Posts Tagged ‘hormone replacement therapy’

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.

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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.

January 21, 2017

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.

  1. 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.

  1. 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.

 

 

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.

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.

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.

Low Testosterone and Sexual Problems From Pain Pills

May 4, 2015

Men with chronic pain in any location but commonly for low back pain who use potent analgesic (Oxycontin, Percocet, Oxycodone) medication are at risk for lowering the testosterone level or the hormone produced in the testicles that is responsible for sex drive or libido. Consequently some men who use pain medications for a long period of time may have sexual problems, lethargy and fatigue.

Narcotic pain tablets such as Percocet™, Oxycodone™, Roxycodone™ and Oxycontin™ come with severe adverse side effects associated with narcotics addiction.

Adverse Effects of Long Term Pain Pills (Opiates)
Narcotic Pain Pills (opioids) are highly addictive with severe adverse effects related to drug withdrawal. Opiate containing narcotic pain pills are highly effective for short term use for pain, but were never intended for long term use. Over time, these drugs cause profound suppression of the endocrine system, and in men, profound inhibition of testosterone production.

Low Testosterone Goes Largely Unrecognized
Although quite common, opioid-induced androgen deficiency and has gone largely unrecognized by the medical profession. Low testosterone is caused by opioid drug inhibition of LH (Luteinizing Hormone), a pituitary hormone involved in testosterone production, as well direct inhibition of testosterone production, itself. Similarly, there is also inhibition of the entire endocrine system, and adrenal hormone suppression. Symptoms of low testosterone include fatigue, depression, hot flashes, night sweats, diminished libido, erectile dysfunction, and diminished sexual arousal and satisfaction. Men may also develop osteoporosis, anemia, and diminished muscle mass.

These drugs also have a negative impact on women. Women who consume opioid-pain pills will stop having menstrual cycles and will notice greatly diminished libido (sex drive).
Testosterone Treatment Effective and Recommended by Mainstream Medicine
Administration of both topical (transdermal) testosterone and injectable testosterone has been studied and found effective for men with low testosterone on pain pills.

Opiate Detoxification Program is Essential
The reality is that hormone supplementation and nutritional supplementation for the long term opiate pain pill user is only a temporary band aid. To fully restore health, the opiate addiction must be addressed and the patient must ultimately get off the pain pills. Drug withdrawal may be difficult because of severe drug withdrawal symptoms. Therefore, we refer the patient to a center that specializes in narcotics detoxification, and urge the patient to strongly consider this option.

Bottom Line: Opioid pain medication is helpful for short term use. However, use of these addicting drugs for chronic pain can result in sexual problems in both men and women. For those who have sexual problems, consider seeing a pain management specialist, find alternative methods of pain relief, and using testosterone replacement therapy.

Low T (Testosterone) May Mean No Baby

February 19, 2015

I am often seeing men with symptoms of low testosterone levels who are still planning to have children. These men need to know that the standard treatment of hormone replacement may not apply to those men who are still interested in having children. This blog will discuss the management of men with low T and who wish to continue to have children.

Testosterone replacement therapy (TRT) can bring your testosterone levels back to normal and restore your sex drive.
But if you want to have children, there’s one downside to TRT you should know about. It gives you back your sex life, but it might also reduce your ability to father children as long as you’re on it.
Testosterone replacement therapy has a profound impact on a man’s reproductive potential.

Approximately 90% of men can drop their sperm counts to zero while on testosterone. By increasing testosterone, you’re not going to increase fertility.

Testosterone, the hormone produced in the testicles, plays an important role in making sperm. Your brain makes special hormones, called gonadotropin-releasing hormones (GnRH). These hormones signal the testes to make more testosterone, vital for a healthy sperm count. When you’re getting testosterone replacement therapy, testosterone is added into the bloodstream by patches, gels, or other treatment methods such as pellets placed under the skin. Your brain interprets this rise in testosterone levels as a sign that you now have enough testosterone. So it stops sending signals to the testes to make more testosterone. But when your testes don’t make more testosterone, your sperm production goes down.
Therefore, a low sperm count makes it harder to conceive a child. My advice is that if you have any kind of reproductive goal, you should not be using TRT.

If you have low testosterone, one way to improve sperm count is with gonadotropin injections. This stimulates the production of sperm. It may be considered as a way to increase a man’s fertility when your partner are having trouble conceiving a child.
It’s standard practice to check a man’s sperm count when a couple has difficulty getting pregnant. If your sperm count is low, the next step is to measure your testosterone. If it’s below normal, we can then inject the signal to produce more testosterone by giving a gonadotropin.

You should also make sure to follow a lifestyle of regular exercise and a healthy diet if you want to father a child. Overweight and obese men tend to have lower testosterone levels because excess belly fat converts testosterone to estrogen, another hormone that can impact sperm production. Shedding those extra pounds will likely have a positive effect on your fertility. Losing weight can definitely increase testosterone.

Bottom Line: If you have symptoms of low testosterone levels or if you have an abnormal sperm count, hormone replacement with testosterone is not the treatment of choice. You should consider gonadotropin injections as a solution.

Read This To See About Low T (Testosterone)

February 19, 2015

Low testosterone affects millions of American men. Men who suffer from low testosterone have decreased libido, decrease in erections, and lethargy or loss of energy. In this blog I will discuss the importance of testosterone and the treatment options for the diagnosis of low T.

What Is Testosterone and Why Does It Decline?
Testosterone is a hormone produced in the testicles. It’s what puts hair on a man’s chest and responsible for his beard. It’s the force behind his sex drive.
During puberty, testosterone helps build a man’s muscles, deepens his voice, and boosts the size of his penis and testes. In adulthood, it keeps a man’s muscles and bones strong and maintains his interest in sex. In short, it’s what makes a man a man (at least physically).
After age 30, most men begin to experience a gradual decline in testosterone about 1% a year. A decrease in sex drive sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that their loss of interest in sex is simply due to getting older.
The diagnosis of low T is made by a history of the symptoms of low T and a simple blood test that checks the testosterone level. The test is best done in the morning before 10:00 A.M. when the hormone level is the highest.

The bottom of a man’s normal total testosterone range is about 300 nanograms per deciliter (ng/dL). The upper limits are 1,000 to 1,200 ng/dL. A lower-than-normal score on a blood test can be caused by a number of conditions, including:

Injury to the testicles
Testicular cancer or treatment for testicular cancer
Hormonal disorders
Infection
HIV/AIDS
Chronic liver or kidney disease
Type 2 diabetes
Obesity
Some medicines and genetic conditions can also lower a man’s testosterone score. One of the most common drugs associated with low T are the SSRIs which are used to treat depression. Aging does contribute to low scores. In some cases, the cause is unknown.

Risks and Benefits of Testosterone Treatment?

There are also risks. Testosterone treatment can raise a man’s red blood cell count as well as enlarge his breasts. It can also accelerate prostate growth. Men with breast cancer should not receive testosterone treatment. These are uncommon side effects of testosterone treatment.

Men with prostate cancer who have symptoms of low T and have a low and stable PSA can receive testosterone treatment, however, they need to have a PSA and digital rectal exam every 1-2 months while receiving testosterone replacement.

The treatment with testosterone is safe as long as men receive careful monitoring.

Treatment options for low T include injections of testosterone given every two to three weeks, the daily application of gels under the arm or on the abdomen or lower thighs, and pellets inserted under the skin in the doctor’s office which last for 4-6 months.

Bottom Line: Low T is common. Help is available. See your doctor and get a blood testosterone level and if it is low consider hormone replacement therapy.

What Every Woman Should Know….About Her Man

November 26, 2014

Men live 5-7 years less than women and often have poorer health than their female counterparts. This may be due to many factors but certainly one is that men seek out preventive healthcare much less often than women. This blog is intended to give you an overview of the unique healthcare problems of men and what women can do to help their men lead happier and healthier lives.

ED\Impotence
ED is a common condition that affects as many as 30 million American men. Most men are uncomfortable discussing their sexual problems with either their partners or their healthcare providers. As a result men feel embarrassed and women often feel that the man in their life doesn’t find them attractive.

About 70% of the time, ED is caused by an underlying health problem, most often diabetes, high blood pressure, high cholesterol levels, or heart disease. The remaining 30% of men suffer from ED caused by stress, anxiety, depression, the side effects of medication, or drug and alcohol abuse.

In most cases, ED is treatable, which means that it doesn’t have to be a natural or inevitable part of growing older. Treatments include drug therapy (Cialis, Levitra, or Viagra) vacuum devices, injections, or penile implants. If your partner is suffering from ED, encourage him to seek medical care as certainly this condition can be effectively treated.

Testosterone
Testosterone is one of the most important hormones for the normal growth and development of male sex and reproductive organs. It is responsible for the development of male characteristics such as body and facial hair, muscle growth and strength, and deep voice.

Men’s testosterone levels naturally decrease as men age. But if the levels drop below the normal range, some uncomfortable and often distressing symptoms may develop, including:
Decreased libido or sex drive
Importance or ED
Depression
Fatigue or loss of energy
Loss of muscle mass

As many as 10 million men suffer from low testosterone (low T) but only 5% are being treated.

The diagnosis is made with a simple blood test that measures the blood level of testosterone. If the T level is decreased and the man has symptoms of low T, then replacement therapy with injections, topical gels, or pellets can be prescribed.

Prostate
The prostate is a walnut-sized gland that manufactures fluid for semen. It is located at the base of the bladder and surrounds the urethra or the tube that transports urine from the bladder through the penis to the outside of the body.

Prostatitis is a condition often caused by a bacterial infection or an inflammatory response similar to that seen with allergies and asthma. Symptoms may include a discharge, discomfort, pain in the area underneath the scrotum or testicles, frequent urination, and burning with urination. Treatment usually consists of medication and medications t decrease the inflammatory response in the prostate gland.

Benign prostate gland enlargement affects most men after age 50. The symptoms consist of frequent urination, getting up at night to urinate, and a decrease in the force and the caliber of the urine stream. Treatment consists of oral medication to reduce the size of the prostate gland, or medication that can relax the prostate and improve the urine flow. Now there are minimally invasive treatments such as microwaves, lasers, and even a new treatment, UroLift, that pins open the prostate gland in a 15 minute procedure in an outpatient setting.

Prostate cancer is the most common cancer in men. Nearly 240,000 new cases are diagnosed every year and causes 30,000 deaths each year making it the second most common cause of death due to cancer in men. The diagnosis is made by a digital rectal exam and a blood test, PSA test. If prostate cancer is caught early, it is often curable and nearly always treatable.

In the early stages, prostate cancer usually causes NO symptoms. However, as the disease progresses, so do the symptoms such as hip or back pain, difficulty with urination, painful or burning on urination or blood in the urine.

Every man should consider a baseline PSA test and a digital rectal examination at age 40. Additionally, African Americans and men with a family history of prostate cancer see a physician annually beginning at age 40.

Treatment options for prostate cancer include surgical removal of the prostate gland, radiation therapy, hormone therapy, immunotherapy or cryosurgery. Some men with localized, low risk prostate cancer might select active surveillance or watchful waiting which closes monitors the cancer to see if it progresses or becomes aggressive. If the cancer progresses, then treatment is usually instituted.

Testicular cancer
Cancer of the testicle is the most common cancer in men between the ages of 15-35. Although, there is nothing to prevent testicular cancer, if the cancer is diagnosed early, there is a high cure rate. Early detection is the key to success.

Symptoms of testicle cancer include:
Lumps or enlargement of either testicle
A feeling of pulling or unusual weight in the scrotum
Pain or discomfort in the testicle or scrotum
Dull ache in the lower abdomen
Enlargement or tenderness of the breasts

The best way to diagnose testicle cancer is be doing a testicle self-examination. Men\boys should examine themselves once a month just as women are recommended to do a monthly breast self examination. If a man experiences a lump or bump on the testicle or in the scrotum, contact your physician as soon as possible.

So what do I recommend?
In your 20s
A physical examination every three years
Check blood pressure every year
Screening for cancers of the thyroid, testicles, lymph nodes, mouth, and skin every three years
Cholesterol test every three years
Testicular self-exam every month

In your 30s
All of the above and a physical exam every two years

In your 40s
A physical exam every two years
A PSA test and a digital rectal exam if you are in a high-risk group
A stool test for colon and rectal cancer every year

At age 50 and above
A colonoscopy every 5 years or as recommended by your physician
A PSA and digital rectal exam every year

Bottom Line: Women can be so helpful in guiding men to good health. If you love your man, encourage him to follow these guidelines.

In the next blog we will discuss what men need to know about women’s health.