Posts Tagged ‘low testosterone’

Arimidex For Treating Low Testosterone Levels

February 13, 2017

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

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

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

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

 

 

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.

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.

The Link Between Low T (Testosterone) and Depression

August 17, 2015

Most men think of testosterone as the sex hormone responsible for libido or sex drive. Yes, that is true but there is a also link between low testosterone levels and depression.

A study released at this year’s meeting of the Endocrine Society bring important news that men should know: Depression can go along with borderline or low testosterone levels.

A solid 56 percent of testosterone-deficient participants in the study, from the division of endocrinology at George Washington University in Washington, D.C., had significant symptoms or a diagnosis of depression and/or were taking an antidepressant.

The study involved men with testosterone levels of between 200 and 350 nanograms per deciliter. (A level below 300 ng/dL is considered low.)

Although I don’t recommend screening for low testosterone levels, I do suggest that men who are feeling depressed or not as happy as they would like to feel, consider getting their T levels checked.  It’s something your doctor could have missed that is very important to be addressed.

 Discussions about sex and erections

In general, doctors say men don’t like to discuss symptoms of low testosterone – such as erectile dysfunction and reduced sex drive – and that can make getting to the root cause of the condition and treating it harder.

There are symptoms of low testosterone that are specific to low testosterone – like a blood level less than 300 ng/dL, erectile dysfunction, low sperm count, large breasts and osteoporosis – and symptoms that are not, such as weight gain, decreased muscle strength and mood changes. Depression falls into the non-specific category.

If a person is treated for low testosterone and their mood improves, it could be said in hindsight that low testosterone probably caused their depression, but it’s hard to make a definite correlation at the onset.

Testosterone naturally starts to drop after age 30 at a rate of about 1%\year.

Testosterone replacement therapy, which can be given in the form an injection, a patch, a topical gel or a pellet inserted beneath the skin which lasts for 4-6 months.

Low T and Other Medical Problems

There is a correlation between low testosterone and a variety of indicators of poor health – obesity, high blood pressure, diabetes, metabolic syndrome, cardiovascular disease, a lack of exercise as well as depression.

There is a well known connection between low T and obesity.  Obesity is the No. 1 cause of low testosterone levels and if you lose 10 to 15 percent of your total weight, your testosterone level will come up. In patients who have a testosterone level of less than 200 ng/dL and in younger patients who have a disease or a cancerous tumor that is causing low testosterone, medication is the obvious choice and usually yields improvement.

Paying attention to decreased testosterone is important because low testosterone raises a man’s risk of death and its decline is markedly accelerated by each co-morbidity.

Low Testosterone May Be Risk Factor for Prostate Cancer

August 7, 2015

For many years it has been thought that testosterone fuels prostate cancer and should be avoided at all costs regardless of a man’s symptoms of low libido, lack of energy and a decrease in muscle mass, just to name a few of the symptoms of low T.
Low testosterone levels predict an increased likelihood of high-grade prostate cancer being found as a result of a prostate biopsy.

A South Korean team studied 681 men who underwent an initial 12-core transrectal prostate biopsy. Of these, 86 had low testosterone levels (less than 300 ng/dL) and 143 had normal levels (300 ng/dL or higher). In addition, 143 men had a positive biopsy and 99 had high-grade prostate cancer.

Compared with a normal testosterone level, a low testosterone level was not significantly associated with a prostate cancer diagnosis overall, but it was associated with a significant 2.1 times increased risk for high-grade prostate cancer.

Bottom Line: Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out.
Reference
Park J et al. BJU Int. 2015;doi:10.1111/bju.13206.

Warning Signs of Low T (testosterone)

February 21, 2015

Millions of American men suffer from low T or low testosterone. Often they suffer in silence and not aware that there are treatment options for this common condition. This blog will discuss some of the most common symptoms that are associated with low T. In the next blog I will discuss the treatment options.

Men like to make jokes about testosterone, but testosterone deficiency is no laughing matter. The latest research suggests that men without enough of the hormone face a higher risk of several serious illnesses, including diabetes, osteoporosis, and cardiovascular disease. A simple blood test can reveal whether a man has low T.

Testosterone is what fuels a man’s sex drive. If a man is low on T, he’s likely to have a decrease or loss of his libido. Testosterone is what’s responsible for a man’s sex interest. For men with low testosterone, it’s significantly deficient or completely absent.

A testosterone deficiency can cause significant medical problems, including diabetes, osteoporosis and heart disease Three parts of a man’s body work together to produce the sperm-containing fluid that’s released when a man ejaculates. A man with waning testosterone may notice a sharp decline in his volume of his ejaculate. Men with low testosterone often complain of feeling numbness in their penis and scrotum. They may not be completely numb, but a touch of the penis or scrotom fails to elicit that feeling of electricity needed to spark sexual encounters – and make sex so pleasurable. It’s perfectly normal for a man to feel tired at the end of a busy day. But men with low T feel completely depleted. These men complain of being more tired than they think they ought to be. They seem to run out of gas in the late afternoon or early even. They often remark that “My tank is empty.”

Decreased energy level
In addition to feeling severe fatigue, guys with low testosterone often lose their drive and initiative. Guys who used to be up and at ’em all day long are sidelined on the sofa.

Even if they’re not experiencing clinical depression, men with low testosterone often feel down or blue. They feel less optimistic than they used to feel.

Low testosterone can cause guys to be irritable. Sometimes the problem is more apparent to partners, friends, family members and colleagues – than to the men themselves

It’s not like they become weaklings, but men with low testosterone often feel that they’re not as strong as they once were. Some men actually notice shrinkage in their arm and leg muscles, and in their chest. And if they try to build muscles with weight-lifting, they often find it frustratingly difficult to build muscle mass.

Low testosterone often results not only in reduced muscle mass, but also in increased body fat. Some men add weight around the middle. Others develop gynecomastic, a.k.a as breast development.

Low testosterone can cause them to shrink a bit and feel softer than normal.

The good news about low testosterone is that it’s easily treated – commonly with testosterone skin gels or under-the-skin pellets that release testosterone slowly. And in addition to helping resolve problems with sexuality, mood and appearance, testosterone therapy can help protect men against several serious medical problems, including diabetes, osteoporosis, and cardiovascular disease.

Bottom Line: Testosterone deficiency can affect millions of American men. This blog has provided some of the common symptoms of low T and in the next blog I will discuss treatment options.

Everything You Wanted to Know About Low T (Testosterone) But Afraid To Ask

February 21, 2015

Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.

Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.

The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.

My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Obesity
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
Hormonal disorders
Infections

What is the treatment for low testosterone (Low-T)?

Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.

Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.

Injections: Testosterone can be delivered by direct injection.

Pellets: Pellets can be implanted into the soft tissue and release the testosterone.

I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.

Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Skin reactions
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.

Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.

In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.

Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.

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.

Testosterone and the Prostate Gland-It’s Not Gasoline On a Fire

November 3, 2014

For the past two years I have made the decision of treating prostate cancer patients who are documented to be hypogonadal with testosterone replacement therapy. Many of my colleagues have asked me about this decision and I would like to provide you with the evidence that this treatment of hypogonadal men who have been treated for localized prostate cancer with either radical prostatectomy or radiation therapy is safe.

In the late 1980s Dr. Abraham Morgentaler, a urologist in Boston, Massachusetts, began researching the relationship between testosterone and prostate cancer.  Since the early 1940s testosterone had been believed to be a key contributor to the development of prostate cancer, and once cancer was established, testosterone was believed to be its fuel.  As a result, generations of medical students around the world were taught that providing additional testosterone to a man with prostate cancer was “like pouring gasoline on a fire.” On the flip side, it was similarly believed that low levels of testosterone protected a man from ever having prostate cancer.

As one of the first physicians in the modern era to offer testosterone therapy to otherwise healthy men with sexual problems, Dr. Morgentaler was concerned that this treatment, while effective, might precipitate rapid growth of undetected, “occult” prostate cancers in his patients.  In order to avoid causing more harm than good, Dr. Morgentaler took the bold step of performing prostate biopsies in these men to exclude the possibility that these men harbored an undetected prostate cancer, even though they had none of the standard indications for a biopsy, such as elevated PSA or a nodule.  Although it had been assumed these men were at extremely low risk for prostate cancer because of their low testosterone levels, Dr. Morgentaler and his colleagues found exactly the opposite. One in seven of these “normal” men that underwent biopsy was found to have cancer, a rate similar to that seen in men known to be at increased risk.

Dr. Morgentaler presented his findings at the annual meeting of the American Urological Association in 1995.  At the end of the presentation an influential chairman of a major urology department came to the microphone and loudly described this work as “garbage.” “Everyone knows high testosterone causes prostate cancer and low testosterone is protective,” he proclaimed in a booming voice.  The research was published the following year in the prestigious Journal of the American Medical Association.

As the testosterone and prostate cancer link became less persuasive, Dr. Morgentaler began to offer testosterone to men with pre-cancerous abnormalities on prostate biopsy, and reported no increased rate of subsequent cancer. Yet at his own hospital, the Beth Israel Deaconess Medical Center, a senior endocrinologist complained to the administration that this research was “dangerous”.

However, Dr. Morgentaler prevailed and went on to publish clinical research on the safety of testosterone in men with actual prostate cancer, some treated with radiation or surgery, and even in selected men with untreated prostate cancer.

Dr. Morgentaler’s results were difficult to accept initially because a longstanding treatment for advanced prostate cancer has been androgen deprivation, a surgical or medical treatment designed to permanently reduce testosterone levels as much as possible. Numerous studies in these men had shown improvement in prostate cancer with this treatment, so it seemed logical that raising testosterone would cause prostate cancer progression.

Dr. Morgentaler’s elegant solution to this apparent paradox was the saturation model, based on studies in humans, animals, and in prostate cancer cell lines in the laboratory. It turned out that prostate tissue does indeed require testosterone for optimal growth, but that it can only use a limited amount of testosterone (or its metabolite, dihydrotestosterone) before it reaches a maximum. In biological terms, this is called saturation.  Once saturation is achieved, additional testosterone has little or no capability to stimulate further growth. And saturation occurs at very low levels of testosterone, approximately 20ng\dl. This explained why testosterone treatments did not appear to harm men with existing or treated prostate cancer, namely because the cancers already had seen all the testosterone they could use.

The Evidence

A number of physicians have treated patients with testosterone despite the fact that they’d been treated for prostate cancer in the past. The first to publish their experience with doing this were Drs. Joel Kaufman and James Graydon, whose article appeared in the Journal of Urology in 2004.

In this article, Drs. Kaufman and Graydon described their experience in treating seven men with T therapy some time after these men had undergone radical prostatectomy as treatment for prostate cancer, with the longest follow-up being 12 years. None of the men had developed a recurrence of his cancer. Soon afterward, there was another paper by a group from Case Western Reserve University School of Medicine describing a similar experience in 10 men with an average follow-up of approximately 19 months. Then another group from Baylor College of Medicine reported the same results in 21 men.

In all these reports, not a single man out of the 38 treated with testosterone developed a cancer recurrence. It is important to emphasize that all these reports included only men who were considered good candidates because they were at low risk of recurrence anyway. And in some cases, the duration of time the men received T therapy was relatively short. But it was reassuring that none of the 38 men who had suffered from prostate cancer in the past and who were treated for years with testosterone had developed a recurrence of prostate cancer.

This reassuring experience was bolstered by the published experience of Dr. Michael Sarosdy, who reported the results of T therapy in a group of 31 men who had received prostate cancer treatment in the form of radioactive seeds, called brachytherapy. This less-invasive form of treatment does not remove the prostate, so theoretically there is the possibility that a spot of residual cancer might still be present. With an average of five years of follow-up in these men, none of the 31 men had evidence of cancer recurrence.

My Approach

Men who have low-grade prostate cancer, i.e., Gleason score of <6, and low stage disease, T1 or T2, and have a nadir of their PSA following curative treatment with either surgery or radiation for 9-12 months, and have symptoms of hypogonadism and documented low testosterone levels, are candidates for hormone replacement therapy. I provide them with educational materials similar to what is in this newsletter and request that they return every month to monitor their PSA levels. Any increase in PSA levels for two successive months results in cessation of their hormone replacement therapy. Of the several dozen patients that meet this criteria and have received testosterone replacement therapy, none have had a rise in their PSA or evidence of recurrence of their prostate cancer.

Bottom Line: Today, most urologists throughout the world, myself included, are comfortable using testosterone in men without the fear of causing prostate cancer, and in the US a majority will now offer testosterone treatment to some men previously treated for prostate cancer.  This revolutionary change in medical beliefs and practice resulted directly from the work of Dr. Morgentaler, who became a David against Goliath and was relentless in his pursuit of scientific truth and making it possible for some men who have prostate cancer with documented hypogoandism to receive hormone replacement therapy.