctor if you have any questions.

Lack of ZZZZZ’s Can Affect Your TTTTTTs

July 24, 2014

There’s now a relationship between lack of sleep and your testosterone level. Lack of sleep can affect your libido (sex drive), your energy level, and even your ability to concentrate. It is of interest that sleep deprivation can affect the testosterone level, and low testosterone level can affect your ability to sleep so it is a double edged sword.

Sleep Deprivation and Low T: What the Research Shows
A 2011 study published in the Journal of the American Medical Association (JAMA) reported the effect of one week of sleep restriction in healthy, young men. Previous studies have shown that gradual decrease in sleep time is partially responsible for low T in older men. Studies also have shown that sleep disturbance caused by obstructive sleep apnea (OSA)— a chronic breathing disturbance that occurs during sleep — is linked to low T.

In the JAMA study, 10 men volunteered to have their testosterone levels checked during eight nights of sleep restriction. They were only allowed five hours of sleep per night. The study found that their daytime testosterone levels decreased by 10 to 15 percent. The lowest testosterone levels were in the afternoon and evening. The study also found a progressive loss of energy over the week of sleep deprivation.

OSA is a common condition in which breathing becomes obstructed during sleep. Symptoms are daytime sleepiness, loud snoring at night, and short periods of absent breathing (apnea). Sleep apnea causes an abnormal sleep cycle and can result in low testosterone. Treating sleep apnea has been shown to return testosterone to normal levels.

A study presented at the American Urological meeting in 2012 evaluated 2,121 male law-enforcement officers to see if there was an association between sleep apnea and low testosterone. About 38 percent of the men had low testosterone, and 43 percent were considered to have sleep apnea. The men with sleep apnea were almost 50 percent more likely to have low T than men without sleep apnea.

Why the Link Between Sleep and Low T?
Normal testosterone production requires restful, undisturbed sleep called REM sleep. Over time, sleep disturbance also can cause an increase in the stress hormone cortisone. High cortisone levels also can cause low testosterone.

The majority of the testosterone used every day is replenished at night. In older men, gradual reduction in hours of sleep has been closely correlated with gradual lowering of testosterone. Studies have shown that men with low testosterone, especially older men, tend to have more trouble sleeping.

Tips for Better Sleep
Good sleep habits are called sleep hygiene. According to the U.S. Centers for Disease Control and Prevention (CDC), an adult should get seven to nine hours of sleep every night. Here are the basics for maintaining good sleep hygiene:
Set a routine. Go to bed and get up at the same time every day, including weekends.
Get comfortable. Keep your bedroom quiet, dark, and at a comfortable temperature for sleeping.
Stay focused. Make sure your bed is comfortable and use it only for sex or sleeping. Avoid bedroom distractions like TV, books, and computers.
Don’t chow-down. Avoid eating a big meal before bedtime.
Now here’s the best one: Sex before bedtime can be a sleep.

Bottom Line: Low testosterone can impact so many areas of your life. It is important to get plenty of sleep and sleep deprivation and disturbed sleep can lower your testosterone. So be good to your sex life and get an adequate amount of sleep each night.

Kegel Exercises For Men- Non Medical Treatment of Overactive Bladder

July 24, 2014

For decades, women have been doing Kegel (named after the gynecologist who invited the exercises) to help control urinary incontinence. Now we know that regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence even in men.

Kegel or pelvic muscle exercises are discrete exercises that work the perineal or pubococcygeus muscles. In the past, they have been largely promoted by physicians to their female patients in an effort to aid with stress incontinence following childbirth. However, these same exercises are now being promoted to men in an effort to improve urinary incontinence, fecal continence, and even sexual health such as the treatment for erectile dysfunction and premature ejaculation. Unlike typical exercise routines, these exercises don’t require the participant to buy any weights or expensive machines. You don’t need a trainer, a gym membership, or any special equipment.

Kegel exercises primarily aid men with urinary incontinence. Besides preventing embarrassing urine leakage, they also decrease the urge to void. Secondly, they have been shown to help male sexual health by allowing some men’s erections to last longer when affected by sexual dysfunction and premature ejaculation. These benefits all equate to a better quality of life.
These exercises are often recommended to patients with weakened pelvic floor muscles such as patients with diabetes, patients having had a prostate surgery in the past such as a radical prostatectomy, or obese patients. It should also be mentioned that these exercises have not been scientifically proven to increase penis size and are thus not recommended solely for this purpose.
Kegel exercises are harmless if performed correctly. Chest and abdominal pain have been reported in some, but these occurrences are the result of inappropriately performed exercises.

How can men perform Kegel exercises?
Prior to beginning the exercises, it is important to correctly localize the pubococcygeus muscles. To achieve this, one can simply attempt to stop his urine flow midway through. The muscles allowing for the pause in urination are the ones targeted by the Kegel exercises.
There are many different techniques that can be used to efficiently strengthen one’s pelvic floor muscles. Women often use Kegel balls or Kegel weights to perform the exercises, but those are unnecessary for men.

The first technique requires a contraction of the anus muscles as if trying to hold in gas. The feeling of a pulling or lifting sensation on the anus tells you that you are performing the exercise correctly.

The second exercise is used to observe the movement of your penis vertically without moving the rest of your body. An elevator analogy can be used to illustrate the exercise. The anus, in this case, can represent an elevator. The goal of the exercise is to bring up the elevator over 5 seconds to its maximal level and then to bring it gradually back down to the resting level.
The techniques are interchangeable. Men can perform a different technique each day. However, the important thing is to always use only the pelvic muscles. When men first start performing these exercises, they may use other muscles to help them. Often, they may use their abdominal or gluteal maximus (buttocks) muscles. It is thus important to become aware of which muscles are being contracted. It is also important to avoid holding the breath or crossing the legs.

Arguably, one of the strongest points of Kegel exercises is that they can be performed anywhere without anyone but the participant noticing. Unlike typical core exercises for men requiring sit-ups, planking, or other unusual positions, Kegel exercises can be performed during a variety of activities such as shaving, sitting at one’s desk, or even while driving. This feature allows them to be universally accepted by men.

Men are accustomed to exercises such as push-ups or sit-ups. However, a very small proportion of them know how to efficiently perform Kegel exercises. This is unfortunate since many doctors recommend incorporating these into one’s core routine.
Unlike typical workouts for men, when it comes down to Kegel exercises, there is no magic number of sets one should do in a day. It is recommended, however, for men to perform at least two sessions of Kegel exercises every day. To keep things simple, men should perform their first session in the morning and their second at night. A session comprises of 10 to 30 individual contractions and relaxations exercises. Each exercise should last 10 seconds divided into 5 seconds of contraction and 5 seconds of relaxation. Once a man excels at performing these, he can do them in different positions. Of the 10 to 30 exercises, he can do one-third while laying down, one-third while sitting, and one-third while standing. Counting out loud certainly helps and as time goes by many men are surprised at the ease with which they can perform the exercises that at first seemed unnatural to them.

This is of greatest importance for men undergoing prostate surgery, either for prostate cancer needing radical prostatectomy (complete prostate removal) or for benign prostate hyperplasia (BPH) needing transurethral resection of the prostate. Both of such surgeries reduce the resistance to the bladder which can result in postsurgical urinary incontinence. As we can see from the following image, the anatomic changes reduce bladder outlet resistance. As such, strengthening the pelvic floor and sphincter are of paramount importance and Kegel exercises can help.

Bottom Line: Kegel exercises are not just for women with incontinence. They work for men, too. Results aren’t immediate so stick with it and you will be amazed at the results.

July 12, 2014

Urinary Problems Can Impact Your Sex

Overactive bladder or urge incontinence can have a significant impact on a man or woman’s quality of life include their ability to engage in sexual intimacy with their partner. This blog will discuss the concept of the overactive bladder and what can be done to tame the bladder and improve the intimacy of those who suffer from this condition.

OAB can take its toll in many areas of your life, including your romantic relationships. Women with OAB worry about urine leakage during sex or orgasm.

OAB or urinary incontinence can cause physical symptoms as well as fear, anxiety, and shame about sex and intimacy.
Unfortunately, many women with OAB will avoid sex altogether.
Unless you have a prolapsed bladder, sex is not dangerous and will not cause your bladder to become damaged.
Women may feel embarrassed by leakage during sex or orgasm, and even if their partner knows and says ‘It’s OK,’ it certainly can stop you from allowing oral sex.

Once you are open with your partner, you can face the situation together. For example, if there is urine incontinence during sex or orgasm, you may need a special sheet or towel.
Non-medication treatment for OAB

Natural Treatment for Overactive Bladder
Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these non-drug remedies can be very effective for many women, and they have almost no side effects.
Before starting any OAB treatment, however, it’s important to understand bladder function and what factors may cause overactive bladder.
• Bladder training. This is the most common OAB treatment that doesn’t involve medication. Bladder training helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting — for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
• Pelvic floor exercises. Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Using a special form of training called biofeedback can help you locate the right muscles to squeeze. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is with electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.
Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage that occurs.
Other behavioral tips for preventing incontinence include:
• Avoiding drinking caffeine or a lot of fluids before activities
Not drinking fluids right before you go to bed
I also suggest that before engaging in sexual intimacy, empty your bladder so there is less fluid in the bladder and not likely to trigger an unwanted bladder contraction.

Bottom Line: Intimacy can take place if either partner has an overactive bladder. Speak to your partner and your physician to find a solution for this common condition that doesn’t have to affect your sex life.

Incontinence In Men-You Don’t Have to Depend on Depends

July 12, 2014

Loss of urine is one of man’s most devastating maladies. It usually is related to problems with the bladder or the prostate gland especially after prostate gland surgery.

Male Stress Urinary Incontinence (SUI) also known as, Post-Prostatectomy Incontinence, commonly occurs following a surgical procedure to remove a cancerous prostate. Studies have indicated that as many as 90% of men report leakage in the first few weeks following surgery for removal of the prostate gland, after removal of the catheter. Over the course of the first year, SUI can be a significant problem impacting the quality of life of men who suffer from this condition.

Fortunately, there are effective treatment options for many cases of post-prostatectomy incontinence. Men often say the leakage from post-prostatectomy incontinence is worse than the actual cancer. Unfortunately, there is a lack of information for men with stress urinary incontinence.

Urinary incontinence can be short-term or long-lasting (chronic). Short-term incontinence is often caused by other health problems or treatments.
Chronic urinary incontinence can be categorized as:
• Stress incontinence means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder.
• Urge incontinence is an urge to urinate that’s so strong that you can’t make it to the toilet in time. It also happens when your bladder squeezes when it shouldn’t. This can happen even when you have only a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. But not everyone with an overactive bladder leaks urine.
• Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your bladder doesn’t empty as it should, it then leaks urine later.
• Total incontinence means that you are always leaking urine. It happens when the sphincter muscle no longer works.
• Functional incontinence means that you can’t make it to the bathroom in time to urinate. This is usually because something got in your way or you were not able to walk there on your own.

Different types of incontinence have different causes.
• Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone.
• Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can’t hold back the urine. This causes a very strong urge to urinate.
• Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. It may also happen because of weak bladder muscles.
In men, incontinence is often related to prostate problems or treatments.
Drinking alcohol can make urinary incontinence worse. Taking prescription or over-the-counter drugs such as diuretics, antidepressants, sedatives, narcotics, or nonprescription cold and diet medicines can also affect your symptoms.
The diagnosis is easily made with a careful history and physical exam. Your doctor will do a test on your urine to be certain there is no evidence of infection. Often this is enough to help the doctor find the cause of the incontinence. You may need other tests if the leaking is caused by more than one problem or if the cause is unclear.
Treatments depend on the type of incontinence you have and how much it affects your life. Your treatment may include medicines, simple Kegel exercises, or both. A few men need surgery, but most don’t.
There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.
• Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And limit alcohol to no more than 1 drink a day.
• Eat foods high in fiber to help avoid constipation.
• Don’t smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Stay at a healthy weight.
• Try simple pelvic-floor exercises like Kegels.
• Go to the bathroom at several set times each day and avoid your bladder getting to full. Wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
• When you urinate, practice double voiding. This means going as much as you can, relaxing for a moment, and then going again.
• Use a diary to keep track of your symptoms and any leaking of urine. This can help you and your doctor find the best treatment for you.
If you have symptoms of urinary incontinence, don’t be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.

Bottom Line: Urinary incontinence in men affects their quality of life. Help is available and it begins with sharing the problem with your doctor.

Vasectomy And Prostate Cancer-What’s the Risk

July 10, 2014

I often receive calls about the relationship between prostate cancer and vasectomy. There have been many studies that have looked into this relationship and this blog will shed some light on the issue and help men make an informed decision on having a vasectomy, one of the best methods of permanent contraception.

Men who had a vasectomy had a significantly greater risk of developing aggressive, potentially fatal prostate cancer, according to data from a 50,000-patient cohort study.
A recent study in the Journal of Clinical Oncology stated that the overall association between vasectomy and prostate cancer was modest.

The lead authors was quoted as saying, “I think we need to tell men that vasectomy has some risk with prostate cancer, may be linked, but we don’t know. It’s something they need to be aware of and monitored, but really, to me, this is not something that is such a strong association that we need to be changing the way we practice, either prostate cancer screening or vasectomy.”
Studies dating back to the early 1990s have yielded conflicting results about the association between vasectomy and prostate cancer. Some studies have shown as much as a twofold increase in the risk of prostate cancer after vasectomy, whereas others showed no association, the authors noted.

During follow-up through 2010, 6,023 participants had newly diagnosed prostate cancer, including 811 lethal cases. The data showed that 12,321 of the men had vasectomies. The primary outcomes were the relative risk (RR) of total, advanced, high-grade, and lethal prostate cancer, adjusted for a variety of possible confounders.

Vasectomy did not have a significant association with low-grade or localized prostate cancer.

The study adds information to the discussion and controversy surrounding vasectomy and prostate cancer but leaves many questions unanswered. Use of transurethral resection of the prostate, statins used to treat elevated cholesterol levels, selenium, and a number of other factors can influence prostate cancer risk.

The study added little information that goes beyond what previous studies had shown, said Gregory Zagaja, MD, of the University of Chicago. The study suffered from the same limitations of studies that came before it.

Multiple experts state that no consensus exists about potential biological explanations for reported associations between vasectomy and prostate cancer or whether the association is biologically plausible.

Bottom Line: There is a modest risk of prostate cancer in men who undergo a vasectomy. All men, whether or not they have had a vasectomy, need to have a regular PSA and digital rectal exam. For more information on this topic and the relationship between prostate cancer and vasectomy, speak to your doctor.

Expert Panel Says Healthy Women Don’t Need Yearly Pelvic Exam

July 7, 2014

The annual pelvic exam often dreaded by women may be antiquated and now unnecessary.
Ask any woman about getting a pelvic exam and they will tell you that it is uncomfortable, embarrassing, and seldom yields any results that impact a woman’s healthcare. Now a recent report by the American College of Physicians suggests that the annual pelvic exam is unnecessary.

For decades, doctors have believed this exam may detect problems like ovarian cancer or a bacterial infection even if a woman had no symptoms. And sometimes it does. But recently experts have questioned whether the yearly ritual adds value to a woman’s health.

In the new guidelines, published in the Annals of Internal Medicine, an expert panel appointed by the American College of Physicians recommends that healthy, low-risk women not have routine annual pelvic exams. The panel based this advice on a systematic review of prior studies. They not only found no benefit from the annual pelvic exam, they found that it often causes discomfort and distress. Sometimes it also leads to surgery that is not needed.

The new guidelines only apply to the pelvic exam, and only in healthy women. The panel urged women to keep getting checked for cervical cancer. Also, the experts emphasized that pelvic exams remain a necessary part of the evaluation in any woman with symptoms that could be related to a problem with the vagina, cervix, uterus, Fallopian tubes, or ovaries.

A test women do need
Although seemingly healthy women may not need a pelvic exam every years, being tested regularly for cervical cancer can save a woman’s life. Here are the recommendations for women at average risk of cervical cancer:
• ages 21 to 29: a Pap smear once every 3 years.
• ages 30 to 65: a Pap smear every 3 years or a combination of a Pap smear and HPV test every 5 years.
• over age 65: routine Pap screening not needed if recent tests have been normal.
Keep in mind that these are guidelines. For personal reasons, you and your doctor may wish to choose HPV testing first or have more frequent Pap smears than recommended.
If during a routine appointment your doctor wants to perform a pelvic exam, and you aren’t keen on the idea, feel free to ask why you need it and what he or she is looking for. That’s not a challenge. Based on current evidence, there should be a reason for doing a routine pelvic exam.

Bottom Line: The annual pelvic exam should be a shared decision between doctor and patient. It is reasonable for women to ask their doctor whether a routine pelvic exam is necessary, and to ask for more information on the possible benefits and risks of the examination.


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