Pain Pills Won’t Put Potency In Your Penis

There’s a opioid epidemic in the United States as the number of prescriptions written for opioids has skyrocketed over the years. From 1991 to 2013, the total number of prescriptions written for opioid painkillers skyrocketed by 172%. It is estimated to cause nearly 40,000 deaths in the United States which is more than those people who died in car accidents each year.  Besides the risk of death and havoc on the user and his\her family, opioids cause a deficiency in testosterone which significantly impacts a man’s sexuality.

Testosterone deficiency is an underappreciated consequence of using opioids.

Understanding the risks and the potential treatment options available may help minimize the impact of opioids on testosterone levels. This blog will discuss the relationship between opioid use and testosterone deficiency.

Yes, it is true that opioids are well-known to be highly effective at managing pain. Also well-known is their negative impact on testosterone levels in men taking these potent pain killers.   Interestingly, even with the recognition of this phenomenon, this side effect of reducing testosterone remains an underappreciated consequence of treatment.

Testosterone deficiency can lead to serious health consequences. Symptoms include reduced libido, erectile dysfunction, osteoporosis and decreased bone density, fatigue, depressed mood, reduced muscle mass, poor concentration, and sleep disturbances. As such, testosterone deficiency also impacts quality of life and may even be involved in the development of heart disease.

New Findings

In a large study a higher risk of low testosterone was found with opioids. Data revealed that men on long-acting opioids were significantly more likely to be testosterone deficient.

Treatment Options

The management of low testosterone levels in men taking opioids begins with the checking the symptoms of low T such as decreased sex drive, loss of energy, loss of bone and muscle mass and the confirmation with testosterone testing. However, monitoring of hypogonadism can be a challenge as patients may not necessarily report their symptoms.

Additionally, when possible, baseline serum testosterone levels should be obtained prior to initiating therapy with potent pain medications. Testosterone levels could then be recorded at regular intervals to monitor changes.

If a patient presents with opioid-induced low T, there are several possible treatment options that can be pursued. Strategies that allow for opioid reduction could be considered, such as the concomitant use of non-opioid pain medications. The good news is that discontinuing opioid therapy can result in the normalization of testosterone, with data suggesting recovery of symptoms may occur as fast as a few days to up to 1 month after stopping treatment. Unfortunately, this is an unlikely option for men suffering from chronic pain.

Lastly, testosterone replacement therapy is a viable option for some patients. Testosterone can be given via injections, topical gels, or pellets inserted beneath the skin to restore the normal level of testosterone that will improve the symptoms of low T.  Close monitoring by your doctor will help identify the development of low T levels. Men who are educated on this potential side effect of low T can also be active participants in helping to identify this complication. While several treatment options are available, the best course of action for treating hypogonadism will ultimately depend on symptoms and the blood level of testosterone.

Bottom Line:  Opioids can help with the control of pain but with the price of decreasing the testosterone level in men.  Men who use opioids should speak to their doctor about their symptoms of decrease in sex drive, loss of energy or loss of muscle mass are candidates for hormone replacement therapy.

ED and Good Health

Many men are unaware of the relationship between ED (impotence) and their overall health.  ED not only include ability to engage in sexual intimacy but also includes problems with libido, and abnormal ejaculation.

ED is defined as the consistent inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse.

The process of diagnosis and treatment begins with a careful sexual history.  Men with a sexual problem will probably be asked:

• Are you currently having sexual relations?
• With whom do you have these relations (men, women, or both, and how many partners)?
• When was the last time you had intercourse?
• Are you satisfied with the quality and frequency of your sexual experiences?

The answers will clarify what aspects of sexual dysfunction are occurring and inform the rest of the evaluation. If libido is intact but ED is a complaint, then what underlying medical conditions or medications may be contributing to the problem? If libido is affected, are there significant psychologic or emotional contributing factors that need to be addressed as well as measuring the serum testosterone level.

Although sexual problems are not necessarily caused by aging; it is true that aging is associated with an increase in sexual issues. As early as 40 years of age, up to 40% of men report some impaired sexual function.  Inability to attain or maintain an erection consistently for satisfactory intercourse was reported in 67% of males over 69 years of age in another study.  Testosterone decline is common with age. While this may play a hormonal role in sexual dysfunction, it is important to thoroughly evaluate all possible causes before initiating testosterone replacement therapy for sexual dysfunction alone.

Similarly as men age, interest in sex may decline due to lack of novelty as well as an increase in stress that often occurs in older men. Fatigue, lack of privacy in the family setting, and unresolved anger with a partner may all be determinants of sexual problems in the older male. More critically, loss of interest in sexual activity and loss of libido may be manifestations of depression.  Depression can cause sexual problems, but the reverse may also be true.

In addition to these factors, diabetes, blockage of the blood vessels, and adverse effects from medications, both prescribed and recreational (marijuana and cocaine) may all play roles in sexual functioning. Disease states such as hypertension, diabetes, heart disease, and obesity can affect the blood flow into the penis. Blockage in any of the major arteries feeding the blood supply to the penis can lead to inability to obtain and maintain an erection. Diabetes, for example, this can also affect the mechanism of erection and cause ejaculatory disorders such as backward ejaculation of the fluid to the bladder instead of out of the tip of the penis at the time of orgasm.

Medications that are often identified as causes of erectile disorder which include medications used to treat depression, blood pressure lowering medications, cholesterol medications, and drugs used to treat prostate cancer.  Excessive alcohol use is the most common substance that can lead to ED, though cocaine, heroin, and marijuana have all been linked as well.

Bottom Line:  ED is a common problem affecting millions of middle age and older American men.  The diagnosis can often be attributed to underlying disease states.  A careful history and physical examination will help to elucidate the problem and start you on the road to successful treatment.

Low T-Review of New York Times Editorial, March 28, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.

Testosterone Replacement-Relationship With Heart Disease

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

HCG And Testosterone: Double Bang For Your Sex Drive Buck

If you find that your sex drive is in the tank, you have difficulty with erections, that Viagra, Levitra, and Cialis which once worked, are no longer effective, then you may be suffering from low T or low testosterone.  The diagnosis is easily made from a blood test.

If you are like most men, you will find that your manhood and confidence level comes from the area between your belly button and your knees, i.e., your “package”.  It is there in the testicles which are are responsible for making testosterone, the male hormone associated with so many functions including sexual activity, energy level, muscle mass, and even your mood.

Not only does testosterone control so many of these functions, so does hCG or human chorionic gonadotropin.  hCG stimulates the gland at the base of the brain, the pituitary gland to produce more LH or luteinizing hormone (LH) to encourage the testicles to release more testosterone. hCG can be injected and administered to stimulate the right dose of healthy testosterone production.

The benefits of hCG for men include boosting healthy levels of testosterone that’s needed for every biological process to ensure optimal health. Correcting low testosterone levels by using hCG for men can bring on many benefits for men which include:

• Increase red blood cells
• Support the cardiovascular system
• Increases flow of blood and oxygen
• Healthy body hair growth
• Weight loss, reduction of fat mass
• Increased energy levels, endurance, and performance
• Increase in lean muscle mass and muscle strength
• Reduced risks of obesity
• Improved oxidation in the groin area
• Increase in libido
• Improved penile growth due to oxidation
• Proper stimulation to continue boosted sexual desire
• Proper stimulation to improve endurance and sexual performance
• Reduced risks of erectile or other sexual dysfunctions
• Increase in bone density
• Reduced risks of arthritis-related conditions

 Although hCG is both safe and effective for females and males to use, there are possible side effects that you should be aware of. These include:

• light-headedness
• nausea
• headaches
• mild fatigue
• irritation at injection site

More serious side effects are rare and are normally associated with incorrect use of hCG but can include:

• Swelling of breast tissue in males
• Depression, irritability and other mood changes
• Swelling of feet or ankles
• Early onset of puberty in young boys

Bottom Line: It is crucial to discuss treatment with your doctor to determine if the benefits of using hCG therapy outweigh the possible side effects you may experience and to ensure correct dosing and application of the hCG.

Arimidex For Treating Low Testosterone Levels

I have seen on several occasions men who have low testosterone levels who are on hormone replacement therapy and yet fail to improve their libido, energy level, or their erections.

One explanation is that some of the testosterone is converted to estrogen which is the female hormone.  If men fail to respond to testosterone replacement therapy for low testosterone, then it is important to check the estrogen level (estradiol) and if this is elevated then the man will need to add an estrogen lowering medication, commonly Arimidex (anastrozole). It’s from the class of medications called aromatase inhibitors, which essentially block the conversion of testosterone to estrogen.

It helps by forcing testosterone output to remain high while keeping estrogen levels low.  The dosage is 0.25mg every third day.

Bottom Line: anastrozole therapy, given over 12 months, significantly increased serum testosterone and modestly reduced E2 levels in men 60 years of age and older with mild-to-moderate hypogonadism. Aromatase inhibitors intervention resulted in the restoration of testosterone levels into the mid-normal range with improvement of the symptoms of low testosterone.

 

 

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.

Boosting T Levels Without Medication

Testosterone is the male hormone produced in the testicles that is responsible for sex drive, energy, muscle and bone mass.  Testosterone decreases slowly in the late 20s and becomes symptomatic in men around middle age.  This blog will discuss natural ways of preserving and increasing your testosterone levels.

Get Moving: Drop 10, 15, or more pounds

Overweight men are likely to have less testosterone, which means less energy and increased susceptibility to depression.  If you shed pounds, you can cause your T levels to surge.

No Zinc In the Sink

Research has shown that supplementing your diet with zinc can improve testosterone levels. According to the National Institutes of Health, 45 per cent of us aren’t getting enough of the stuff.  Protein-rich foods like meat and fish are packed full of zinc, along with raw cheese, beans and natural yoghurt.

Sweet Nothings

In addition to causing you to pile on the pounds, sugar can also wreak havoc on testosterone production. Regular intake of the sweet stuff can cause insulin to spike, which is a factor leading to low levels of testosterone.

To counteract the effect, simply limit your sugar intake – the overall health benefits far outweigh a quick dopamine hit from a soft drink.

Take D and See

Vitamin D is a steroid hormone, which means it boosts your sperm count, , libido and  testosterone.  You can increase your vitamin D by being exposed to sunshine.  Since I don’t condone exposure to sun as it causes skin cancers, then vitamin D supplementation is in order, 1000 IU\day.  This is available in most nutrition and drug stores.

Stress Less

Kicking back is easier said than done, but a reduction in stress will work wonders for your testosterone production. Cortisol (the stuff your body makes when you get hot under the collar) actually blocks testosterone. Chronic stress has actually been shown to stop testosterone production, which translates to bad moods, fatigue and decreased libido.

Exercise and weight loss are beneficial in reducing stress levels so this is another reason to getting moving!

Fat and Fit

Eat ‘good’ fats of the monounsaturated variety. You can find a high dose of these fats in foods like olive oil, almonds, avocados and grass-fed meats.

Going From ZZZZZ to T

Men who got a full eight hours sleep had 60 per cent more testosterone than their sleep-deprived counterparts.  I recommend stop looking at screens, i.e., computer and TV screens at least an hour before bedtime as screen watching affects melatonin which if decreased can make it difficult to have a good nights sleep.

It’s Quicker Without Liquor

We all know that alcohol consumption is bad for us – but it’s bad for your Johnson. Not only does too much booze lower growth hormone levels and increase cortisol, it will reduce your testosterone levels for up to 24-hours.  I recommend 1-2 glasses of alcohol a day and definitely avoid binging.

Bottom Line:  Testosterone is a necessary ingredient for your sex drive, your energy level, and overall body metabolism.  The hormone also affects our moods and psychological well-being.  I have provided you some suggestions for boosting this very important hormone.

Depression, Anti-Depressants, and Low Testosterone Levels

Hormone deficiency is common in many middle age and older men.  It is of interest that many men using anti-depressants also are found to have low testosterone levels.

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have low testosterone.  We are not certain about the mechanism of action of SSRI’s and low T levels but the effect is certainly prevalent.

Many men with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. Men may be so depressed and have a decreased libido, that they don’t feel like having sex.

If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.

Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression.

It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many men that have taken SSRI’s believe that the drugs they took lowered their testosterone.

On average, men tend to naturally experience lower levels of testosterone by the time they reach age 50. By age 60 it is estimated that 1 in 5 men have problems with their testosterone. In cases where men experienced a reduction in their level of testosterone and simultaneously became depressed, increasing testosterone levels can be therapeutic.

In older men, testosterone therapy may prove to yield antidepressant effects. Most medical research demonstrates that testosterone can have positive effects on mood. It seems as though testosterone treatment tends to be most beneficial for men who are experiencing depression as a result of testosterone decline.

Bottom Line:  Many middle age men have been placed on SSRI’s for depression.  This can result in a decrease in the testosterone level.  If you are experiencing a decrease in your libido, have decreased energy, and loss of muscle mass, you may have low T levels.  The diagnosis is easily made with a blood test and treatment consists of testosterone replacement therapy.

Non-Medical Solutions to Raising Your T Level

I am often asked what can a man do to raise his testosterone level without taking testosterone replacement therapy.  Here are a few suggestions that may be helpful.

1. Exercise and lift weights

If you want to increase your testosterone levels, you will need to increase your exercise frequency. Regular exercise will not only help you by preventing different lifestyle related health problems, but it will also help you by boosting your testosterone levels. Men who regularly exercise have a higher testosterone levels. Even elderly men will also have higher testosterone levels if they regularly exercise.

2. Reduce stress and cortisol levels

If you are suffering from long-term stress, it can increase the levels of cortisol hormone. If your cortisol levels are high, testosterone levels will decrease.

That’s why, you need to reduce stress as much as possible and which will also decrease the cortisol levels in your body. Regular exercise, whole foods, good sleep, balanced lifestyle and laughter can help you to reduce stress and also improve your overall health.

3. Get more Vitamin D

Vitamin D offers several health benefits and it boosts testosterone naturally. If you consume just 3,000 IU of vitamin D3 per day, it can increase testosterone levels in the body by 25%.

You can get more vitamin D by increasing your exposure to sunlight regularly. You can also take a daily supplement of 3,000 IU of a vitamin D3 supplement.

4. Get Enough Sleep.

A lack of sleep affects a variety of hormones and chemicals in your body. This, in turn, can have a harmful impact on your testosterone.

The time honored goal is try for 7 to 8 hours per night.

5. Keep a Healthy Weight.

Obesity can have a deleterious effect on your testosterone levels.  Exercise and diet can improve your testosterone and also is good for your heart to avoid obesity. 

6. Review Your Medications.

Some medicines can cause a drop in your testosterone level. These include: pain medications, steroids (prednisone), anabolic steroids such as those used by athletes and body builders, and anti-depressants. 

7. Deep 6 the Supplements.

You may be bombarded with unsolicited snail mail and E –mail offering testosterone boosting supplements such as DHEA.  Let the truth be told, you are wasting your money as these supplements will not boost your testosterone.   

Bottom Line: Although these suggestions may be helpful, they are just a step in the right direction.  For more information about testosterone replacement therapy, speak to your physician.