There’s More To Testosterone Replacement Than Meets the Eye

Today, it is very common for middle aged men to have symptoms of low testosterone.  Many times these men will complain of decreased libido and decrease in their erections.  The treatment is hormone replacement therapy.  In addition to improving your libido, there are other advantages to hormone replacement therapy.  This blog will discuss the other benefits of testosterone replacement therapy.

Breast Formation. Male breast formation, also known as gynecomastia, is a source of anxiety for most men when they start to sprout. Men can form breasts during infancy, adolescence, old age, or anywhere in between. It all start with lowered testosterone and increased estrogen levels. Male breasts can be reduced or removed through gynecomastia surgery, but in other cases a simple adjustment of body sex hormone levels may be enough to provide the change desired.

Bone Density. Men start to lose bone mass as testosterone levels go south.  The same thing happens to women (though by a different mechanism), and typically starts to be noticed during old age. However, the groundwork for bone strength  starts in young adulthood, when your body starts to store calcium that will last for the rest of your life. If you don’t have sufficient testosterone, you can’t form bones that are strong enough to last until you die. Get tested for testosterone now to learn about how your health will be as you age.

Libido and Sexual Development. Testosterone has an enormous impact on secondary sex characteristics like body hair, but it’s absolutely central to sexual desire and performance. If you are having trouble with sexual intimacy, you may need to get checked for testosterone. Many men have seen improvement that changes their lives for the better after getting testosterone replacement therapy, without ever having to resort to pills for erections like Viagra, Levitra, Cialis.

Red Blood Cell Formation. Red blood cells are necessary for oxygen transportation in the body.  Testosterone increases the red blood cell production.  However, it is important to check the red blood cell count every 4-6 months if you are using testosterone replacement therapy as too high a level of red blood cells can be harmful.  Therefore, it is imperative to have a testosterone level, a PSA test (a screening test for prostate cancer), and a red blood cell count on a regular basis if you are using testosterone replacement options.

Bottom Line:  If you are middle age and complain of lethargy, weakness, loss of muscle mass, and alternation of your moods, then you may have testosterone deficiency.  The diagnosis is easily made with a simple blood test.  Treatment consists of injections, topical gels, patches and even small rice-sized pellets inserted under the skin.  For more information speak to your doctor.

FAQs on Erectile Dysfunction

It often is a mystery about men are able to achieve and hold an erection.  Even more mysterious is what are the causes of failure of erections and to fix the problem.  It is not uncommon for me to feel uncomfortable broaching the topic with their physician.  Fortunately, after the introduction of oral medication to treat impotence or erectile dysfunction in 1999, men are talking about their problems in the bedroom with their physicians.

In this blog I will discuss some of the most frequently asked questions about ED and the treatment for this common condition that impacts over 14 million American men.

1. Why does Viagra fix the problem?

An erection requires an increase in the blood supply to the penis and more blood has to rush into the chambers of the penis than comes out of the penis.  When this happens, an erection will occur. Viagra helps blood vessels relax and increases the blood supply to the penis.

2. Does the male hormone, testosterone, have a role in the erection process?

Testosterone acts on a series of different areas of the body to enhance bone development, muscle growth, sexual interest and function. Testosterone is primarily responsible for the libido or sex drive.  The testosterone level slowly decreases at a rate of about 1% a year starting around 25.  By middle age, most men start experiencing signs and symptoms of testosterone deficiency and men often need hormone replacement therapy.  This can be accomplished with injections, topical gels, or pellets of testosterone inserted under the skin.

3. Why does sex feel good?

There is a high concentration of nerve endings in the penis and vagina, which triggers stimulation and orgasm. Dopamine is triggered and there is a pleasant feeling in the brain during ejaculation. It could also be an evolutionary thing. When we were cavemen with only animal instincts, the fact that sex feels good encouraged us to reproduce to keep the species going.

4. Do sexually transmitted disease cause erectile dysfunction?

Gonorrhea and chlamydia are both sexually transmitted diseases that are caused by direct and unprotected sexual contact. Both STDs live in reproductive genital tracts of men and women and can be cured with antibiotics. If both STDs go untreated, it can lead to infection that will lead to infertility in men but usually does not cause erectile dysfunction.

5 Why does sex hurt?

The obvious reason is if the man’s penis is much larger than a woman’s vagina opening. The other possibility is that women have a decrease in lubrication of the vagina and the friction is a source of pain and discomfort usually for the men but also for the male partner as well.

Bottom Line:  Impotence is a common condition especially in middle age or older men.  Treatment is available and most men can be helped.  Talk to your doctor.

Drug Treatment For Prostate Cancer

Many man will require drug treatment for prostate cancer.  Some of the drugs lose their effectiveness and need to have additional therapy.  This blog will discuss drugs that are used to stop the effect or the production of testosterone which is a necessary hormone for prostate cancer growth.

Drugs that stop androgens from working

Anti-androgens

Androgens have to bind to a protein in the cell called an androgen receptor in order to work. Anti-androgens stop androgens from working by binding to the receptors so the androgens can’t.

Drugs of this type, such as flutamide (Eulexin®), bicalutamide (Casodex®), and nilutamide (Nilandron®), are taken daily as pills.

Anti-androgens are not often used by themselves in this country. An anti-androgen may be added to treatment if orchiectomy, an LHRH analog, or LHRH antagonist is no longer working by itself. An anti-androgen is sometimes given for a few weeks when an LHRH analog is first started to prevent a tumor flare.

Anti-androgen treatment may be combined with orchiectomy or LHRH analogs as first-line hormone therapy. This is called combined androgen blockade (CAB). There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH analog alone. If there is a benefit, it appears to be small.

Some doctors are testing the use of anti-androgens instead of orchiectomy or LHRH analogs. Several recent studies have compared the effectiveness of anti-androgens alone with that of LHRH agonists. Most found no difference in survival rates, but a few found anti-androgens to be slightly less effective.

In some men, if hormone therapy including an anti-androgen stops working, the cancer will stop growing for a short time from simply stopping the anti-androgen. Doctors call this the anti-androgen withdrawal effect, although they are not sure why it happens.

Enzalutamide (Xtandi®)

This drug is a newer type of anti-androgen. When androgens bind to the androgen receptor, the receptor sends a signal for the cells to grow and divide. Enzalutamide (also known as MDV3100) blocks this signal from the androgen receptor to the cell.

In men with castrate-resistant prostate cancer, enzalutamide can lower PSA levels, shrink or slow the growth of tumors, and help the men live longer.

Enzalutamide is a pill, with the most common dose being 4 pills each day. In studies of this drug, men stayed on LHRH agonist treatment, so it isn’t clear how helpful this drug would be in men with non-castrate levels of testosterone.

Other androgen-suppressing drugs

Estrogens (female hormones) were once the main alternative to orchiectomy for men with advanced prostate cancer. Because of their possible side effects (including blood clots and breast enlargement), estrogens have been largely replaced by LHRH analogs and anti-androgens. Still, estrogens may be tried if androgen deprivation is no longer working.

Ketoconazole (Nizoral®), first used for treating fungal infections, blocks production of certain hormones, including androgens, similarly to abiraterone. It is most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer effective.

Ketoconazole can block the production of cortisol, an important steroid hormone in the body. People treated with ketoconazole often need to take a corticosteroid (like hydrocortisone) to prevent the side effects caused by low cortisol levels.

Possible side effects of hormone therapy

Orchiectomy, LHRH analogs, and LHRH antagonists can all cause similar side effects due to changes in the levels of hormones such as testosterone and estrogen. These side effects can include:

• Reduced or absent libido (sexual desire)
• Impotence (erectile dysfunction)
• Shrinking of testicles and penis
• Hot flashes, which may get better or even go away with time
• Breast tenderness and growth of breast tissue
• Osteoporosis (bone thinning), which can lead to broken bones
• Anemia (low red blood cell counts)
• Decreased mental sharpness
• Loss of muscle mass
• Weight gain
• Fatigue
• Increased cholesterol
• Depression

Anti-androgens have similar side effects. The major difference from LHRH agonists and orchiectomy is that anti-androgens may have fewer sexual side effects. When these drugs are used alone, libido and potency can often be maintained. When these drugs are given to men already being treated with LHRH agonists, diarrhea is the major side effect. Nausea, liver problems, and tiredness can also occur.

Abiraterone does not usually cause major side effects, although it can cause joint or muscle pain, high blood pressure, fluid buildup in the body, hot flashes, upset stomach, and diarrhea.

Enzalutamide can cause diarrhea, fatigue, and worsening of hot flashes. This drug can also cause some neurologic side effects, including dizziness and, rarely, seizures. Men taking this drug are more likely to have problems with falls, which may lead to injuries.

Many side effects of hormone therapy can be prevented or treated. For example:

• Hot flashes can often be helped by treatment with certain antidepressants or other drugs.
• Brief radiation treatment to the breasts can help prevent their enlargement, but it is not effective once breast enlargement has occurred.
• Several different drugs are available to help prevent and treat osteoporosis.
• Depression can be treated by antidepressants and/or counseling.
• Exercise can help reduce many side effects, including fatigue, weight gain, and the loss of bone and muscle mass.

There is growing concern that hormone therapy for prostate cancer may lead to problems with thinking, concentration, and/or memory. But this has not been studied well in men getting hormone therapy for prostate cancer. Studying the possible effects of hormone therapy on brain function is hard, because other factors may also change the way the brain works. A study has to take all of these factors into account. For example, both prostate cancer and memory problems become more common as men get older. Hormone therapy can also lead to anemia, fatigue, and depression – all of which can affect brain function. Still, hormone therapy does seem to lead to memory problems in some men. These problems are rarely severe, and most often affect only some types of memory. More studies are being done to look at this issue.

Bottom line: Many man experience recurrence of their prostate cancer after treatment. Hormone therapy is the most common treatment option for men in this situation.