Archive for the ‘hormone replacement therapy’ Category

Body Builders Using “Juice” Beware!

March 30, 2017

I don’t know of any physicians who would condone the use of anabolic steroids in men with normal testosterone levels whose only complaint is desire to increase their muscle mass or their athletic performance.  The use of anabolic steroids in young men is fraught with danger and can result in permanent hormone deficiency and permanent infertility.

Testosterone was first identified in 1935 as responsible for its masculinizing effects along with the effect of increasing lean muscle mass.

However, recently the illicit use of performance enhancing drugs has become an issue for athletes and those men wishing to increase their athletic performance, their strength and muscle mass.   It is estimated that there are 3 million anabolic steroid users and abusers.  And now we have found that nearly 5-6% of middle and high school students have or are using anabolic steroids.

These anabolic drugs are now identified to negatively affect the pituitary glands hormones that stimulate the testicle to produce testosterone and result in prolonged reduction of natural testosterone production and even permanent decrease in testosterone production for many months and even permanently in men who have used and abused anabolic steroids.  Most men will return to baseline natural production of testosterone in 1-2 years after discontinuing the use of anabolic steroids.

There are numerous reports of profound suppression of testosterone in nearly half of all men who have used anabolic steroids.  Because anabolic steroid can have a profound reduction in sperm production, men should understand the consequences of anabolic steroid use.  That is, if they want to father a child, they need to stay farther away from anabolic steroids.

Bottom Line: Anabolic steroid abuse can affect a man’s production of testosterone and may cause permanent reduction in testosterone production by a man’s testicles.  I suggest that all men who might consider using anabolic steroids to take this into consideration before making a bad choice that may affect their health and well being forever.

 

Advertisements

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

January 28, 2016

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.

Testosterone Safety In Men Receiving Hormone Replacement Therapy

August 10, 2015

The medical literature states that one of the adverse effects of testosterone replacement therapy is increased in the red blood cell count or polycythemia. The increased red blood cell count increases the viscosity or thickness of the blood and makes men amenable to clots forming in the lower extremities. These clots can break loose and go to the lungs and cause a medical emergency

Middle-aged and older men undergoing testosterone replacement therapy aren’t at increased risk of these fatal clots.

Researchers studied 30,572 men 40 years of age and older who were enrolled in one of the country’s largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. They identified 7,643 cases, defined as men diagnosed with deep vein clots or pulmonary embolism at any time during the study period who received at least one prescription for an anticoagulant to prevent clots from reforming.

Exposure to testosterone therapy within 15 days of the event/index date wasn’t associated with increased risk of VTE (adjusted odds ratio, 0.90), nor were any of the routes of administration that the authors examined—topical, transdermal, or intramuscular. The finding extended to men who received therapy 30 or 60 days before the VTE diagnosis.

Bottom Line: I still recommend that men who are receiving testosterone replacement therapy have their red blood cell count checked every six months. If the red cell count is too high, I suggest that the man cut his dosage or decrease the frequency of testosterone replacement therapy. I still believe that testosterone is effective in men who have symptoms of low testosterone and have documented evidence of a low blood level of testosterone.

Menopause or Andropause-Not the “Pause” That Refreshes Either Women or Men

July 19, 2015

Around age 50 women have a drop in their hormones and enter into menopause. At about the same age men start experiencing a decrease in testosterone occurs. This is the male hormone that is responsible for sex drive, muscle mass, bone strength, and even erections. This condition in men is referred to as andropause and it affects millions of American men.

The symptoms of andropause include hot flashes, fatigue, night sweats, mood swings; all the fun things that females going through menopause may endure. Men lose one percent testosterone for every year past 30 but usually don’t develop symptoms until age 50. As testosterone decreases, estrogen increases. Abdominal fat causes excess estrogen and low levels of testosterone may also lead to prostate problems. Ever wonder why suddenly you are gaining weight around the middle? It could be your hormone levels are unbalanced.

The diagnosis is easily made with a blood test to measure the testosterone level. Men more than 50 years of age should also have a digital rectal exam to check their prostate gland and a PSA test which is a screening test for prostate cancer. Treatment options include testosterone replacement therapy. This can be administered with self injections of testosterone, topical gels, or the insertion of testosterone pellets under the skin.

Bottom Line: Testosterone deficiency in middle age and older men affects millions of American men. The diagnosis is easily made and effective treatment is available. You don’t have to suffer this common condition. Help is available. See your doctor.

Myths and Misinformation On Prostate Cancer

June 10, 2015

Prostate cancer is the second most common cancer in men, following lung cancer, with 250,000 new cases discovered each year. There are many areas of confusion about prostate cancer. Let me debunk a few of these myths.

Myth 1: Prostate cancer surgery will end your sex life and cause urine leakage.
Fact: Your surgeon may be able to spare the nerves that help trigger erections. Then you will probably be able to have an erection strong enough for sex again. But it may be a while. Recovery can take from 4 to 24 months, maybe longer. Younger men usually recover sooner.
If you still have trouble, ask your doctor about treatments for erectile dysfunction. Cialis, Levitra, and Viagra are common medications that can help. Your doctor will tell you if these are right for you.

Other prostate cancer treatments, such as radiation and hormone therapy, also can affect your sex life. Urine leakage may occur after surgery, but it’s usually temporary. Within a year, about 95% of men have as much bladder control as they did before surgery.

Myth 2: Only elderly men are at risk of prostate cancer.
Fact: Prostate cancer is rare for men under 40. If you are concerned, ask your doctor if you need to get tested earlier. Age isn’t the only factor. Others risk factors include:
Family history. If your father or brother had prostate cancer, your own risk doubles or triples. The more relatives you have with the disease, the greater your chances of getting it.
Race. If you are African-American, your risk of prostate cancer is higher than men of other races. Scientists do not yet know why.
You may want to discuss your risks with your doctor so you can decide together when you should be tested for prostate cancer with a screening PSA test and a digital rectal examination.

Myth 3: All prostate cancers must be treated.
Fact: You and your doctor may decide not to treat your prostate cancer. Reasons include:
Your cancer is at an early stage and is growing very slowly.
You are elderly or have other illnesses. Treatment for prostate cancer may not prolong your life and may complicate care for other health problems.
In such cases “active surveillance” may be an option to consider. This means that your doctor will regularly check you and order tests to make sure your cancer does not worsen. If your situation changes, you may decide to start treatment.

Myth 4: A high PSA score means you have prostate cancer.

Fact: Not necessarily. Your PSA could be high due to an enlarged prostate or inflammation in your prostate. The PSA score helps the doctor decide if you need more tests to check for prostate cancer. Also, your doctor is interested in your PSA score over time. Is it increasing, which could be a sign of a problem? Or, did it decrease after cancer treatment, which is great.

Myth 5: If you get prostate cancer, you will die of the disease.
Fact: You’re likely live to an old age or die of some other cause. That doesn’t mean checking for prostate cancer is not important. Most men with prostate cancer die with the cancer and not from it.

Bottom Line: I hope this article puts the perspective of prostate cancer back in its proper perspective. The diagnosis is common and help is available for most men with prostate cancer.

Low Testosterone and Sexual Problems From Pain Pills

May 4, 2015

Men with chronic pain in any location but commonly for low back pain who use potent analgesic (Oxycontin, Percocet, Oxycodone) medication are at risk for lowering the testosterone level or the hormone produced in the testicles that is responsible for sex drive or libido. Consequently some men who use pain medications for a long period of time may have sexual problems, lethargy and fatigue.

Narcotic pain tablets such as Percocet™, Oxycodone™, Roxycodone™ and Oxycontin™ come with severe adverse side effects associated with narcotics addiction.

Adverse Effects of Long Term Pain Pills (Opiates)
Narcotic Pain Pills (opioids) are highly addictive with severe adverse effects related to drug withdrawal. Opiate containing narcotic pain pills are highly effective for short term use for pain, but were never intended for long term use. Over time, these drugs cause profound suppression of the endocrine system, and in men, profound inhibition of testosterone production.

Low Testosterone Goes Largely Unrecognized
Although quite common, opioid-induced androgen deficiency and has gone largely unrecognized by the medical profession. Low testosterone is caused by opioid drug inhibition of LH (Luteinizing Hormone), a pituitary hormone involved in testosterone production, as well direct inhibition of testosterone production, itself. Similarly, there is also inhibition of the entire endocrine system, and adrenal hormone suppression. Symptoms of low testosterone include fatigue, depression, hot flashes, night sweats, diminished libido, erectile dysfunction, and diminished sexual arousal and satisfaction. Men may also develop osteoporosis, anemia, and diminished muscle mass.

These drugs also have a negative impact on women. Women who consume opioid-pain pills will stop having menstrual cycles and will notice greatly diminished libido (sex drive).
Testosterone Treatment Effective and Recommended by Mainstream Medicine
Administration of both topical (transdermal) testosterone and injectable testosterone has been studied and found effective for men with low testosterone on pain pills.

Opiate Detoxification Program is Essential
The reality is that hormone supplementation and nutritional supplementation for the long term opiate pain pill user is only a temporary band aid. To fully restore health, the opiate addiction must be addressed and the patient must ultimately get off the pain pills. Drug withdrawal may be difficult because of severe drug withdrawal symptoms. Therefore, we refer the patient to a center that specializes in narcotics detoxification, and urge the patient to strongly consider this option.

Bottom Line: Opioid pain medication is helpful for short term use. However, use of these addicting drugs for chronic pain can result in sexual problems in both men and women. For those who have sexual problems, consider seeing a pain management specialist, find alternative methods of pain relief, and using testosterone replacement therapy.

Using Hormone Therapy To Reduce Recurrent UTIs in Women

April 13, 2015

Women often experience recurrent UTIs after menopause. The cause is often a result of reduced estrogen levels that is so common after menopause. This blog will discuss the use of topical estrogens to reduce the frequency to recurrent urinary tract infections.

Topical hormone replacement therapy (HRT) was associated with a lower incidence of urinary tract infections (UTIs) compared with both oral HRT or even no HRT.

UTIs are a frequent problem among postmenopausal women necessitating antimicrobial use, and resistance is increasing. Every year, 8–10% of postmenopausal women have 1 episode of a urinary tract infection; of these, 5% will have a recurrence in the next year.

Studies have demonstrated use of oral estrogens does not reduce the incidence of UTIs, but topical HRT reduced the number of UTIs in two small studies.

To determine whether a difference existed in incidence of UTIs in women 60–75 years of age, a study compared the number of UTIs per patient per year over 1 year in 3 groups of postmenopausal women: topical HRT, systemic HRT, and control (n=75 per group).
Women aged 60–75 years with a history of UTI (n=448) were identified from retrospective charts (2011–2013). Patients were excluded if they were taking antibiotics for UTI prophylaxis, treated with antibiotics for reasons other than UTI for 2 or more weeks, were on both topical and systemic HRT, or on chronic methenamine hippurate.
The number of UTIs per patient per year was significantly different among the 3 groups. There was a significant difference between topical HRT and systemic HRT, and topical HRT and control, but not systemic HRT and control. The control group had an average of 1.24 UTIs per patient per year, compared with 1.01 in the systemic group and 0.65 in the women who used topical estrogen replacement.

Bottom Line: Topical estrogens may be beneficial when other preferred agents cannot be utilized.

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.

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.

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.