Archive for the ‘hormone deficiency’ Category

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.

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.

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 T, To Treat Or Not To Treat?

April 11, 2014

There’s controversy on the use of testosterone in men who suffer from low T. In this blog I would like to share the benefits of treating low T
from several thousand men who had symptoms of decreased testosterone.

About 40% of men older than 40 have low T. If you have low T, with symptoms that are decreasing your enjoyment of life, you need to weigh the risks and benefits of treatment. There could be a big upside to treatment.

Once you start low T treatment, you need to continue it or your testosterone level will drop back down.

The U.S. Food and Drug Administration has approved testosterone treatment for men with low testosterone and symptoms of low T, such as:
• Lack of sex drive
• Fatigue
• Weak bones
• Depressed mood
• Loss of muscle
• Erectile dysfunction (ED)

The Benefits of Treating Low T
If you meet the guidelines for treatment and you and your health care provider decide the benefits outweigh the risks for you, there are good reasons to treat low T.
Possible benefits you may experience include:
• Reduced weakness
• Less chance of falls and fractures
• Improved mental ability
• Improved sexual desire
• More energy
• Better quality of life
According to the American Urological Association, you may also experience:
• Better sleep
• Better erections
• Decreased body fat
• Increased muscle mass
• Stronger bones

Current Guidelines
The most up-to-date guidelines for when to treat low T are from the Endocrine Society. The guidelines say that low T should be treated if you have an early morning blood test that shows low testosterone and you have symptoms of low T.
The guidelines also list other medical conditions where the risks of low T therapy outweigh the benefits. The conditions include prostate cancer, sleep apnea, and heart disease.

Bottom Line: Millions of American men suffer from low T. Low testosterone on a blood test is not enough reason to treat low T. If you meet have symptoms of low T and have a blood test that confirms low T, the benefits can make treatment worthwhile.
If you have any questions about the management of low T, speak to your doctor.

What You Need To Know About Low T (Testosterone) and Heart Disease

March 27, 2014

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.

Testosterone Replacement Therapy (TRT) After Prostate Cancer Diagnosis

March 7, 2014

For nearly 50 years the medical profession has had the opinion that men with prostate cancer or at risk for prostate cancer should avoid testosterone as it was like adding gasoline to a fire. Well, that assumption has been reversed and there are certain men with prostate cancer who have symptoms of low testosterone, such as lethargy, falling asleep after meals, loss of muscle mass, and decreased libido, and who have documented low blood testosterone levels.
Testosterone replacement therapy (TRT) might be suitable for men with hypogonadism who also have a history of prostate cancer, but more research is needed, according to a group of Canadian and American scientists.

Typically, TRT is not considered for this population because exogenous testosterone is believed to stimulate the growth of prostate cancer cells. However, recent research has suggested that TRT might be safe for these men. Still, these studies have been small and the safety of TRT is still questioned.
This study took another look at this issue. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the researchers examined the prostate cancer-specific outcomes, disease-specific survival, and overall survival information for 149,354 men with prostate cancer. The men’s median age was 73 years. Less than one percent of the men (1,181) underwent TRT after their cancer diagnosis.

Testosterone was administered via injections or subcutaneous pellets. Men on TRT underwent a median of 8 years of follow up; for men who did not take testosterone, the follow-up median was 6 years. TRT was more common among men who had had radical prostatectomy and those who had well-differentiated tumors. TRT was less common among men on watchful waiting or active surveillance protocols.

Overall and cancer-specific mortality rates were higher among men who were not on TRT. Also, TRT was not associated with higher rates of salvage androgen deprivation therapy.
The researchers noted the following:
• TRT did not appear to raise the rates of overall or cancer-specific mortality. In fact, the men taking testosterone had fewer mortality events than those who were not on TRT. The researchers were not certain why this occurred and noted the need for more follow-up.
• The percentage of men using TRT was low and declined over time. In 1992, 1.24% of the men underwent TRT after prostate cancer diagnosis. By 2006, that rate fell to 0.40%. In contrast, the researchers pointed out that the prevalence of hypogonadism, for which TRT is often prescribed, is much higher, ranging from 2.1% to 25%, depending on the parameters used.
• Income and educational status were factors in TRT use. “Seemingly, educated young men of means are more likely to either seek out, be offered, or accept TRT than other men,” wrote the study authors.
They added, “As the effects of hypogonadism intensify with age, and as our understanding of hypogonadism and testosterone deficiency expands, improved access to testosterone replacement will be important for older, low-socioeconomic (SES) men with prostate cancer, should further studies corroborate TRT safety.”
In light of these results, the researchers concluded that TRT could be safe for men after prostate cancer diagnosis. However, they stressed the need for prospective studies to confirm their findings.

The study was published online in January in the Journal of Sexual Medicine.

Bottom Line: There are times when it is necessary to challenge old ideas and assumptions. This certainly applies to testosterone replacement therapy and men with prostate cancer. If a man has a stable PSA after treatment for localized prostate cancer, has symptoms of low testosterone, and a documented decrease in the blood testosterone levels, then hormone replacement therapy may be helpful.

Resources
The Journal of Sexual Medicine
Kaplan, Alan L., MD
“Testosterone Replacement Therapy Following the Diagnosis of Prostate Cancer: Outcomes and Utilization Trends”
(Full-text. First published online: January 21, 2014)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12429/full

Testopel for Hormone\Testosterone Replacement Therapy In Men

March 4, 2014

Millions of American men suffer from low T or decreased testosterone levels. The symptoms include a decrease in libido or sex drive, lethargy, decrease muscle mass, decrease in bone density, and even depression.

Treatment options include injections of testosterone, which can be done at the doctor’s office or by the man in his own home, testosterone gels, which are applied every day to the skin, and testosterone pellets or Testopel. Testopel is the only FDA-approved testosterone treatment on market designed to continually deliver testosterone for 4 – 6 months.
The three treatment options include injections of testosterone every two to three weeks, topical gels, and injections of pellets or Testopel under the skin which will last for 4-6 months.
The pellets are inserted under the skin using a local anesthetic. The procedure takes approximately 10-15 minutes for the insertion process. The procedure requires the creation of a small opening in the buttocks area and using a special insertion device to insert from 9-12 pellets. The number of pellets is dependent upon the testosterone level.

Testopel is contraindicated in men with an elevated PSA or who have an abnormal digital rectal exam.

Men have to discontinue the use of any blood thinners such as aspirin, Plavix, Coumadin, and even fish oil prior to the insertion of the pellets.
There is a small possibility that the pellets may exit the insertion site and that the insertion site may become inflamed and require the use of antibiotics.
There may be a small amount of pain at the injection site which can usually be controlled with Advil or Tylenol. The pain can also be reduced by applying ice to the insertion site.
It is important to understand that men receiving Testopel will need to monitor their PSA, blood counts, testosterone levels, and possibly his liver functions on a regular basis.
Men with breast cancer should not use Testopel. In patients with breast cancer, Testopel may cause elevated calcium levels in the blood.

Men who have or might have prostate cancer or have had an adverse reaction should not use Testopel .

Men treated with Testopel may be at an increased risk for developing an enlarged prostate and prostatic cancer.

Swelling of the ankles, feet, or body with or without heart failure may be a serious problem in patients treated with Testopel who have heart, kidney, or liver disease. In addition to your doctor stopping treatment with Testopel, your doctor may need you to take a medicine known as a diuretic

It is also a possibility that gynecomastia (enlarged breasts in men) frequently develops and occasionally persists in patients being treated for hypogonadism

Because Testopel pellets are placed under the skin it is more difficult for your doctor to change the dosage compared to medicines taken by mouth or medicines injected into the muscle (intramuscular injection). Surgical removal may be required if treatment with Testopel needs to be stopped.

In addition, there are times when the Testopel pellets may come out of the skin

While taking Testopel, your doctor may periodically do tests to check for liver damage. Your doctor may also check for increased red blood cells if you are receiving high doses of Testopel

Side effects of Testopel include more erections than normal or erections that last a long time, nausea, vomiting, changes in skin color, ankle swelling, changes in body hair, male pattern baldness, acne, suppression of certain clotting factors, bleeding in patients on blood thinners, increase in libido, headache, anxiety, depression, inflammation and pain at the implantation site and rarely anaphylactoid reaction (a sudden onset of allergic reaction)

Bottom Line: Androgen or testosterone deficiency is a common problem in middle age and older men. Help is available and Testopel is one solution.

Testosterone and Heart Disease – Facts & Caveats

January 30, 2014

I have received numerous calls from men who have symptoms of low testosterone, a documented decrease in their serum testosterone level, and who are receiving testosterone replacement therapy regarding a study that recently appeared in PLOS One.*

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “the ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from the norm. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, the doctor will recommend increasing the consumption of this necessary vitamin. These actions are what we do every day; we attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal. The unstudied/published issue is what is the target value? Most experts feel that there is no absolute “correct” value, but rather treatment is targeted at relief of symptoms.

There are more than 13 million men in the United States who reportedly suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

The study recently reported a study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre).
The results of this study in all subjects revealed the rate ratio (RR) for TT prescription was 1.36. In men aged 65 years and older, the RR was 2.19 for TT prescription. The RR for TT prescription increased with age from 0.95 for men under age 55 years to 3.43 for those aged ≥75 years. In men under age 65 years, excess risk was confined to those with a prior history of heart disease.
The study summary stated that in older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.

Some comments about the study:

No follow-up or research was done on whether or not the men on testosterone therapy achieved therapeutic levels or if they stayed on treatment. It is not accurate to assume that all men treated had their testosterone levels elevated by therapy.

There is no documentation as to whether or not Endocrine Association guidelines were followed, including morning testosterone level assessments and repeating the test at least once.

In closing, a larger study in the Journal of Clinical Endocrinology and Metabolism showed that among male veterans over 40, those on testosterone had lower rates of death than those that did not. This certainly makes sense, since hypogonadism is associated with metabolic syndrome, which is associated with an increased risk of heart attack, stroke, and death.

Finally, the International Consultation in Sexual Medicine (J Sex Med 2010;7:1608) concluded that:
• Low endogenous testosterone levels correlate with an increased risk for adverse cardiovascular events
• High endogenous testosterone levels appear to be beneficially associated with decrease mortality due to all causes, including cardiovascular disease and cancer
• Testosterone supplementation in men is relatively safe in terms of cardiovascular health
• Testosterone use in men with low testosterone leads to inconsequential changes in blood pressure, glycemic control and all lipid fractions.
Bottom Line: Low testosterone levels are associated with increased atherosclerosis. Most studies confirm that administration of testosterone to men has neutral effects on cardiovascular risk factors and cardiac events. For men with a history of heart disease, a careful discussion between the doctor and patient should take place.
*http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+(PLOS+ONE+Alerts%3A+New+Articles)

Testosterone And Heart Disease – Facts and Caveats

November 6, 2013

Like most urologists, endocrinologists, and cardiologists, I have received numerous calls from men who have symptoms of low testosterone, documented decrease in their blood testosterone level, and who are receiving testosterone replacement therapy about a study that appeared in a reputable medical journal that treatment with testosterone increases the risk of heart disease. (JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386).

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from normal. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, then the doctor will recommend increase the consumption of this necessary vitamin. These actions are what doctors do every day; they attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal.

There are more than 13 million men in the United States who suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

I would like to list several comments about the study that was reported in the recent Journal of the American Medical Association (JAMA).

Of nearly 7,500 guys who did not get extra T, about 1 in 5 had bad cardiovascular outcomes, including stroke, heart attack or death. In the more than 1,200 men who got testosterone, nearly 1 in 4 had those terrible problems, an increased risk of nearly 30 percent. A truly scientific study has similar number of study patients in each group, not 7500 in the control group and 1200 in the experimental group.
The researchers concluded that taking testosterone came with an increased risk of an adverse outcome. If a statistician would add up the actual reported events in the paper for each group and divide by the numbers of men in each group. What you will find is that the absolute risk of events (death, heart attack, or a stroke) was 10% in men treated with T and 21% in men not treated. That’s right- the risk was REDUCED BY HALF in men treated with T. So a closer scrutiny needs to be done before conclusions can be made and distributed to the media.
This is obviously the opposite of what the authors reported. They come up with absolute risk rates that are not explained by any numbers in their paper. They used a complex statistical analysis to get to their conclusions without showing the numbers it was based on.

That’s not the whole story, though. Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania wrote in an accompanying editorial: “The most important question is the generalizing the results of this study to the broader population of men taking testosterone ….” The take home message is not possible to generalize from this study to the entire population of men some of whom may have a low testosterone level.
That’s a very big caveat: By definition, all the men in the study were older than 60 and all had heart problems. It’s still not clear whether those same risks apply to younger, healthier guys.
“These were sick, older veterans,” Dr. Michael Ho, a cardiologist with the VA Eastern Colorado Health Care System who helped direct the study, said in an interview. Many were obese, had diabetes, and other ailments, he said. Obese men with diabetes and other co-morbid conditions are certainly at risk for heart disease, stroke, and even death.

Bottom Line: So what is a man who has low testosterone to do? I would suggest that they have a discussion with their doctor. If they have symptoms of low testosterone, and a documented level of low testosterone blood test, then the doctor and the patient have to weight the risks of testosterone replacement therapy versus the benefits. Certainly if the benefits outweigh the risks and the risks are composed of an older man with heart disease, diabetes, and other illnesses, then raising the testosterone level may not be in his best interest.

Sex Drive In The Tank? DHEA Is An Option

February 13, 2013

Women with a decreased sex drive or decreased libido now have treatments that can restore their interest and enthusiasm for sexual intimacy. Options include testosterone, yes the hormone produced in the testicles of men, but also produced in small amounts in women and is responsible for a women’s sex drive. Testosterone is available in pills, lozenges, patches, gels injections, and small rice-sized pellets inserted underneath the skin. Although there are advantages and disadvantages to each, most gynecologists and urologists will not prescribe pills, which can increase the risk of liver toxicity and lower levels of HDL (the “good” cholesterol).

A slightly “milder” alternative to testosterone is DHEA (dehydroepiandrosterone). This steroid hormone is converted to testosterone. Supplementary DHEA, which is available in pill or cream form, increases testosterone levels by one-and-a-half to two times. So it’s not surprising that DHEA provides many of the same therapeutic benefits, including increased sexual interest and enhanced physical and mental satisfaction.

If you think you might be a candidate for testosterone therapy, here’s what to do:
Have your testosterone, DHEA and estrogen levels measured. Normal concentrations of testosterone range from between 25 and 100 nanograms per milliliter of blood.
Eat a well-balanced diet to stabilize your hormones Fiber and foods rich in minerals, such as potassium and magnesium can help balance hormones. Tofu, tempeh and other soy products are excellent sources of phytoestrogens, plant compounds that behave like mild estrogens in the body, helping relieve menopausal symptoms. Other sources of phytoestrogens include apples, alfalfa, cherries, potatoes, rice, wheat and yams. A diet rich in fruits and vegetables will also help maintain optimal health as you transition into menopause.
If you begin androgen therapy, be sure to report any side effects, such as acne, deepening of your voice, go to your doctor so he or she can monitor your progress and decrease your dosage as necessary.

Bottom Line: Although it is not for everyone, emerging research may reveal androgen to be one of the most promising therapies available to menopausal women. Sexuality and vitality need not be passing pleasures of youth.

This was modified from “Testosterone: A Major Breakthrough for Menopausal Women”. This article appeared in Fit & Health and can be accessed at: http://health.howstuffworks.com/wellness/women/menopause/testosterone-major-breakthrough-for-menopausal-women5.htm


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