Testosterone and the Prostate Gland-Hormone Replacement Is Safe For Your Prostate Gland

I am also asked if using testosterone, injections, topical gels, or pellets, will worsen urinary symptoms in men suffering from testosterone deficiency.

Millions of Americans suffer from testosterone deficiency.  They have symptoms of loss of energy, erectile dysfunction, loss of libido, loss of muscle mass, and emotional mood swings.  The diagnosis is easily made with a testosterone blood test.

A recent review finds no evidence that testosterone replacement therapy causes or worsens urinary tract symptoms or increase the size of the prostate gland.

Although the Endocrine Society and other associations have suggested severe urinary symptoms as a contraindication to TRT treatment, investigators found little evidence to support it worsening urinary symptoms in men using testosterone replacement therapy.

The investigators discovered that men with mild urinary sympmtoms experienced either no change or an improvement in their symptoms following TRT.

Remarkably, the study explained that the therapy may actually improve voiding symptoms.

Bottom Line:  Testosterone replacement therapy is safe in men with urinary symptoms and will not worsen those symptoms but may actually improve their symptoms.

Source

Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, and Seftel A. The Relationship Between Testosterone Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology S0090-4295(15)01053-3. doi:10.1016/j.urology.2015.11.006.

Update on ED-When It Is Dead Down There

ED is the inability to achieve and maintain a normal erection adequate for penetration that impacts the intimate relationship between partners.  There are nearly 30 million American men suffering from ED.

ED may occur under various circumstances ranging from diabetes, hypertension, prostate gland surgery, spinal injuries, neurological and emotional problems.  There are times when there is no identifiable cause. However, it’s far more frequently seen in diabetics and to some extent in those with cardio vascular diseases, hypertension and peripheral vascular disease. The effect on the blood vessels leading to poor blood flow seems to be the primary reason.

People suffering from ED should carry out assessment of blood sugar, cardio vascular evaluation, measurement of hormones like testosterone and prolactin. A psychological evaluation will often benefit those who suffer from performance anxiety. Depression is often seen as an accompanying factor of erectile dysfunction in many people especially when there is no other identifiable cause. A detailed evaluation of a man’s medication is also important. Smoking and excessive drinking are both known to have significant adverse impact on erectile dysfunction.

Alcohol is a depressant, and using it heavily can dampen mood, decrease sexual desire, and make it difficult for a man to achieve erections or reach orgasm while under the influence.

According to the U.S. Centers for Disease Control and Prevention, CDC, moderate drinking is no more than two drinks a day for men (and one drink a day for women). The liver can only break down the amount of alcohol in about one standard-size drink an hour, so regularly drinking more than that means that toxins from alcohol can build up in your body and affect the blood vessels supplying the penis.

Heavy drinking can lead to temporary erectile dysfunction. This is because pre-sex drinking decreases blood flow to the penis, reduces the intensity of your orgasm, and can dampen your level of excitement.  Also, Long-term erectile dysfunction has been linked to chronic heavy use of alcohol. In fact, studies show that men who are dependent on alcohol have a 60 to 70 percent chance of suffering from sexual problems. The most common of these are erectile dysfunction, premature ejaculation and loss of sexual desire.

Bottom Line:  ED is a common problem affecting millions of American men.  Help is available.  If you or one you love is suffering from ED, speak to your doctor.

PSA Testing-What Every Man Needs to Know

Prostate specific antigen is a simple blood test that can be a metric for prostate health.  It is a good screening test for prostate cancer.  This blog will discuss the PSA test and what you need to know to make a decision to obtain this common test.

Let’s start by reassuring men that having an elevated PSA level does not necessarily mean you have prostate cancer.

PSA is also likely to be increased with benign enlargement of the prostate gland as well as prostate infections or prostatitis.

It is important to emphasize that the PSA test is not a specific prostate cancer test, but it is a vital first step in screening for the potential presence of cancer.

The other factors that can cause PSA levels to rise:

• Age: PSA levels can increase gradually as you age
• Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
• Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
• Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
• Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
• Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days. That is why I usually recommend that men refrain from sexual intimacy for 48 hours prior to PSA testing
• Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter inserted into the blader, a prostate biopsy, or a cystoscopy which is a look using a lighted tube through the urethra (tube in the penis that transports semen and urine) can increase the PSA temporarily.

A PSA level of less than 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of prostate cancer.

I point out that there is a familial or inherited basis of prostate cancer and also an increased risk of prostate cancer in African-American men.  In these men who are are at a greater risk of prostate cancer, I suggest annual testing with a digital rectal examination and a PSA test after age 40.  For all others, I suggest testing begin at age 50.

For men who have an elevated PSA test, then a discussion with the doctor about repeating the test in a few weeks or proceeding to an ultrasound examination and a prostate biopsy is in order.

Bottom Line: PSA testing is a non-specific test used to screen for prostate cancer.  Not all elevations of the PSA test indicate cancer.  Further testing and close monitoring as well as a prostate biopsy is in order.  For more information, speak to your doctor.

Preventive Health For All Men

Do you know that most men spend more time taking care of their cars or planning a vacation than they do taking care of their health?  In the U.S., women live 5-7 years longer than men.  I believe one of the reasons is that women seek out regular medical care throughout their entire lives.  They see a obstetrician during child bearing years; they get regular mammograms; they obtain routine PAP smears and other preventive health measures for their entire lives.  Men, on the other hand, stop seeing a doctor around age 18 and never see the inside of a medical office until middle age.  During that time they can have high blood pressure, elevated cholesterol levels, diabetes, and prostate diseases.

But there are some things men, in particular, should keep in mind when it comes to maintaining their health:

Heart disease and cholesterol

According to the Centers for Disease Control and Prevention, about 200,000 people die each year from preventable heart disease and strokes, with men being significantly more at risk than women.

Men should begin screenings for these issues in their mid-30s.

Annual health examinations should begin at around age 50.  This should include a test for anemia, a cholesterol level, a chest x-ray if the man is a smoker, a PSA test for prostate cancer, and a blood pressure determination.

For those men with an elevated cholesterol level, they can lower the level by adhereing to  a healthy diet consisting less heavy in red meats and carbohydrates, and limiting alcohol consumption, i.e., 2 drinks\day. Men of all ages should also continue to stay physically active by incorporating aerobic activities, i.e., any activity that increases the heart rate for 20 minutes 3-4 times a week, into their lifestyle, as well as strength training.

Prostate health

There is some debate among health care professionals about when men should begin screening for prostate cancer. The U.S. Preventive Services Task Force and the CDC recommend against screening unless men begin experiencing the symptoms associated with prostate cancer. These include frequent urination, especially at night, pain during urination and difficulty fully emptying the bladder.

Prostate screening can begin earlier in life, around age 40, if there is a high risk for prostate cancer, such as family history, or bothersome lower urinary tract symptoms.

Testosterone

As men age, lowering testosterone levels can become another area men should monitor.  Significantly low testosterone levels can predispose a man to low bone mineral density with subsequent bone fractures, erectile dysfunction (impotence) and low energy levels.

Testing for testosterone levels is done through a blood test.

Bottom Line: these are the minimal preventive care that all men should consider around age 30-40.  Remember if it ain’t broke don’t fix it, may apply to your car, but not to your body.  You need to take preventive measures with your body just as you do with your automobile.

Pelvic floor exercises for men

Historically, pelvic floor exercises, have been recommended for women with urinary incontinence.  However, doctors have discovered that these same exercises are useful for men as well.  This blog will discuss the use of pelvic floor exercise for men.

The muscles of the pelvic floor not only hold organs in place, but they are also important for bladder control. Because these muscles often weaken with age, men are advised to exercise them regularly by doing pelvic floor exercises in order to maintain their continence of urine as well as having improvement in their sexual functioning.

What are the pelvic floor muscles?

The muscles that support the organs in the pelvic area are known as pubococcygeus or pelvic floor muscles. These muscles are like a trampoline or sling that stretches along the bottom of the pelvic area from the pubic bone in the front to the tail bone (or coccyx) at the back, as well as from side to side between the sitting bones. In men, they support both the bladder and the bowel, with the urethra (the tube carrying urine from the bladder) and the rectum (back passage) passing through the muscles. Pelvic floor muscles are also important for erectile function, and they work with other muscles to help stabilise the back. 

Why exercise the pelvic floor muscles?

The pelvic floor muscles naturally stretch and weaken with age, which can gradually make them less efficient. The muscles can also be weakened in men who often strain to empty their bowels – such as having constipation on a regular basis – who have a chronic cough, bronchitis or asthma, who perform tasks that involve repeated heavy lifting, and who are overweight or generally unfit. Having surgery for an enlarged prostate gland can cause the pelvic floor muscles to weaken, as can neurological damage such as from a stroke, diabetes, multiple sclerosis or a spinal injury.

Weak pelvic floor muscles in men can lead to stress urinary incontinence, in which small amounts of urine leak when pressure is placed on the bladder – for example, when bending forward, sitting, coughing or laughing – or urge incontinence, when there is an urgent need to urinate more often. You may leak just a few drops of urine, have a dribble after you finish urinating or leak a steady stream of urine. Weak pelvic floor muscles can affect erectile function too.

However, in a similar way that you can strengthen the muscles of your arms or legs through exercise, you can also strengthen your pelvic floor muscles.

These exercises are also recommended for men prior to having surgery for an enlarged prostate or prostate cancer to help improve their bladder control. They are also recommended for men who experience chronic pelvic pain syndrome – performing the exercises when pain starts can help to interrupt a cycle of pain-spasm-pain.

How can you find your pelvic floor muscles?

Before you start doing pelvic floor muscle exercises, it’s important to find the correct muscles to ensure you are exercising them. The next time you urinate, stop urinating mid-stream and concentrate on the muscles that allowed you to do this – these are also the same ones you use to prevent passing wind. Once you have emptied your bladder (don’t stop the flow mid-stream more than once), try contracting the same muscles – you should notice the base of your penis rising towards your tummy and see your testicles move up as you contract the muscles.

Another way to find your pelvic floor muscles is to sit comfortably or lie down, ensuring the muscles of your abdomen, thighs and buttocks are relaxed. Now, tighten only the muscles that control your back passage as if you are trying to avoid passing wind for a few seconds, then relax.

To ensure you aren’t squeezing other muscles, try squeezing your pelvic floor muscles again and:

• Rest your hand on your tummy – you should not feel your abdominal muscles tighten
• Pay attention to your breath – if you are holding your breath, you are using your chest muscles; try to breathe normally while squeezing your pelvic floor muscles
• Sit in front of a mirror – if you notice your body moving up and down, even slightly, you are squeezing your buttocks
• Watch your thighs – their muscles should be relaxed without noticeable movement in the upper legs. 

How should men do pelvic floor exercises?

Now that you’ve identified your pelvic floor muscles, simply contract them, squeezing and drawing up the muscles around your urethra and back passage at the same time, and holding them for a count of 5, then release the muscles slowly. By doing this simple technique, you have just flexed your pelvic floor muscles. Don’t hold your breath, and make sure you are not working other muscles such as those in the buttocks, thighs or abdominal area.

Wait a few seconds before repeating the technique, doing a set of 8-10 squeezes using strong slow contractions, then follow with one set of 8-10 quick rapid contractions. Repeat this sequence 4-5 times a day. Once you find it easy, you can increase the count for longer, up to 10 seconds. However, take care you don’t over-exercise the muscles and cause muscle fatigue towards the end of the day, thereby increasing urine leakage.

It will take 4-6 weeks before you notice any improvement, but after about 3 months you should experience the full benefit of doing pelvic floor exercises. At this point, you can change your routine to doing pelvic floor exercises twice a day.

If you have problems with incontinence or have recently had prostate surgery, you may be referred to a specialist who will help train you in how to do the exercise correctly and establish a program based on the strength of your muscles.

Pelvic floor exercises take very little time and can be done while sitting, standing, lying down or walking. Because others will not notice the muscles moving, you can do them discreetly during your everyday activities, such as while on a bus or train, sitting in a car, even standing in a queue – the main thing is to get into a routine of doing them every day. Try getting into the practice of doing them at the same time, such as when brushing your, after urinating, when commuting home from work or during advert breaks while watching the TV in the evening.

Bottom Line:  Pelvic floor exercises aren’t just for women but men can also benefit from these exercises.  Men should consider doing these exercises that don’t require any equipment, very little time, and have very effective results.

At Last a Reversible Vasectomy At the Touch of a Button

Clemens Bimek is a German inventor of a device to control the sperm flow through a flipping switch.

The device is implanted through surgery and attached to the vas deferens. The device is equipped with a valve which is closed and opened as desired through the skin on the scrotum.

If the valve is in the off position sperm cells are prevented from reaching the seminal fluid. This allows ejaculation no sperm is present in the seminal fluid.

The procedure basically works as a vasectomy. But in comparison with a vasectomy which is only reversible through microscopic surgery the new device makes it reversible with a flip of the switch.

I believe that clinical trials in humans are underway. Until now the only men who tested the device is the inventor.

At the present the inventor is satisfied with his device so he plans to implant it to 25 men during a clinical trial this year and if everything goes well the device will hopefully get on the market by 2018.

As new information becomes available on this device, I will post a blog on what I find out.

Sex and the Senior or Senior Sex

It is not a myth that seniors engage in sexual intimacy or wish to enjoy intimacy perhaps just as much as younger men and women. However, intimacy like many other physical and social interactions that occur as men and women get older. This blog will discuss simple suggestions for seniors to have enjoyable and more fulfilling sex life.

Start your intimacy by engaging your mouth or your communication skills before engaging in sex. You should be able to communicate your thoughts, fears, and desires with your partner. Be frank with your partner and encourage them too to be open with you. Holding back or hiding certain things will only dampen your spirits and diminish your performance.

Be open to new ideas and experiment

Just because you are growing old, doesn’t mean you can’t expand your horizons. Be open to new ideas and discuss them freely with your partner. Don’t hesitate and put your creative mind to use. If erectile dysfunction is an issue for you, try sex with the woman on top, as hardness is less important. If you are used to having sex in the evening, try the morning and visa versa.

Eat right and exercise

High blood pressure and cholesterol can cause the vascular problems that lead to trouble with your erections. It is important to maintain a healthy lifestyle by exercising and keeping your weight and cholesterol in check.

Avoid large quantities of alcohol and smoking

It’s no news that both alcohol and smoking can hinder a man’s ability to achieve an erection. If you are having sexual difficulties, consider abstaining from smoking and alcohol.

Sex does not always mean intercourse

You need to broaden your definition of sex. Holding each other, gentle touching, cuddling, kissing, and sensual massage are also ways which will fulfill you. Try oral sex or masturbation as substitutes to intercourse.

Know when to visit a doctor

Your doctor can help you manage chronic conditions and medications that affect your sex life. If you have trouble maintaining an erection, ask your doctor about treatments. If you have vaginal dryness, see your doctor as help is available.

Be optimistic

You need to maintain a positive approach when it comes to these sensitive issues. Having said that, you need to be realistic too to accept the changes that your body is going through. But nevertheless, accept these natural changes with confidence.

Bottom Line: Sex is enjoyable at any age. Seniors enjoy sexual intimacy just as younger men and women do. You need to know that you can be successful as a senior both in and out of the bedroom.

2016 Update of Peyronie’s Disease (PD)

PD is a health issue in which a scar or plaque forms under the skin of the penis. Most of this plaque builds up leading to a curved erection, which can make intercourse difficult or painful for a man and his partner. PD is thought to impact about 6% of men between the ages of 40 and 70 years of age. This may be an underestimate as many men are too embarrassed to seek help or report the problem to their physician.

Doctors do not know what causes PD or how to prevent the disease before it starts. We do know that PD runs in the family. We also know that forceful sexual activity causes minor injuries to the penis that may initiate the process of scar formation. The disease is not related to a sexually transmitted disease or is a source of cancer.

The symptoms of PD include a curvature of the penis. A man may also be able to feel one or more hard lumps on the penis. Men may also experience painful erections and the man’s partner may also complain of vaginal pain or discomfort.

The treatment options for PD include watchful waiting, non-surgical treatments, and surgery. Watchful waiting is appropriate for a man with a minimal curvature that does not cause pain or impede sexual intimacy. Injection therapy includes the use of interferon\verapamil\collagenase drugs directly into the plaque, which may dissolve the plaque. Surgical options include straightening surgery or plication. The plaque can also be removed the defect repaired with a graft of human tissue or synthetic disuse. Finally the plaque can be removed and a penile prosthesis inserted. (See my website, http://www.neilbaum.com, for more information on Peyronie’s Disease and the use of a penile prosthesis)

Bottom Line: Peyronie’s disease is a common urologic disorder. It is a source of potential pain and discomfort. Help is available and most men can achieve relief from the disabling curvature.