Archive for the ‘testosterone replacement’ Category

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.

Body Builders Using “Juice” Beware!

March 30, 2017

I don’t know of any physicians who would condone the use of anabolic steroids in men with normal testosterone levels whose only complaint is desire to increase their muscle mass or their athletic performance.  The use of anabolic steroids in young men is fraught with danger and can result in permanent hormone deficiency and permanent infertility.

Testosterone was first identified in 1935 as responsible for its masculinizing effects along with the effect of increasing lean muscle mass.

However, recently the illicit use of performance enhancing drugs has become an issue for athletes and those men wishing to increase their athletic performance, their strength and muscle mass.   It is estimated that there are 3 million anabolic steroid users and abusers.  And now we have found that nearly 5-6% of middle and high school students have or are using anabolic steroids.

These anabolic drugs are now identified to negatively affect the pituitary glands hormones that stimulate the testicle to produce testosterone and result in prolonged reduction of natural testosterone production and even permanent decrease in testosterone production for many months and even permanently in men who have used and abused anabolic steroids.  Most men will return to baseline natural production of testosterone in 1-2 years after discontinuing the use of anabolic steroids.

There are numerous reports of profound suppression of testosterone in nearly half of all men who have used anabolic steroids.  Because anabolic steroid can have a profound reduction in sperm production, men should understand the consequences of anabolic steroid use.  That is, if they want to father a child, they need to stay farther away from anabolic steroids.

Bottom Line: Anabolic steroid abuse can affect a man’s production of testosterone and may cause permanent reduction in testosterone production by a man’s testicles.  I suggest that all men who might consider using anabolic steroids to take this into consideration before making a bad choice that may affect their health and well being forever.

 

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.

February 13, 2017

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.

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.

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.

Low Testosterone And Depression: there is a relationship

September 27, 2015

Testosterone is more important that sex drive\libido, erections, and energy levels. A new study has documented low testosterone and testosterone that is the lower limits of normal may be associated with depression.

The study from the George Washington School of Medicine and Health Sciences in Washington, DC. included 200 adult men, who were referred for borderline total testosterone levels between 200 and 350 ng/dL. Doctors typically treat men for hypogonadism or low T if they have symptoms of low testosterone and their testosterone levels are below 300 ng/dL.

The results show that more than half (56%) of the men had depression or depressive symptoms, which is significantly higher than rates seen in general populations. A recent survey of US adults found that 6% of those who are overweight or obese were depressed. One-quarter of the men used antidepressants.

Also worth noting, the men had high rates of overweight or obesity and physical inactivity. Common symptoms were erectile dysfunction, decreased libido, fewer morning erections, low energy, and sleep disturbances.

The study authors concluded that clinicians should consider screening for depression/depressive symptoms and overweight and unhealthy lifestyle risk factors in men referred potential hypogonadism.”

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men who have documented low testosterone levels.

The researchers published their results online on July 1, 2015 in the Journal of Sexual Medicine.