DHEA For Low T: Facts and Warnings

February 27, 2015

I have treated many men with low testosterone and many ask for a solution that does not involve testosterone replacement therapy. This blog will discuss the use of DHEA in men and how effective it may be for solving the symptoms of low T.

DHEA is a hormone that is naturally made by the human body. It can be made in the laboratory from chemicals found in wild yam and soy. However, the human body cannot make DHEA from these chemicals, so simply eating wild yam or soy will not increase DHEA levels.

Athletes and other men use DHEA to increase muscle mass, strength, and energy. But DHEA use is banned by the National Collegiate Athletic Association (NCAA).

DHEA is also used by men for erectile dysfunction (ED) and in men who have low levels of testosterone in order to improve well-being and sexuality.

Like many dietary supplements, DHEA has some quality control problems. Some products labeled to contain DHEA have been found to contain no DHEA at all, while others contained more than the labeled amount.

How does DHEA work?
DHEA is a “parent hormone” produced by the adrenal glands near the kidneys and in the liver. In men, DHEA is also secreted by the testes. It is changed in the body to a hormone called androstenedione. Androstenedione is then changed into the major male hormones including testosterone.

DHEA levels seem to go down as people get older. Some researchers think that replacing DHEA with supplements might prevent some diseases and conditions.

DHEA is Possibly Effective for:
• Aging skin. Some research shows that taking DHEA by mouth increases the thickness and hydration of the top layer of the skin in elderly people. Early research shows that applying DHEA to the skin for 4 months improves the appearance of skin.

DHEA has Insufficient Evidence for:
• Aging. Taking DHEA does not seem to improve body shape, bone strength, muscle strength, insulin sensitivity, or quality of life in people older than 60 who have low DHEA levels.
• Hormone deficiency in men (partial androgen deficiency). Early research suggests that taking 25 mg of DHEA daily for one year might improve mood, fatigue and join pain in older men with hormone deficiency.
• Physical performance. Some research shows that older adults who take DHEA have improved measures of muscle strength. However, other research has found no effect of taking DHEA on muscle strength.
• Sexual dysfunction. Evidence on the effectiveness of DHEA for sexual dysfunction is inconsistent. Taking DHEA by mouth for 24 weeks seems to improve symptoms including erectile dysfunction and overall satisfaction in men. However, it does not seem to be helpful if erectile dysfunction is caused by diabetes or nerve disorders.
• Weight loss. Early evidence suggests that DHEA seems to help overweight older people who are likely to get metabolic syndrome to lose weight. It is not known if DHEA helps younger people to lose weight.

Bottom Line: DHEA is probably not a panacea for low T or a treatment for ED or erectile dysfunction.

Androstenedione: Is It Safe and Effective?

February 27, 2015

I am often asked by men if taking androstenedione is a substitute for testosterone in those who have symptoms of low T and don’t want to take testosterone.

Androstenedione (ASD) is a steroid hormone used by the body to make testosterone and estrogen. Studies on men taking 100-300mg\day have not shown any increase in muscle strength, muscle size, or lean body mass when used for 2-3 months in connection with weight training. ASD does not increasing energy or improve sexual desire and function.

In addition to not being effective ASD is POSSIBLY UNSAFE for most men when taken by mouth. Some side effects experienced by men include reduced sperm production, shrunken testicles, painful or prolonged erections, breast development, behavioral changes, heart disease, and others. ASD can increase the chances of getting cancers of the breast, prostate, or pancreas; and it is poisonous to the liver. Certainly if you have liver disease, don’t take ASD. Even if you don’t have liver disease, it’s best to get liver function tests if you take androstenedione.

Bottom Line: ASD has not shown to be helpful for men with low T or symptoms of low T. ASD may also be dangerous to your health and probably should be avoided by men with low T.

50 Shades of Sex In the Golden Years

February 24, 2015

So many seniors think that after sixty sexual intimacy goes into the tank. This is hardly the case as an interest in intimacy and sexual activity continues throughout life even in the golden years. Our society tends to have ageist concept of intimacy, portraying sex among seniors as inappropriate or unnatural. The truth is that many seniors, both men and women, continue to be sexually active and are interested in meeting others with whom they can become intimate. There is documentation that 70% of men and 35% of women continue to be sexually active over the age of 70. This blog will discuss sex and the senior and what you can do if you are having problems with sexual intimacy in your senior years.

While most long-married individuals reported steady declines in sexual activity, those who passed the 50-year marriage mark began to report a slight increase in their sex lives.

And notably, frequency in the sex lives of long-married couples continued to improve. The study, published last month in The Archives of Sexual Behavior, researchers noted that an individual married for 50 years will have somewhat less sex than an individual married for 65 years.

The analysis of this study showed that the warm glow after the 50-year marriage mark, although flickering, was steadier than that of those in marriages of shorter duration. The researchers are sociologists at Louisiana State University, Florida State University and Baylor University.

Sexual frequency doesn’t return to two to three times a month, but it moves in that direction, which was reported by the investigator from LSU.

But the finding that some long-married couples continue to have sex decade after decade was not news to Jennie B., an 82-year-old widow who lives in a village in upstate New York. She married her first and only husband, Peter, in 1956, when they were in their mid-twenties. The couple, married 47 years, remained sexually active until he had quintuple heart bypass surgery two years before his death in 2003.

In this snapshot study of older adults, some were not having sex at all. And a few were even having sex daily. But in the main, the study looked at trends. The average older adult who had been married for a year had a 65 percent chance of having sex two to three times a month or more. At 25 years of marriage, the likelihood of that frequency dropped to 40 percent. If the marriage lasted 50 years, the likelihood was 35 percent. But if the marriage — and the lifespan — of the older adults continued, at 65 years of being together, the chance of having sex with that frequency was 42 percent.

And so, as adults age, their social circles shrink, they know time is limited, they look around and what do they see? Each other. Seniors will often place intimacy as a high priority.

I might add that seniors often engage in intimacy without having intercourse but that intimacy can occur with touching, holding hands and kissing is often just as satisfying and gratifying as sexual intercourse which occurs at an earlier age.

Bottom Line: Sex after sixty is an activity that is normal and should be encouraged. It may take a little creativity and it may take a little more planning and effort but it can happen and both partners feel a sense of enjoyment and pleasure.

Recommended Reading 30 Lessons for Loving, by Karl Pillemer, PhD.

Perhaps even 50 Shades of Grey!

Warning Signs of Low T (testosterone)

February 21, 2015

Millions of American men suffer from low T or low testosterone. Often they suffer in silence and not aware that there are treatment options for this common condition. This blog will discuss some of the most common symptoms that are associated with low T. In the next blog I will discuss the treatment options.

Men like to make jokes about testosterone, but testosterone deficiency is no laughing matter. The latest research suggests that men without enough of the hormone face a higher risk of several serious illnesses, including diabetes, osteoporosis, and cardiovascular disease. A simple blood test can reveal whether a man has low T.

Testosterone is what fuels a man’s sex drive. If a man is low on T, he’s likely to have a decrease or loss of his libido. Testosterone is what’s responsible for a man’s sex interest. For men with low testosterone, it’s significantly deficient or completely absent.

A testosterone deficiency can cause significant medical problems, including diabetes, osteoporosis and heart disease Three parts of a man’s body work together to produce the sperm-containing fluid that’s released when a man ejaculates. A man with waning testosterone may notice a sharp decline in his volume of his ejaculate. Men with low testosterone often complain of feeling numbness in their penis and scrotum. They may not be completely numb, but a touch of the penis or scrotom fails to elicit that feeling of electricity needed to spark sexual encounters – and make sex so pleasurable. It’s perfectly normal for a man to feel tired at the end of a busy day. But men with low T feel completely depleted. These men complain of being more tired than they think they ought to be. They seem to run out of gas in the late afternoon or early even. They often remark that “My tank is empty.”

Decreased energy level
In addition to feeling severe fatigue, guys with low testosterone often lose their drive and initiative. Guys who used to be up and at ‘em all day long are sidelined on the sofa.

Even if they’re not experiencing clinical depression, men with low testosterone often feel down or blue. They feel less optimistic than they used to feel.

Low testosterone can cause guys to be irritable. Sometimes the problem is more apparent to partners, friends, family members and colleagues – than to the men themselves

It’s not like they become weaklings, but men with low testosterone often feel that they’re not as strong as they once were. Some men actually notice shrinkage in their arm and leg muscles, and in their chest. And if they try to build muscles with weight-lifting, they often find it frustratingly difficult to build muscle mass.

Low testosterone often results not only in reduced muscle mass, but also in increased body fat. Some men add weight around the middle. Others develop gynecomastic, a.k.a as breast development.

Low testosterone can cause them to shrink a bit and feel softer than normal.

The good news about low testosterone is that it’s easily treated – commonly with testosterone skin gels or under-the-skin pellets that release testosterone slowly. And in addition to helping resolve problems with sexuality, mood and appearance, testosterone therapy can help protect men against several serious medical problems, including diabetes, osteoporosis, and cardiovascular disease.

Bottom Line: Testosterone deficiency can affect millions of American men. This blog has provided some of the common symptoms of low T and in the next blog I will discuss treatment options.

Everything You Wanted to Know About Low T (Testosterone) But Afraid To Ask

February 21, 2015

Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.

Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.

The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.

My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Obesity
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
Hormonal disorders
Infections

What is the treatment for low testosterone (Low-T)?

Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.

Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.

Injections: Testosterone can be delivered by direct injection.

Pellets: Pellets can be implanted into the soft tissue and release the testosterone.

I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.

Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Skin reactions
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.

Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.

In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.

Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.

Low T-Is Clomid a Solution For Men Who Wish To Have Children?

February 19, 2015

I am now seeing many younger men with low testosterone levels who have symptoms of lethargy, decreased libido, and problems with their erections. Upon further testing, many of these men are found to have low testosterone levels or low T. This blog will discuss the use of Clomid for the management of younger men with low T levels.

Whether you are a 30, 50, 80 or even 110 year old man, having low testosterone levels (hypogonadism) is neither fun nor healthy. The symptoms of low testosterone in men range from lack of energy, depressed mood, loss of vitality, muscle loss, muscles aches, low libido, erectile dysfunction, and weight gain.
Low testosterone in men may be caused by problems in the testes (or gonads). This is called primary hypogonadism and can be brought on by the mumps, testicular trauma, or testicular cancer, etc., and is often treated with testosterone replacement therapy.

Traditionally, if low testosterone is diagnosed, testosterone replacement therapy is prescribed, and it most commonly comes in the form of a cream, gel, pellet, patch, and by injection. And although these types of therapy are effective, some methods are better than others, and there are side-effects with all of them. For example, testicular shrinkage, gynecomastia (breast enlargement), low sperm count/sterility, and polycythemia (overproduction of red blood cells) are common side-effects of testosterone replacement therapy.
However, specifically due to the risk of sterility and low sperm count, such testosterone treatments aren’t a good option for men who want to have children. In these young men, clomiphene citrate (or Clomid) and/or human chorionic gonadotropin (HCG) have been used for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help stimulate the testes to produce testosterone and thereby increase testosterone levels.

Clomid works by stimulating the pituitary gland to make more LH and there is an increased production of testosterone by the testes. HCG works by mimicking LH, which also increases the release of LH to produce more testosterone in the testes. I caution you that using testosterone in a young man wishing to have more children does the opposite of what clomiphene and HCG do and can shut off the release of LH and thus affect the testicles production of testosterone and affect sperm production.

With traditional testosterone replacement therapy, the brain (hypothalamus and pituitary) gets the message that there is plenty of testosterone being made in the testes, so much so that it doesn’t need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases, which is why traditional testosterone replacement results in testicular shrinkage and low sperm count. Clomiphene citrate and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some hypogonadal men require continuous use of clomiphene, for others it can be used for a 3-6 month time period and then discontinued. And, the checks and balances system is not interrupted, so there aren’t the testosterone replacement side-effects which may occur with tstosterone injections, gels, or pellets.
The 5 Main Reasons Clomiphene Citrate (Clomid) May be a Good Alternative to Testosterone Replacement Therapy in Men with Low Testosterone Due to Secondary Hypogonadism:
1. Clomiphene citrate stimulates the body’s own production of testosterone
2. Clomiphene citrate doesn’t interfere with the body’s checks and balances of testosterone
3. Clomiphene citrate comes as a pill easily administered by mouth
4. Clomiphene citrate is generic and very cheap
5. Clomiphene citrate has little side-effects and low risk of developing these side-effects

Bottom Line: Clomid is a treatment option in young men with low T who wish to continue to have children.

Low T (Testosterone) May Mean No Baby

February 19, 2015

I am often seeing men with symptoms of low testosterone levels who are still planning to have children. These men need to know that the standard treatment of hormone replacement may not apply to those men who are still interested in having children. This blog will discuss the management of men with low T and who wish to continue to have children.

Testosterone replacement therapy (TRT) can bring your testosterone levels back to normal and restore your sex drive.
But if you want to have children, there’s one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you’re on it.
Testosterone replacement therapy has a profound impact on a man’s reproductive potential.

Approximately 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you’re not going to increase fertility.

Testosterone, the hormone produced in the testicles, plays an important role in making sperm. Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count. When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods such as pellets placed under the skin. Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don’t make more testosterone, your sperm production goes down.
Therefore, a low sperm count makes it harder to conceive a child. My advice is that if you have any kind of reproductive goal, you should not be using TRT.

If you have low testosterone, one way to improve sperm count is with gonadotropin injections. This stimulates the production of sperm. It may be considered as a way to increase a man’s fertility when your partner are having trouble conceiving a child.
It’s standard practice to check a man’s sperm count when a couple has difficulty getting pregnant. If your sperm count is low, the next step is to measure your testosterone. If it’s below normal, we can then inject the signal to produce more testosterone by giving a gonadotropin.

You should also make sure to follow a lifestyle of regular exercise and a healthy diet if you want to father a child. Overweight and obese men tend to have lower testosterone levels because excess belly fat converts testosterone to estrogen, another hormone that can impact sperm production. Shedding those extra pounds will likely have a positive effect on your fertility. Losing weight can definitely increase testosterone.

Bottom Line: If you have symptoms of low testosterone levels or if you have an abnormal sperm count, hormone replacement with testosterone is not the treatment of choice. You should consider gonadotropin injections as a solution.

Read This To See About Low T (Testosterone)

February 19, 2015

Low testosterone affects millions of American men. Men who suffer from low testosterone have decreased libido, decrease in erections, and lethargy or loss of energy. In this blog I will discuss the importance of testosterone and the treatment options for the diagnosis of low T.

What Is Testosterone and Why Does It Decline?
Testosterone is a hormone produced in the testicles. It’s what puts hair on a man’s chest and responsible for his beard. It’s the force behind his sex drive.
During puberty, testosterone helps build a man’s muscles, deepens his voice, and boosts the size of his penis and testes. In adulthood, it keeps a man’s muscles and bones strong and maintains his interest in sex. In short, it’s what makes a man a man (at least physically).
After age 30, most men begin to experience a gradual decline in testosterone about 1% a year. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of interest in sex is simply due to getting older.
The diagnosis of low T is made by a history of the symptoms of low T and a simple blood test that checks the testosterone level. The test is best done in the morning before 10:00 A.M. when the hormone level is the highest.

The bottom of a man’s normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL. A lower-than-normal score on a blood test can be caused by a number of conditions, including:

Injury to the testicles
Testicular cancer or treatment for testicular cancer
Hormonal disorders
Infection
HIV/AIDS
Chronic liver or kidney disease
Type 2 diabetes
Obesity
Some medicines and genetic conditions can also lower a man’s testosterone score. One of the most common drugs associated with low T are the SSRIs which are used to treat depression. Aging does contribute to low scores. In some cases, the cause is unknown.

Risks and Benefits of Testosterone Treatment?

There are also risks. Testosterone treatment can raise a man’s red blood cell count as well as enlarge his breasts. It can also accelerate prostate growth. Men with breast cancer should not receive testosterone treatment. These are uncommon side effects of testosterone treatment.

Men with prostate cancer who have symptoms of low T and have a low and stable PSA can receive testosterone treatment, however, they need to have a PSA and digital rectal exam every 1-2 months while receiving testosterone replacement.

The treatment with testosterone is safe as long as men receive careful monitoring.

Treatment options for low T include injections of testosterone given every two to three weeks, the daily application of gels under the arm or on the abdomen or lower thighs, and pellets inserted under the skin in the doctor’s office which last for 4-6 months.

Bottom Line: Low T is common. Help is available. See your doctor and get a blood testosterone level and if it is low consider hormone replacement therapy.

Over the Counter Cold Medicine Can Leave You With More Than A Stuffy Nose

February 17, 2015

Millions of Americans purchase over the counter cold medication to control the symptoms of stuffy nose and a dry cough. However, these OTC medications are not without their precautions. This blog will cover some of the most common OTC cold preparations and what are the caveats before using these not so harmless drugs.

Acetaminophen and liver damage. Acetaminophen, which is found in Tylenol, which can suppress a headache can be associated with fatal liver damage. The maximum safe daily dose is 3000 milligrams. If you use large quantities of acetaminophen, stay away from alcohol. Also take the lowest dose that brings relief. Also many medications contain acetaminophen, so you may be taking more than you realize.

Ibuprofen, ulcers, kidney problems. Ibuprofen, which is in Advil and Motrin, is a nonsteroidal anti-inflammatory drug that relieves mild aches and pains. Ibuprofen increases the risk for a a heart attack or stroke, especially if you already h ave heart disease or high blood pressure, you smoke, you have diabetes or you use it long term. If you use ibuprophen, avoid alcoholic beverages. Call your doctor if develop blood or black stools; if you experience changes in the frequency of urination; or if you have problems walking or with your vision or speech.

Decongestants and high blood pressure. Decongestants found in Triaminic, Afrin nasal spray and Dimetapp Cold Drops relieve nasal congestion by reducing swelling and constricting blood vessels in the nose, allowing you to breathe more easily. These decongestants may cause blood pressure to spike and interfere with the effectiveness of prescription medication to control blood pressure. If you have a heart condition, high blood pressure, diabetes, glaucoma or an overactive thyroid, speak to your doctor before using decongestants.

Antihistamines and falls. Antihistamines found in Benedryl and Chlor-Trimeton, can relieve the symptoms of runny nose. However, they make users sleepy and contribute to falls and hip fractures especially in the elderly. If you have glaucoma, an enlarged prostate gland, breathing problems, high blood pressure or heart disease, you may have worsening of symptoms and probably should avoid antihistamines.

Combination medications and heart problems. OTC combinations of acetaminophen with the decongestant phenylephrine (Contac) can bring on irrgullarg heartbeat, high blood pressure and tremors. I suggest that you use a single ingredient medication.

Bottom Line: Many OTC medications are safe if used properly and with precaution in men and women who have certain conditions such as heart disease, high blood pressure, prostate gland problems, or glaucoma, these medications are probably safe.

Erectile Dysfunction High Cholesterol? Statins An Option For ED

February 16, 2015

ED affects millions of American men and many of these men have high cholesterol levels which causes narrowing of the blood vessels all over the body including the blood supply to the penis. Now there is evidence that statins, drugs used to lower the cholesterol level, may offer help for men with ED. statin – not only to improve their quality of life but also to reduce their future cardiovascular risk.

The study from treated men with high cholesterol levels and a history of ED with statins 6 months and the men had improvement in their sexual health-related quality of life and reduced their risk of heart disease.

A greater benefit was seen in men with severe ED treated with statins who had improvements of 12% versus 5% in men who did not receive a statin.
Improvement in erectile function (on the International Index of Erectile

Bottom Line: If you have either ED or an elevated cholesterol level, speak to your doctor about using a statin, which not only improves your quality of sexual life but also reduces your future cardiovascular risk.


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