Archive for the ‘testosterone replacement therapy’ Category

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.

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.

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 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.

Safety of Testosterone Reported In Two Medical Journals

August 26, 2015

Two recently published studies significantly contribute to current knowledge regarding testosterone therapy and cardiovascular health. Researches from Harvard reported that 3 years of testosterone replacement therapy (TRT) in older men with low or low-normal testosterone does not cause progression of subclinical atherosclerosis o hardening of the arteries. The clinical trial was published in JAMA (2015; 314:570-81).

In addition, an article in the European Heart Journal (Aug. 6, 2015), showed that testosterone replacement therapy significantly reduced risks of death, myocardial infarction, and stroke.

The findings of both studies add to the ongoing evidence of testosterone treatment safety, cardiovascular safety in particular.

Bottom Line: These studies provide substantial confidence regarding the use of testosterone therapy when administered and monitored appropriately in well-selected individuals. These are men who have symptoms of low testosterone and confirmed by a blood test that documents low testosterone.

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.