Archive for the ‘hypogonadism’ Category

There’s More To Testosterone Replacement Than Meets the Eye

February 9, 2017

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.

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Everything You Wanted to Know About Low T (Testosterone) But Afraid To Ask

February 21, 2015

Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.

Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.

The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.

My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Obesity
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
Hormonal disorders
Infections

What is the treatment for low testosterone (Low-T)?

Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.

Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.

Injections: Testosterone can be delivered by direct injection.

Pellets: Pellets can be implanted into the soft tissue and release the testosterone.

I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.

Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Skin reactions
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.

Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.

In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.

Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.

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.