Low T-Review of New York Times Editorial, March 28, 2017

March 29, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.

Testosterone Replacement-Relationship With Heart Disease

March 27, 2017

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

Non-Medical Solution For GERD-Heartburn

March 26, 2017

Millions of Americans suffer from heartburn, indigestion, or GERD, an acronym for gastro esophageal reflux. This is a condition where acid stomach contents backwards from the stomach into the lower esophagus which is the tube from the mouth to the stomach. GERD is also associated with a dry cough, sore throat, hoarseness, burping, abdominal bloating, and difficulty swallowing. The symptoms are often accentuated when a man or woman lies down which allows the acid stomach contents to go backwards into the esophagus producing the burning and pain associated with GERD.

Many who suffer from GERD take medications called proton pump inhibitors. These medications while preventing GERD also cause nutrient deficiencies, joint pain, infections, heart attacks, and even dementia.

Nearly 15 million Americans use proton pump inhibitors. However, there are non-medical solutions that don’t require the medications and don’t expose those with GERD to the side effects of the medications.

One of the risk factors for GERD is obesity. Those men and women who have a BMI or body mass index greater than 30 are twice as likely to experience GERD. Therefore, weight loss is one of the best and easiest ways to decrease GERD and not use any medication.

Other risk factors include smoking and excessive use of alcohol. Both alcohol and nicotine in cigarettes relax the muscles between the stomach and esophagus and allow the acid contents of the stomach to go backwards into the esophagus. Consequently, discontinuing the use of cigarettes and limiting the alcohol especially in the evening will help alleviate the symptoms of GERD.

Simple solutions include avoid eating large quantities of food at one time as this distends the stomach and causes the acidic content to reverse direction into the esophagus. Consider having five or six small meals a day instead of the standard three large ones. I suggest avoid exercising soon after consuming a meal. Also, if you experience GERD when laying down, then raise the head of the bed by six to eight inches.

Next in order of non-medical treatment of GERD is diet. Certain foods like coffee, onions, garlic, acidic fruit juices like grapefruit and orange juice, and chocolate are likely to precipitate GERD. Another caveat is to avoid high fat foods as they take time to digest and remain in the stomach for longer periods of tie. I recommend natural, unprocessed foods, especially lean protein foods like poultry, fish, egg whites, and low fat dairy products, whole grans, and non-acidic vegetables and fruits. High fiber foods are also helpful. I suggest consuming a pound of vegetables a day, half of which are cooked and the other half eaten raw as well as a pound of raw fruit a day. This will add ample amounts of fiber to your diet.

Bottom line: GERD is a common condition that is often treated with medication, i.e., proton pump inhibitors. I suggest you try these non-medical solutions first before considering the use of medications.

Non-Medical Solutions to Raising Your Low T Level

March 23, 2017

I am often asked by patients what can a man do to raise his testosterone level without taking testosterone replacement therapy?  Here are a few suggestions that may be helpful.

  1. Exercise and lift weights

If you want to increase your testosterone levels, you will need to increase your exercise frequency. Regular exercise will not only help you by preventing different lifestyle related health problems, but it will also help you by boosting your testosterone levels. Men who regularly exercise have a higher testosterone levels. Even elderly men will also have higher testosterone levels if they regularly exercise.

  1. Reduce stress and cortisol levels

If you are suffering from long-term stress, it can increase the levels of cortisol hormone. If your cortisol levels are high, testosterone levels will decrease.

That’s why, you need to reduce stress as much as possible and which will also decrease the cortisol levels in your body. Regular exercise, whole foods, good sleep, balanced lifestyle and laughter can help you to reduce stress and also improve your overall health.

  1. Get more Vitamin D

Vitamin D offers several health benefits and it boosts testosterone naturally. If you consume just 3,000 IU of vitamin D3 per day, it can increase testosterone levels in the body by 25%.

You can get more vitamin D by increasing your exposure to sunlight regularly. You can also take a daily supplement of 3,000 IU of a vitamin D3 supplement.

4. Get Enough Sleep.

A lack of sleep affects a variety of hormones and chemicals in your body. This, in turn, can have a harmful impact on your testosterone.

The time honored goal is try for 7 to 8 hours per night.

5. Keep a Healthy Weight.

Obesity can have a deleterious effect on your testosterone levels.  Exercise and diet can improve your testosterone and also is good for your heart to avoid obesity.

6. Review Your Medications.

Some medicines can cause a drop in your testosterone level. These include: pain medications, steroids (prednisone), anabolic steroids such as those used by athletes and body builders, and anti-depressants.

7. Deep 6 the Supplements.

You may be bombarded with unsolicited snail mail and E –mail offering testosterone boosting supplements such as DHEA.  Let the truth be told, you are wasting your money as these supplements will not boost your testosterone.

Bottom Line:  Although these suggestions are helpful, they are just a step in the right direction.  For more information about testosterone replacement therapy, speak to your physician.

Diet and Exercise May Reduce Risk of Cancer

March 23, 2017

There isn’t a day that goes by that the Internet or the print media isn’t bombarding readers with a new diet that prevents cancer.

Every day, there are headlines that bombard readers with various diets that purportedly prevent cancer: “The Diet That Stops Cancer” and “Eating Your Way Out of Cancer.” But what do the hard data really say about lifestyle choices preventing cancer?  Studies have shown that the combination of healthy eating, not smoking, and regular exercise can reduce the risk of heart disease by 80 percent and of stroke and some cancers by 70 percent.

Although no diet has received conclusive evidence of presenting cancer, there are lifestyle choices such as exercise that support conclusions that they can serve as deterrent of cancer.  Even the American Cancer society recommends avoid being overweight and includes being physically active for at least 30 minutes every day.  They also suggest eating a mostly plant-based diet; limiting red meats and avoiding processed meats; limiting alcoholic drinks (two glasses of wine a day for men and one glass for women); and to protect against cancer (Table 1). Other recommendations include avoid sugary drinks, limit consumption of processed foods and eat more vegetables, whole grains, and legumes such as beans.  Limit salt intake to 1.5 grams per day and limit consumption of salty foods, chips, pretzles, smoked or cured meats like salami, baloney, and beef jerky.

Other Cancer Prevention Recommendations

To prevent breast cancer, the ACS recommends at least 150 minutes of moderate-intensity physical activity per week, alcohol intake of one or fewer drinks per day, and maintaining a body mass index (BMI) less than 25 kg/m2. In a study of 2905 women at high-risk for breast cancer, adherence to these three recommendations reduced the risk for breast cancer by 44%.

Perhaps this shouldn’t be all that surprising, given that BMI itself is a risk factor for cancer. Too much body fat triggers insulin resistance, raising levels of insulin and growth factors that promote cancer. Fat also increases estrogen production, which can fuel some cancers, and fat secretes enzymes that promote inflammation.

Numerous medical studies have concluded that avoiding adult weight gain confers protection against certain types of cancer, particularly among nonusers of hormone replacement therapy (HRT). The study found that for each 5-kg increase in adult weight gain, the relative risk was increased 11% for postmenopausal breast cancer among no or low HRT users; 39% and 9% for postmenopausal endometrial cancer among HRT nonusers and users, respectively; and 13% for postmenopausal ovarian cancer among no or low HRT users. For each 5-kg increase in men, the risk for colon cancer increased by 9%. The relative risk for kidney cancer comparing highest and lowest level of adult weight gain was 1.42.

In addition to lowering the risk of cancer, eating a diet that is high in fruits and vegetables is associated with a lower risk for all-causes of death and lower risk of dying of cardiovascular causes such as heart disease or stroke.

Bottom line on diet and exercise and cancer prevention:  Weight gain, lack of exercise, and high alcohol intake are the key factors for leading a healthy lifestyle and decreasing the risk of cancer.

 

 

The Semen Analysis: There’s Even an App for That!

March 23, 2017

The first examination for male infertility is a history followed by a physical exam.  Next comes the semen analysis, where a single drop of seminal fluid is examined under the microscope.  The semen is examined for the number of sperm, the motility of the sperm, and the shape of the sperm.  This test is performed after 48 hours of abstinence and the cost is $75-$150 depending on the sophistication of the lab performing the test.

Soon it is possible to have an accurate sperm count in the privacy of your home and will be as easy as a home pregnancy test.

Researchers have developed a device costing less than $5 to make that attaches to your cellphone and provides a quick and easy semen analysis. The results in early testing are just as accurate as the elaborate computer-assisted semen analysis machines costing tens of thousands of dollars in measuring sperm concentration, sperm motility, total sperm count and total motile cells.

The device uses an optical attachment for magnification and a disposable microchip for handling the semen sample. With two lenses that require no manual focusing and an inexpensive battery, it slides onto the smartphone’s camera. Total cost for manufacturing the equipment: $4.45, including $3.59 for the optical attachment and 86 cents for the microfluidic chip that contains the semen sample.

The software is designed with a simple interface that guides the user through the test with onscreen prompts. After the sample is inserted, the app can photograph it, even create a video of the sperm motility and report the results in less than five seconds. The test results are stored on the phone so that semen quality can be monitored over time.  The results can be shared with the medical professional who is evaluating the man\couple for infertility.

Another application of the app is for men who have had a vasectomy and need to be certain that there is absolutely no sperm in the ejaculate following the procedure.  With this app, a man can perform his own semen analysis at home and email the result to the urologist to confirm permanent sterility

The Food and Drug Administration hopefully will approve the device within the next two years.

Bottom Line: Technology is making medical care easier and can be accomplished without being face to face with the doctor or even having to go to the doctor’s office.  This is the way modern medicine is going to be practiced.  Welcome to the new age of medical care.

Puff The Magic Spray That Makes Your Night Time Urination Go Away

March 13, 2017

Sleep is so important for good health. Nothing destroys a good night’s sleep than getting up multiple times a night to urinate. Nocturia is the medical term for excessive urination during the night. Most people don’t need to wake up during the night to urinate and can sleep uninterrupted for six to eight hours. 1 in 3 adults over the age of 30 make at least two trips to the bathroom every night. And while the majority of those who are significantly affected with nocturia are usually over the age of 60, it can happen at any age.

Women generally experience nocturia as a consequence of childbirth, menopause, and/or pelvic organ prolapse. In men, nocturia can be directly attributed to an enlarged prostate gland.

Additional factors that can contribute to nocturia in both sexes include: Diuretic medications, caffeine, alcohol, overactive bladder, excessive fluids before bedtime, or fluid redistribution as may occur in men and women with heart disease.

Sometimes nocturia may be a symptom of a greater problem. Certain conditions can cause urine to be passed in the evening and during sleep. Such conditions include diabetes mellitus, high blood pressure, heart disease, vascular disease, restless leg syndrome and insomnia.

The treatment of nocturia may be as simple as a few lifestyle changes.

Naturally, limiting the intake of fluids in the evening results in a decreased amount of urine produced at night.

After noon naps of 20-30 minutes help reduce fluid build up by allowing liquid to be absorbed in the bloodstream. When awakening from a nap, you can use the bathroom and eliminate excess urine.

Elevating your legs like naps, helps redistribute fluids so it can be reabsorbed into the blood stream.

Compression stockings create an effect similar to elevating your legs. Elastic stockings exert pressure against the leg while decreasing pressure on the veins. This allows fluids to be redistributed and reabsorbed into the bloodstream.

Medications to treat nocturia

Different medicinal options exist to alleviate and even treat nocturia. These may be used alone or combined with some of the behavioral modifications listed above, which has been proven to be more effective. A word of caution about medications: Used alone, studies have confirmed that the medication works only as long as it is taken. Once off the medication, relapses are quite common.

Anticholinergic medications (Vesicare, Ditropan, Enablex) are prescription medications that are effective for treating nocturia associated with bladder over activity. The main side effects with anticholinergic medications are dry mouth, dizziness, and blurred vision.

Another drug, Mybetriq, is helpful as it relaxes the bladder at night and allows the bladder to hold more urine.

If this first line drug therapy is considered ineffective, one or more of the following may be prescribed.

Desmopressin or  vasopressin, is a nasal spray that works on the kidneys to reduce urine production at night. Noctiva is taken daily, approximately 30 minutes before going to bed. The U.S. Food and Drug Administration today approved Noctiva (desmopressin acetate) nasal spray for adults who awaken at least two times per night to urinate. Noctiva is the first FDA-approved treatment for this condition.

Bottom Line: Nocturia can be a debilitating problem for many people as it creates chronic sleep impairment. However, with proper management, motivation, and dedication this condition can be overcome for a better quality of life.

The Month of March Means Time For the Prime Cut – Vasectomy

March 8, 2017

Vasectomy remains one of the easiest and cost effective methods of permanent contraception. Many men opt for the outpatient procedure during the month of March so they can chill out and stay glued to the TV for March Madness the month-long college basketball tournament.

In the past few years, there’s an annual spike of vasectomies of approximately 10% in men getting the prime cut shortly before the nationally-televised tournament begins.

The idea is that, with weeks of games to catch up on, they’ll have plenty to keep them occupied and distracted while they recuperate on the sofa for a few days.

I perform the no-scalpel, no-needle vasectomy in my office. The procedure is usually accomplished in 15 minutes. A single, small, less than 1\4 inch opening, is created on the scrotum using a local anesthetic that does not require a needle to render the skin free of any pain or discomfort. The procedure consists of dividing the vas or the tubes located in the scrotum that transports sperm from the testicles to the ejaculation fluid that exits the penis at the time of orgasm. The vas ends are sealed with tiny clips or sutures. By dividing the vas, no sperm can reach the seminal fluid (semen), which is ejaculated from the penis during sex. Since there is no sperm in the semen, a woman’s egg can’t be fertilized – and the procedure has nearly 100% success rate. Most men will not feel any pain during the procedure. In most cases the small opening requires no sutures and the opening will close within 1-2 days after the procedure.

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in his ejaculate volume, since sperm make up only a tiny part of the semen.

Many men ask what happens to the sperm produced by the testicles. Because the sperm cannot come out after the vas deferens is cut, like other dead body cells, the sperm disintegrate and are reabsorbed by the body.

After the procedure, men are instructed to go home and lay flat in bed and apply an ice pack or a pack of frozen peas on top of the scrotum for 30 minutes of each hour. However, many will feel some minimal discomfort for a couple of days after the procedure. Most men can return to all activities including sexual intimacy within 5-7 days after the procedure

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in a man’s ejaculate volume, since sperm make up only a tiny part (less than 5%) of the semen.

The procedure does not affect the hormones produced in the testicle (testosterone) and therefore, there is no impact on a man’s virility or libido. The only change is in his fertility!

Bottom Line: Vasectomy is an effective and nearly painless means of contraception. So if you want to watch NCAA basketball games in peace and quiet, talk to your doctor about a vasectomy. It’s a cut above the rest!

Give a High Five to High PHI-Prostate Health Index.

March 4, 2017

For the past 20 years the PSA has been the metric for screening for prostate cancer. More recently the U.S. Preventive Services Task Forces issue a recommendation against the use of PSA-based screening for prostate cancer in all men because PSA screening contributed to over treatment and over diagnosis of prostate cancer.

The prostate health index (PHI) was approved by the FDA in 2012 as a blood test that calculates a score based on the combination of three separate tests” PSA, free PSA and p2PSA. These simple blood tests will help determine the probability of finding prostate cancer if you have a prostate biopsy.

PHI should be considered for men with PSA levels >3, who have not had a prostate biopsy as well as for me who had one prior negative prostate biopsy and who might be considered at higher risk for prostate cancer.

The PHI helps to distinguish between prostate cancer and benign prostate diseases like benign enlargement of the prostate gland and prostate infection. The PHI improves the diagnosis of prostate cancer with men who have a PSA between 2-10 where 4.0 is the cut off currently considered for men who should have additional studies, evaluations, or a prostate biopsy.

The PHI enhances the ability to detect prostate cancer in men with a normal physical examination and in men whose PSA is between 2-10. The PHI has helped to decrease the number of men who are subjected to a prostate biopsy, which leads to over diagnosis and over treatment.

Also the PHI can be used in men who have received a diagnosis of prostate cancer and have been placed on an active surveillance protocol, which means no treatment but regular examinations with a digital rectal exam and a blood test. Men followed on the active surveillance protocols who have a low PHI score can be followed without treatment. On the other hand, those with an elevated PHI score may be advised to have a repeat biopsy and consider for definitive treatment. Thus the PHI helps the patient and the doctor determine if the man has more aggressive prostate cancer and needs additional treatment.

Bottom Line: Prostate cancer is most common cancer in men after skin cancer and the second most common cause of death after lung cancer. Now there are blood tests like the PHI that help fine-tune the diagnosis and help men decide to participate in close follow up or proceed to a prostate biopsy.

February 13, 2017

HCG And Testosterone: Double Bang For Your Sex Drive Buck

If you find that your sex drive is in the tank, you have difficulty with erections, that Viagra, Levitra, and Cialis which once worked, are no longer effective, then you may be suffering from low T or low testosterone.  The diagnosis is easily made from a blood test.

If you are like most men, you will find that your manhood and confidence level comes from the area between your belly button and your knees, i.e., your “package”.  It is there in the testicles which are are responsible for making testosterone, the male hormone associated with so many functions including sexual activity, energy level, muscle mass, and even your mood.

Not only does testosterone control so many of these functions, so does hCG or human chorionic gonadotropin.  hCG stimulates the gland at the base of the brain, the pituitary gland to produce more LH or luteinizing hormone (LH) to encourage the testicles to release more testosterone. hCG can be injected and administered to stimulate the right dose of healthy testosterone production.

The benefits of hCG for men include boosting healthy levels of testosterone that’s needed for every biological process to ensure optimal health. Correcting low testosterone levels by using hCG for men can bring on many benefits for men which include:

  • Increase red blood cells
  • Support the cardiovascular system
  • Increases flow of blood and oxygen
  • Healthy body hair growth
  • Weight loss, reduction of fat mass
  • Increased energy levels, endurance, and performance
  • Increase in lean muscle mass and muscle strength
  • Reduced risks of obesity
  • Improved oxidation in the groin area
  • Increase in libido
  • Improved penile growth due to oxidation
  • Proper stimulation to continue boosted sexual desire
  • Proper stimulation to improve endurance and sexual performance
  • Reduced risks of erectile or other sexual dysfunctions
  • Increase in bone density
  • Reduced risks of arthritis-related conditions

 Although hCG is both safe and effective for females and males to use, there are possible side effects that you should be aware of. These include:

  • light-headedness
  • nausea
  • headaches
  • mild fatigue
  • irritation at injection site

More serious side effects are rare and are normally associated with incorrect use of hCG but can include:

  • Swelling of breast tissue in males
  • Depression, irritability and other mood changes
  • Swelling of feet or ankles
  • Early onset of puberty in young boys

Bottom Line: It is crucial to discuss treatment with your doctor to determine if the benefits of using hCG therapy outweigh the possible side effects you may experience and to ensure correct dosing and application of the hCG.