Pain Pills Won’t Put Potency In Your Penis

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.

Non-Medical Solutions to Raising Your Low T Level

I am often asked by patients 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.

2. 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.

3. 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 are helpful, they are just a step in the right direction.  For more information about testosterone replacement therapy, speak to your physician.

Depression, Anti-Depressants, and Low Testosterone Levels

Hormone deficiency is common in many middle age and older men.  It is of interest that many men using anti-depressants also are found to have low testosterone levels.

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have low testosterone.  We are not certain about the mechanism of action of SSRI’s and low T levels but the effect is certainly prevalent.

Many men with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. Men may be so depressed and have a decreased libido, that they don’t feel like having sex.

If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.

Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression.

It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many men that have taken SSRI’s believe that the drugs they took lowered their testosterone.

On average, men tend to naturally experience lower levels of testosterone by the time they reach age 50. By age 60 it is estimated that 1 in 5 men have problems with their testosterone. In cases where men experienced a reduction in their level of testosterone and simultaneously became depressed, increasing testosterone levels can be therapeutic.

In older men, testosterone therapy may prove to yield antidepressant effects. Most medical research demonstrates that testosterone can have positive effects on mood. It seems as though testosterone treatment tends to be most beneficial for men who are experiencing depression as a result of testosterone decline.

Bottom Line:  Many middle age men have been placed on SSRI’s for depression.  This can result in a decrease in the testosterone level.  If you are experiencing a decrease in your libido, have decreased energy, and loss of muscle mass, you may have low T levels.  The diagnosis is easily made with a blood test and treatment consists of testosterone replacement therapy.

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

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-Hormone Replacement Is Safe For Your Prostate Gland

I am also asked if using testosterone, injections, topical gels, or pellets, will worsen urinary symptoms in men suffering from testosterone deficiency.

Millions of Americans suffer from testosterone deficiency.  They have symptoms of loss of energy, erectile dysfunction, loss of libido, loss of muscle mass, and emotional mood swings.  The diagnosis is easily made with a testosterone blood test.

A recent review finds no evidence that testosterone replacement therapy causes or worsens urinary tract symptoms or increase the size of the prostate gland.

Although the Endocrine Society and other associations have suggested severe urinary symptoms as a contraindication to TRT treatment, investigators found little evidence to support it worsening urinary symptoms in men using testosterone replacement therapy.

The investigators discovered that men with mild urinary sympmtoms experienced either no change or an improvement in their symptoms following TRT.

Remarkably, the study explained that the therapy may actually improve voiding symptoms.

Bottom Line:  Testosterone replacement therapy is safe in men with urinary symptoms and will not worsen those symptoms but may actually improve their symptoms.

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

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

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

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

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

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



Depression and Testosterone: Many people may be experiencing depression as a result of low testosterone. Similarly many people may be experiencing low testosterone as a result of depression. Additionally, these two factors could be totally unrelated and independent of each other. In other words the depression could have nothing to do with low T and vice versa.
Depression and sex drive – Many people with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. People may be in such a depressed, low level of arousal, that they don’t feel like having sex. Therefore in this case, it could be that the depression and not testosterone is causing reduced sexual interest.
Testosterone and sex drive – It is well known that healthy testosterone levels are linked with a healthy sex drive. Men that have low T tend to have less fuel for sex, erectile dysfunction, and other performance issues. If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.
Low testosterone causing depression? – Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression. For this reason it is important to rule out all causes of depression (including low T) before you get on an antidepressant.
Antidepressants and low testosterone – It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many people that have taken SSRI’s believe that the drugs they took lowered their testosterone.
Bottom Line: There is no question that there is a relationship between testosterone and depression. I cannot say for certain that low testosterone is a result of the use of SSRIs. However, if you are taking SSRIs and you are experience a low sex drive or libido, it is very easy to ask your doctor to obtain a blood testosterone test. If it is low, treatment is easily accomplished with either testosterone injections, topical gels or pellets.

Testosterone and the Prostate Gland

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.

Male Health Month

June is Male health. Here are 10 health concerns for men:

1. Prostate cancer. Approximately 30,000 men die of prostate cancer each ear. All meds should undergo a baseline prostate specific antigen blood test at age 40. Men with a family history of prostate cancer, African American men, and veterans exposed to agent orange are at high risk. These men should consider getting screening each year beginning at age 40.

2. Benign enlargement of the prostate is also a concern for men after the age of 50. 50% of them between the ages of 50 and 60 will develop enlargement of the prostate which is a benign disease but affects a man’s quality of life.

3. Erectile dysfunction. Failure to achieve and maintain an erection can be caused by heart disease, diabetes, certain medications, lifestyle, or other problems. Effective drugs are available for treating this common condition that affects over 30 million American men.

4. Cardiovascular disease. Heart disease and stroke are often associated with high cholesterol and high blood pressure. Both can usually be controlled with diet and exercise, sometimes combined with medication.

5. Testicular cancer. Testicular cancer is the most common form of cancer in men between the ages of 20-35 and in most cases can be cured.

6. Diabetes. Men with diabetes or more likely to suffer from heart disease, stroke, kidney disease, vision problems and erectile dysfunction.

7. Skin cancer. Anyone who spends a lot of time in the sun is at risk for skin cancer.

8. Low testosterone. As men age, their testosterone decreases. This can called Andropause, a condition similar to menopause in women.

9. Colorectal cancer. Cancer of the colon and rectum can usually be treated if caught early.

10. Depression. Men are less likely than women to seek help for depression and are 4 times more likely to commit suicide. Help can take the form of medication, counseling, or a combination of both.

I know in New Orleans we have the attitude that “if ain’t broke don’t fix it”. That may apply to your car but not to your body. Take good care of yourself and see your doctor once a year for fine-tuning your health and wellness.

DHEA For Low T: Facts and Warnings

I have treated many men with low testosterone and many ask for a solution that does not involve testosterone replacement therapy. This blog will discuss the use of DHEA in men and how effective it may be for solving the symptoms of low T.

DHEA is a hormone that is naturally made by the human body. It can be made in the laboratory from chemicals found in wild yam and soy. However, the human body cannot make DHEA from these chemicals, so simply eating wild yam or soy will not increase DHEA levels.

Athletes and other men use DHEA to increase muscle mass, strength, and energy. But DHEA use is banned by the National Collegiate Athletic Association (NCAA).

DHEA is also used by men for erectile dysfunction (ED) and in men who have low levels of testosterone in order to improve well-being and sexuality.

Like many dietary supplements, DHEA has some quality control problems. Some products labeled to contain DHEA have been found to contain no DHEA at all, while others contained more than the labeled amount.

How does DHEA work?
DHEA is a “parent hormone” produced by the adrenal glands near the kidneys and in the liver. In men, DHEA is also secreted by the testes. It is changed in the body to a hormone called androstenedione. Androstenedione is then changed into the major male hormones including testosterone.

DHEA levels seem to go down as people get older. Some researchers think that replacing DHEA with supplements might prevent some diseases and conditions.

DHEA is Possibly Effective for:
• Aging skin. Some research shows that taking DHEA by mouth increases the thickness and hydration of the top layer of the skin in elderly people. Early research shows that applying DHEA to the skin for 4 months improves the appearance of skin.

DHEA has Insufficient Evidence for:
• Aging. Taking DHEA does not seem to improve body shape, bone strength, muscle strength, insulin sensitivity, or quality of life in people older than 60 who have low DHEA levels.
• Hormone deficiency in men (partial androgen deficiency). Early research suggests that taking 25 mg of DHEA daily for one year might improve mood, fatigue and join pain in older men with hormone deficiency.
• Physical performance. Some research shows that older adults who take DHEA have improved measures of muscle strength. However, other research has found no effect of taking DHEA on muscle strength.
• Sexual dysfunction. Evidence on the effectiveness of DHEA for sexual dysfunction is inconsistent. Taking DHEA by mouth for 24 weeks seems to improve symptoms including erectile dysfunction and overall satisfaction in men. However, it does not seem to be helpful if erectile dysfunction is caused by diabetes or nerve disorders.
• Weight loss. Early evidence suggests that DHEA seems to help overweight older people who are likely to get metabolic syndrome to lose weight. It is not known if DHEA helps younger people to lose weight.

Bottom Line: DHEA is probably not a panacea for low T or a treatment for ED or erectile dysfunction.

Warning Signs of Low T (testosterone)

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.