Archive for the ‘testosterone gel’ Category

5 ways to boost your libido

May 3, 2017

The bad news: men’s sex drive is based on the serum testosterone level which starts to decrease about 1% a year in second decade of a man’s life.  The good news is that low testosterone can easily be replaced.  Here are a few steps or suggestions that you can easily do to restore your libido without testosterone replacement therapy.

Re-connect: Now that the children have left and it’s just you and your partner again, it’s time to re-connect. Raising a family might have kept you very busy, oftentimes taking you away from each other. Spend some time re-connecting and getting to know one another again in order to reignite that flame.  I suggest having a date night with your significant other.  And one other piece of advice: turn off your cell phone and focus on each other! 

Exercise: Health conditions and poor circulation can impede on your libido, while being as healthy as you can is a great way to support your sex drive. Exercise can help reduce your risk of illness and boost your circulation to ensure all your parts are working as they should.  I suggest 20 minutes of cardiovascular exercise at least three times a week.

Be mindful: Stress is a big mood killer, so practicing mindfulness and reducing stress can help boost your libido.  There’s an app for that.  I suggest Headspace.  It’s free and a nice way to learn the art of meditation.

Seek therapy: Maybe you need to see a therapist and work through any underlying issues that could be preventing you and your partner from connecting on a sexual level. Addressing these concerns can help you get past the wall you or your partner may have built between each other.  I suggest that you seek out a therapist that has expertise in dealing with sexual problems.  You can find a therapist near you at: https://www.aasect.org/referral-directory

Check your medications: Some medications cite low libido as a side effect. Antidepressants and pain medications are most known for this. Check with your doctor if you are on any meds.

Bottom Line:  A decrease in libido doesn’t mean you have to live a life devoid of sex. Speak to your doctor.  Get a blood test to check your testosterone level and consider replacement therapy using testosterone injections, topical gels, or tiny pellets inserted under the skin all of which can successfully restore the testosterone level and more importantly your ability to engage in intimacy with your partner.

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Pain Pills Won’t Put Potency In Your Penis

April 25, 2017

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.

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

March 29, 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

March 27, 2017

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.

It’s Time To Talk About Testosterone

November 25, 2016

Testosterone (T) is a hormone produced in the testicles of men (and in the ovaries of women to a much smaller amount than in men.  Testosterone is often referred to as the male sex hormone.  It is normal for the testosterone level to decrease in men after age 30 at a rate of 1-3% a year but men don’t develop symptoms until late 40 or early 50.  During puberty, testosterone helps young boys develop male physical features like body and facial hair, i.e., a beard, and muscle strength.  Testosterone is also needed to help with the development of sperm.

Low T is defined as a decrease in the blood level of the hormone, usually less than 300ng\dl plus symptoms including decrease in libido or sex drive, lethargy, changes in mood, loss of muscle mass and decreased energy levels.

The diagnosis of low T requires a medical history of symptoms, a physical exam and a blood test that confirms a decrease in the hormone level.

Testosterone replacement is possible using injections of testosterone, topical gels, a nasal spray of testosterone, and insertion of testosterone pellets (Testopel).  The side effects of testosterone replacement include an increase in red blood cells, acne, reduction in size of the testicles, and infertility.  It is therefore important to discuss with your doctor if you are still planning to have a family as you should not use testosterone replacement therapy.

Caution:Don’t take testosterone if you don’t have medical reasons for doing so

Don’t’ take testosterone if your trying to achieve a pregnancy

If you use testosterone replacement, then get a routine check-up and blood tests at least every six months

Bottom Line: Millions of American men suffer from low T.  If you have symptoms and a blood test that confirms low testosterone, then you may be a candidate for testosterone replacement therapy.

Latest News on Testosterone-NBC Nightly News on 2\17\16

February 17, 2016

Testosterone gel can help some men get back a little of their loving feelings, and helps them feel better in general, according to a new study published today by the National Institute of Health.

It’s the first study in years to show any benefit for testosterone therapy. This was the first time that a trial demonstrated that testosterone treatment of men over 65 who have low testosterone would benefit them in any way.  The trial showed that testosterone treatment of these men improved their sexual function, their mood, and reduced depressive symptoms—and perhaps also improved walking.

The FDA does not approve the use of testosterone to treat the effects of aging. But it’s already a $2 billion industry, with millions of men buying gel, pills or getting injections.

Experts stress that the results, published in the New England Journal of Medicine, only apply to men over 65 who have medically diagnosed low testosterone. The trial consisted of 800 men.

A few men had heart attacks or were diagnosed with prostate cancer during the study, but the rate were the same in men who got real hormone and in those who got placebo cream.

Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved since the beginning of the trial. Men who received testosterone reported better sexual function, including activity, desire, and erectile function, than those who received placebo. Although the effect sizes were low to moderate, men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved.

Testosterone was also associated with small but significant benefits with respect to mood and depressive symptoms. Men in the testosterone group were also more likely than those in the placebo group to report that their energy was better.

As men age, their bodies make less testosterone. It’s not as sudden as when women lose estrogen, but the effects can be similar – loss of energy, sexual desire, depression and bone loss.

Bottom Line: Testosterone is the male hormone responsible for sex drive, erections, bone strength, muscle mass, and even mood.  The hormone decreases starting in men in their 20’s and usually become symptomatic in the late 40s and 50s.  The diagnosis is easily made with a simple blood test and treatment is easily accomplished with injections, topical gels, or pellets inserted underneath the skin.  For more information speak to your doctor.

Testosterone, Depression, and SSRI’s or Anti-Depressants-What’s the Connection?

December 21, 2015

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have abnormally low testosterone. So what does this all mean? Did the initial low testosterone lead the individual to become depressed and go on an antidepressant? Or did the treatment with an antidepressant actually slowly reduce the individual’s natural ability to produce testosterone?

It really is a “chicken vs. egg” type argument in regards to whether low T caused depression or an antidepressant caused low T. Unfortunately there is no clear-cut scientific answer as to whether the antidepressant you took caused your testosterone to be lowered.

With that said, new research comes out all the time finding new things about antidepressants (SSRI’s) – they really aren’t well understood. Many antidepressants medications are now linked to development of diabetes, birth defects, etc. Although there are no formal studies to link antidepressants with low testosterone, many people taking these drugs are convinced that they are the root cause.

It could have been that the lower testosterone was what caused the person to feel depressed in the first place. The low T could have also merely been a coincidence among those who are depressed – after all, having low T is a pretty common issue.

Antidepressants and Testosterone: Many people taking antidepressants experience low testosterone. Similarly, many people with low testosterone are taking antidepressants. These two factors could also occur independently. In other words a person may develop low testosterone while on an antidepressant without the antidepressant being the cause. 



Depression and Testosterone: Many people may be experiencing depression as a result of low testosterone. Similarly many people may be experiencing low testosterone as a result of depression. Additionally, these two factors could be totally unrelated and independent of each other. In other words the depression could have nothing to do with low T and vice versa.
Depression and sex drive – Many people 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. People may be in such a depressed, low level of arousal, that they don’t feel like having sex. Therefore in this case, it could be that the depression and not testosterone is causing reduced sexual interest.
Testosterone and sex drive – It is well known that healthy testosterone levels are linked with a healthy sex drive. Men that have low T tend to have less fuel for sex, erectile dysfunction, and other performance issues. 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.
Low testosterone causing depression? – 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. For this reason it is important to rule out all causes of depression (including low T) before you get on an antidepressant.
Antidepressants and low testosterone – 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 people that have taken SSRI’s believe that the drugs they took lowered their testosterone.
Bottom Line: There is no question that there is a relationship between testosterone and depression. I cannot say for certain that low testosterone is a result of the use of SSRIs. However, if you are taking SSRIs and you are experience a low sex drive or libido, it is very easy to ask your doctor to obtain a blood testosterone test. If it is low, treatment is easily accomplished with either testosterone injections, topical gels or pellets.

Testosterone and the Prostate Gland

December 14, 2015

Many men suffer from hormone deficiency with symptoms of loss of libido, erectile dysfunction, loss of energy, loss of muscle and bone mass, and even depression.  These men with low levels of testosterone are helped with hormone replacement therapy using either injecitons of testosterone, topical tesotserone gels, or pellets of testosterone inserted under the skin.  Some men are concerend that the use of testosterone will icrease the risk of prostate cancer or cause them to have more urinary symptoms.

A recent review found little evidence to support that urinary symptoms would worsen as a result of using testosterone replacement therapy (TRT).

Furthermore, although the Endocrine Society and other associations have suggested severe LUTS as a contraindication to TRT treatment, investigators found little evidence to support it after reviewing the limited research.

The study showed that men with mild urinary symptoms such as getting up at night or having dribbling after urination experienced either no change or an improvement in their symptoms following TRT.

It is of interest that patients with metabolic syndrome (diabetes, hypertension, high cholesterol, and increase in abdominal fat) experienced symptomatic improvement after TRT.  The study even pointed out that men with the metabolic syndrome who received testosterone replacement therapy also had improvement in the underlying metabolic syndrome, i.e., lower blood pressure, lower cholesterol levels, and improvement in their control of their diabetes.

Bottom Line:  Testosterone is safe for men with mild urinary symptoms and may even help with reduction in urinary symptoms in some men.

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 Deficiency: Male Menopause Which Is HARDly The Pause That Refreshes!

November 21, 2015

Everyone has heard about menopause for women.  This is due to a decrease in estrogen production from the ovaries.  Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50.  The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression.  This blog will discuss the problem of male menopause or andropause.

Men losing testosterone is a steady decline, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.

The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.

The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.  Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.

Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies.

The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer and heart disease.

There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.

Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.

Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before.

Bottom Line: If you don’t feel the same way about yourself or your partner, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that with a brief history, physical exam and a testosterone blood test.

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