Posts Tagged ‘Testosterone deficiency’

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.

Testosterone Replacement In Men Who Wish To Continue Family Planning

November 24, 2014

Testosterone Replacement In Men Who Wish To Continue Family Planning

Millions of men have testosterone deficiency. Most of the men are middle age and older and, therefore, family planning is not an issue. However, if younger men have a low testosterone level and wish to continue family planning, the usual replacement with testosterone injections, gels or pellets is contraindicated because testosterone can reduce the sperm count making fertility difficult or impossible. This blog will discuss treatment of low T in younger men who wish to continue to have a family.

Function of Testosterone

Testosterone is the most important sex hormone or androgen produced in men. The function of testosterone is primarily the producing the normal adult male characteristics. During puberty, testosterone stimulates the physical changes that constitute the attributes of the adult male.

Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass. Testosterone is produced in men by the testes and in the outer layer of the adrenal glands.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Symptoms of Low Testosterone

The failure of the testes to produce a sufficient level of testosterone in the adult male results in a low testosterone level. Physical signs of low testosterone in men may include:

Declining sex drive,
Erectile dysfunction (ED),
Low sperm count
Decrease in lean muscle mass
Insomnia or sleep disorder
Depression
Chronic fatigue.
Conditions Causing Male Testosterone Deficiency

Testosterone deficiency can be caused by different conditions: 1) effects of aging; 2) testes based conditions; 3) genetics; and 4) conditions caused by the pituitary and hypothalamus.

The effects of aging on testosterone production
Testes disorder
Pituitary/Hypothalamus disorder
Genetically-based condition
Function of Testosterone Therapy

The function of testosterone hormone replacement therapy is to increase the level of testosterone in the adult male diagnosed with testosterone deficiency (low testosterone) or hypogonadism. Testosterone replacement should in theory approximate the natural, endogenous production of the hormone. The clinical reasons for treatment of testosterone deficiency in men include:

Increased male sex drive
Improve male sexual performance
Enhance mood in men
Reduce depression in men
Increased energy and vitality
Increase bone density
Increased strength and endurance
Reduce body fat
Increase body hair growth
Reduce risk of heart disease
Develop lean muscle mass with exercise
Function of HCG Therapy is to Stimulate the Testes to Prevent Loss of Natural Testosterone Production and Avoid Testicular Atrophy while the Male Patient is Undergoing Testosterone Hormone Replacement Therapy

The hormone HCG is prescribed for men in this therapy to increase natural testosterone production during the course of therapy as a result of the stimulation of the testes by the HCG. No testosterone medication is administered in this treatment. The treatment objective is to cause the male testes to naturally produce a higher volume of testosterone by HCG stimulation of his testes with the result that the patient experiences a continuing higher blood level of testosterone while on treatment. Another treatment objective is to avoid the use of any anabolic steroid and its adverse side effects upon the patient.

HCG Therapy normally increases natural testosterone production by the male testes while HCG is administered to the patient during the treatment period However, HCG Therapy can also result in a continuation of increased testosterone production and a resulting higher level of testosterone in the bloodstream after treatment is completed when the cause of the patient’s low natural LH secretion by the pituitary is not due to the patient’s natural genetics, aging process, injury to or loss of one or both testes; a medical disorder or disease affecting the testes, or castration.

HCG Therapy can result in a continuing higher level of natural testosterone production by the testes after HCG Therapy is completed when the underlying cause of the low LH secretion and resulting low testosterone production (1) is due to the prior use of one or more anabolic steroids by the patient or (2) due to the administration of testosterone in a prior hormone replacement therapy without the required concurrent HCG Therapy to prevent the patient’s endocrine system (hypothalamus pituitary-testes axis) from shutting down the natural production of testosterone by the testes and causing testicular atrophy.

Types of Testosterone Therapy for Men

A good male testosterone replacement therapy produces and maintains physiologic serum concentrations of testosterone and its active metabolites without significant adverse side effects.

The leading types of testosterone therapy for men include:

Testosterone Injection with HCG
Testosterone Transdermal Cream with HCG
Testosterone Transdermal Gel with HCG
Benefits of HCG Therapy for the Male Patient Undergoing Testosterone Hormone Replacement Therapy

Increases natural testosterone production by the testes
Prevents loss of natural testosterone production by the testes while the male patient is undergoing testosterone hormone replacement therapy
Prevents atrophy of testes while male patient is being treated with testosterone replacement therapy
Increases physical energy and elimination of chronic fatigue
Improves sex drive
Improves sexual performance
Improves mood
Reduces depression
Increases lean muscle mass
Increases strength and endurance as a result of exercise
Reduces body fat due to increased exercise
Increases sperm count and therefore male fertility
HCG Therapy can also result in a higher level of natural testosterone production after HCG Therapy is completed when the cause of a man’s current low testosterone production is the prior use of anabolic steroids that shut down or reduced the pituitary gland’s production of LH and decreased testosterone production.
Human Chorionic Gonadotropin (HCG)

HCG is compounded by a compounding pharmacy or manufactured by pharmaceutical company in 10,000 IU (International Units) for reconstitution with sterile water for injections in 10 cc vials.

HCG is a natural protein hormone secreted by the human placenta and purified from the urine of pregnant women. HCG hormone is not a natural male hormone but mimics the natural hormone LH (Luteinizing Hormone) almost identically. As a result of HCG stimulating the testes in the same manner as LH, HCG therapy increases testosterone production by the testes or male gonads as a result of HCG’s stimulating effect on the leydig cells of the testes.

The Decline in Gonadal Stimulating Pituitary Hormone LH (Leutenizing hormone)

The natural decline in male testosterone production that occurs with aging is attributed to a decline in the gonadal stimulating pituitary hormone LH (Luteinizing hormone). As a result of the hypothalamus secreting less gonadoropin-releasing hormone (GhRH), which stimulates the pituitary gland to produce LH, the pituitary gland produces declining amounts of LH. This decrease in the pituitary secretion of LH reduces the stimulation of the gonads or male testes and results in declining testosterone and sperm production due to the decreased function of the gonads. The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

How HCG Therapy Increases Plasma Testosterone Level in Men with Low Testosterone Production

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone. The male endocrine system is responsible for causing the testes to produce testosterone. The HPTA (hypothalamic-pituitary-testicular axis) regulates the level of testosterone in the bloodstream. and . The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release Leutenizing hormone (LH).

LH released by the pituitary gland then travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without the continuing release of LH by the pituitary gland, the testes would shut down their production of testosterone, causing testicular atrophy and stopping natural testosterone produced by the testes.

As men age the volume of hypothalamus produced gonadotropin-releasing hormone (GnRH) declines and causes the pituitary gland to release less Luteinizing hormone (LH). The reduction if the volume of LH released by the Pituitary gland decreases the available LH in the blood stream to stimulate the testes to produce testosterone.

In males, HCG mimics LH and increases testosterone production in the testes. As such, HCG is administered to patients to increase endogenous (natural) testosterone production. The HCG medication administered combines with the patient’s own naturally available LH released into the blood stream by the Pituitary gland and thereby increases the stimulation of the testes to produce more testosterone than that produced by the Pituitary released LH alone. The additional HCG added to the blood stream combined with the Pituitary gland’s naturally produced LH triggers a greater volume of testosterone production by the testes, since HCG mimics LH and adds to the total stimulation of the testes.

HCG Clinical Pharmacology

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens.

Thus HCG sends the same message and results in increased testosterone production by the testis due to HCG’s effect on the leydig cells of the testis. HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level.

Following intramuscular injection, an increase in serum HCG concentrations may be observed within 2 hours; peak HCG concentrations occur within about 6 hours and persist for about 36 hours. Serum HCG concentrations begin to decline at 48 hours and approach baseline (undetectable) levels after about 72 hours.

HCG is not a steroid and is administered to assists the body in the continuing production of its own natural testosterone as a result of LH signals stimulating production of testosterone by the testis.

This LH stimulates the production of testosterone by the testes in males. Thus HCG sends the same message as LH to the testes and results in increased testosterone production by the testes due to HCG’s effect on the leydig cells of the testes. In males, hCG mimics LH and helps restore and maintain testosterone production in the testes. If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone

Non Medical Ways to Boost Testosterone Levels

November 9, 2014

Testosterone is the male hormone produced in the testicles and it is responsible for man’s sex drive. Low testosterone levels can impact a man’s sexual performance. This blog will discuss life-style changes that men can make to improve their testosterone levels.

The sex hormone testosterone is often touted as helping men maintain their vitality and virility, but levels begin to dip naturally by about 1 percent a year after age 30. Signs that your testosterone may be declining more rapidly include loss of energy, decreased sex drive, irritation or anger, and trouble sleeping.
Although testosterone supplementation is effective, there are risks and side effects that make life style changes a more attractive alternative. There are many tried and true drug-free and hormone-free ways to maintain testosterone levels.

Deep Six the Sauce (Alcohol)
A glass of wine with dinner is no problem, but overdrinking is not a good idea. Moderate alcohol consumption for men is a max of two drinks a day, with one being a 5-ounce glass of wine.

Shed Some Pounds
Being overweight or obese can increase risk for heart disease and certain cancers, but extra weight also increase the risk for low testosterone levels. Research published in Diabetes Care in June 2010 showed that 40 percent of obese men had lower-than-normal testosterone readings, and this percentage increased to 50 percent among obese men with diabetes. Weight loss can be a hormone-free way to combat low T. A benefit of weight loss for obese men is that the penis will appear to be longer because of the loss of the abdominal fat. I usually tell men that every 30 pound weight loss increases the length of the penis by 1.5 inches.

Send Out a Stress SOS
A study done at the University of Texas at Austin in 2010 suggested that the stress hormone cortisol may block the beneficial testosterone. When our stress levels are up, our testosterone can go down.

Regular exercise helps reduce stress levels as well as help you maintain a normal weight, so it packs a double whammy against low testosterone levels. Other stress reduction techniques, like deep breathing, can also serve as natural testosterone support.

Take a Big Dose of Vitamin “E”-Exercise
Exercise can help maintain your testosterone levels and avoid some of the symptoms of low T.
Research in the September 2011 issue of the Journal of Strength and Conditioning Research backs this up. The study showed that a 4-week sprint-interval training program helped boost testosterone levels in a drug-free fashion among wrestlers.

Sleep And Sex
A small study conducted at the University of Chicago School of Medicine found that men who slept less than five hours a night for one week had lower levels of testosterone than when they had a full night’s sleep.
When you are sleep deprived, it impacts levels of the stress hormone cortisol, which reduces testosterone just like stress can. A sleep-deprived state is a testosterone-deprived state. Everyone’s sleep needs are different, but it’s important that you wake up feeling refreshed.

Avoid Plastic Bottles
The controversial chemical bisphenol A (BPA) is found in many plastic water bottles as well as in the lining of food and beverage cans, and exposure to this plasticizer may result in low T. BPA can act like the female hormone estrogen in the body, which means it can lower levels of testosterone,
Don’t cook foods wrapped in plastic in the microwave, and try to drink from a glass or a steel thermos. The more flexible a plastic bottle, the more likely it is to leach BPA and affect the testosterone level

Think Zinc
If you take a multivitamin with zinc or eat oysters every day, your zinc levels are probably within the normal range. Aim for 12 to 15 milligrams a day to help stave off low T.

Some Fat Is Your Friend

Men who eat a low-fat diet have lower testosterone, because the body makes testosterone from cholesterol. But this doesn’t mean you should eat unhealthy bad fats. Instead choose healthy fats such as those found in avocado, nuts, and olive oil. These fats will boost testosterone naturally, but they won’t raise blood levels of artery-clogging cholesterol.

Skip the Sugar

Every time you eat sugar, testosterone is decreased, likely because the sugar causes a high insulin level which can decrease the testosterone level.
Bottom Line: Low testosterone levels are a treatable condition that affects millions of men. There are options that don’t require medication that also improve your overall health and wellness.

Low T May Be the Cause of Your ED (erectile dysfunction)

September 22, 2014

More than 14 million American men suffer from low testosterone levels. It is a normal consequence of aging just as menopause and low estrogen is a normal biological response in women.

Testosterone drives desire and the ability to have erections.

Levels drop naturally with age — by 75, a man’s levels may be half of what they were when he was 20 — but they vary widely with the individual, and experts believe low testosterone only rarely causes erectile dysfunction.

If you suffer from lack of energy, low sexual desire, falling asleep after meals and loss of muscle mass, you might consider asking your doctor to check your T levels— this involves a blood test.

A reading of greater than 300 ng\dl is considered normal, and below 300 is considered low.

If low, your doctor might offer you testosterone replacement therapy (TRT) in the form of a topical gel applied to the skin, injections or pellets inserted under the skin every 4-6 months.

Bottom Line: Low T is a normal part of the aging process. If you have a low T level and have symptoms of low T, speak to your doctor about testosterone replacement therapy.

Non-Medical Treatments for Erectile Dysfunction (ED)

September 22, 2014

I am often asked if there are any non-medical treatments for erectile dysfunction.  These are a few suggestions that are not scientifically proven but have been anecdotally reported as helpful.

L-arginine

Studies show this amino acid can improve erections by boosting the production of nitric oxide, a natural chemical that dilates blood vessels to the penis. I suggest 750mg three to four times a day.

Vitamin D3

This nutrient is linked with the production of testosterone in men. Testosterone is the hormone responsible for libido or sex drive. I recommend patients have their vitamin D levels checked and take supplements if they are deficient.

Yohimbe

This is an herb, which comes from the bark of an evergreen African tree and is thought to work by increasing blood flow to the penis.

GinkGo Biloba

This extract from the leaves of the ginkgo biloba tree is used for circulation problems, low energy levels and fatigue. GinkGo biloba is thought to relax blood vessels while simultaneously improving sluggish circulation. Other studies that compared it with a placebo have found it helped treat sexual dysfunction and impotence in men.

Ginseng

Known as the male remedy in China, there is evidence to suggest this herb can reduce stress by helping to mop up the stress hormones cortisol and adrenaline. The recommended dosage is 150mg three times a day.

ED is a common problem affecting millions of American men.  There are some non medical treatments that may improve your erections without the necessity of taking medications.

Low testosterone in men shouldn’t be ignored

July 28, 2014

Low testosterone in men shouldn’t be ignored

Posted on July 11, 2014 at 5:21 PM
Meg Farris / Eyewitness News
Email: mfarris@wwltv.com | Twitter: @megfarriswwl

NEW ORLEANS – Beginning around the age of 30, men start losing one percent of an important hormone each year.

And doctors say it is important to replace it for quality of life and long term health.
Jerry Tolbert played basketball in the Air Force. In golf, he usually hits a few strokes over par, but in his mid 50s, something changed.

“As men we don’t like to talk about those things. Just seems like it’s something about that you keep to yourself,” said Tolbert.

Jerry was going through andropause. His testosterone levels were declining, like menopause in women. The hormone testosterone is responsible for sex drive and performance, muscle and bone mass, energy, mood, thinking and metabolism, helping decrease fat storage. So when he didn’t feel like himself, he turned to urologist Dr. Neil Baum.
“If your testosterone level is low, it is good medicine to raise it to normal,” explained Dr. Baum, a urologist at Touro. He says with other medical conditions, such as blood pressure, glucose and thyroid levels, doctors don’t hesitate to help patients bring those to normal.

Dr. Baum says when levels of testosterone drop, men can fall asleep after meals more easily, have low sex drive, energy and motivation, along with muscle and fitness loss and mood changes such as irritability and depression.

So with a simple blood test to diagnose low-T along with symptoms, he uses injections or creams or even tiny pellet implants to replace what the body no longer makes.

Dr. Baum wants to make it abundantly clear, this is not about taking a lot of testosterone to make you super human like some of the professional athletes do. This is simply about replacing what your body no longer makes to bring you up to normal.

He says a recent study raising concerns about testosterone replacement and risks for heart attacks and strokes, was poorly done, even including women in the study.

“The study is really flawed from so many different areas and now a new study came out that demonstrates that replacing testosterone improves the cardiac function improves, decreases the risk of stroke and it may be cardio-protective instead of cardio-dangerous,” he added.

Now at 67 years old, Jerry feels normal and his clothes fit better.

“I had this midriff bulge, that’s going away now. It’s not as bad as it was,” said Tolbert about his midsection since he began hormone replacement therapy.
Going years with low testosterone can increase risk for hip and spine fractures, diabetes and heart disease as well as cognitive declines, loss of sex drive, sexual performance and overall energy.

Doctors do not recommend oral hormone replacement at all, or replacement for men not finished having children.

Lack of ZZZZZ’s Can Affect Your TTTTTTs

July 24, 2014

There’s now a relationship between lack of sleep and your testosterone level. Lack of sleep can affect your libido (sex drive), your energy level, and even your ability to concentrate. It is of interest that sleep deprivation can affect the testosterone level, and low testosterone level can affect your ability to sleep so it is a double edged sword.

Sleep Deprivation and Low T: What the Research Shows
A 2011 study published in the Journal of the American Medical Association (JAMA) reported the effect of one week of sleep restriction in healthy, young men. Previous studies have shown that gradual decrease in sleep time is partially responsible for low T in older men. Studies also have shown that sleep disturbance caused by obstructive sleep apnea (OSA)— a chronic breathing disturbance that occurs during sleep — is linked to low T.

In the JAMA study, 10 men volunteered to have their testosterone levels checked during eight nights of sleep restriction. They were only allowed five hours of sleep per night. The study found that their daytime testosterone levels decreased by 10 to 15 percent. The lowest testosterone levels were in the afternoon and evening. The study also found a progressive loss of energy over the week of sleep deprivation.

OSA is a common condition in which breathing becomes obstructed during sleep. Symptoms are daytime sleepiness, loud snoring at night, and short periods of absent breathing (apnea). Sleep apnea causes an abnormal sleep cycle and can result in low testosterone. Treating sleep apnea has been shown to return testosterone to normal levels.

A study presented at the American Urological meeting in 2012 evaluated 2,121 male law-enforcement officers to see if there was an association between sleep apnea and low testosterone. About 38 percent of the men had low testosterone, and 43 percent were considered to have sleep apnea. The men with sleep apnea were almost 50 percent more likely to have low T than men without sleep apnea.

Why the Link Between Sleep and Low T?
Normal testosterone production requires restful, undisturbed sleep called REM sleep. Over time, sleep disturbance also can cause an increase in the stress hormone cortisone. High cortisone levels also can cause low testosterone.

The majority of the testosterone used every day is replenished at night. In older men, gradual reduction in hours of sleep has been closely correlated with gradual lowering of testosterone. Studies have shown that men with low testosterone, especially older men, tend to have more trouble sleeping.

Tips for Better Sleep
Good sleep habits are called sleep hygiene. According to the U.S. Centers for Disease Control and Prevention (CDC), an adult should get seven to nine hours of sleep every night. Here are the basics for maintaining good sleep hygiene:
Set a routine. Go to bed and get up at the same time every day, including weekends.
Get comfortable. Keep your bedroom quiet, dark, and at a comfortable temperature for sleeping.
Stay focused. Make sure your bed is comfortable and use it only for sex or sleeping. Avoid bedroom distractions like TV, books, and computers.
Don’t chow-down. Avoid eating a big meal before bedtime.
Now here’s the best one: Sex before bedtime can be a sleep.

Bottom Line: Low testosterone can impact so many areas of your life. It is important to get plenty of sleep and sleep deprivation and disturbed sleep can lower your testosterone. So be good to your sex life and get an adequate amount of sleep each night.

What You Need To Know About Low T (Testosterone) and Heart Disease

March 27, 2014

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.

What Culprits Send Cupid Out of the Bedroom?

February 14, 2014

Today is Valentine’s Day, the day that couples think about love and intimacy. However, there are relationships where love and affection have left the bedroom. There are many culprits that can affect intimacy between a man and a woman.

Medications

There are literally hundreds of medications that can impact a man or a woman’s sex life. Medications that are prescribed for stroke and heart issues can have devastating effects on sexual functioning. In addition, researchers have found that a family of antidepressants known as selective serotonin-reuptake inhibitors (SSRI) can take the wind right out of your sexual sails. These drugs include Prozac, Zoloft and Paxil.

Doctors can often reduce the dosage of these offending drugs or can change to another drug that can accomplish the same result without the sexual side effects.

Chronic Pain

People of both sexes can develop pain disorders as they get older, and that can have a big effect on sexuality. Arthritis and chronic back pain are just two examples. Those who suffer from chronic pain are advised to find the time of day when pain is at a minimum to engage in sexual intimacy. Also, those who suffer from chronic pain may need to take a pain pill before attempting to have sex. There are positions such as side by side that actually put the least amount of stress on your joints and your back and may make it possible to have successful intimacy.

Sex does not always equal intercourse. There are many successful relationships that do not have penis-vaginal intercourse. However, these people are able to engage in intimacy by sensual touching, massage and mutual masturbation.

Make Time for Rest and Play

The National Sleep Foundation recommends getting seven to eight hours of shut-eye a night. But with the stress of work, kids, bills and, oh yeah, your marriage, who can think about fitting in time to have sex, much less sleep? Still, you have to do your best to get a healthy amount of sleep.

Cupid likes to be included on regular dates. Plan some sex dates around times that you know you feel more energetic. You plan other things in your life and you don’t complain about it. You can do the same with sex.

Menopause and Testosterone Deficiency

Menopause and the accompanying decrease in sex drive and the appearance of vaginal dryness can wreak havoc on your sex life. Menopause results from a decrease in estrogens. The solution is as simple as applying a vaginal cream or a lubricant such as K-Y jelly or estrogens, which can be administered by a pill, a patch, topical gels, or a vaginal ring.

If you aren’t in the mood, you may be suffering from testosterone deficiency. This applies to women as well as men. Women also make low doses of testosterone and if the hormone is deficient, women may not be in the mood for sexual intimacy. The application of a topical gel or the insertion of a small pellet under the skin may quickly solve the problem of a lack of sex drive.

Bottom Line: Valentine’s Day is just one day a year. However, Cupid can be your best friend the other 364 days of the year. Try a few of these ideas to bring Cupid back into your bedroom. It’s the best threesome in the world!

This article appeared in the February 2014 issue of Health & Fitness Magazine

Testosterone and Heart Disease – Facts & Caveats

January 30, 2014

I have received numerous calls from men who have symptoms of low testosterone, a documented decrease in their serum testosterone level, and who are receiving testosterone replacement therapy regarding a study that recently appeared in PLOS One.*

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “the ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from the norm. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, the doctor will recommend increasing the consumption of this necessary vitamin. These actions are what we do every day; we attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal. The unstudied/published issue is what is the target value? Most experts feel that there is no absolute “correct” value, but rather treatment is targeted at relief of symptoms.

There are more than 13 million men in the United States who reportedly suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

The study recently reported a study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre).
The results of this study in all subjects revealed the rate ratio (RR) for TT prescription was 1.36. In men aged 65 years and older, the RR was 2.19 for TT prescription. The RR for TT prescription increased with age from 0.95 for men under age 55 years to 3.43 for those aged ≥75 years. In men under age 65 years, excess risk was confined to those with a prior history of heart disease.
The study summary stated that in older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.

Some comments about the study:

No follow-up or research was done on whether or not the men on testosterone therapy achieved therapeutic levels or if they stayed on treatment. It is not accurate to assume that all men treated had their testosterone levels elevated by therapy.

There is no documentation as to whether or not Endocrine Association guidelines were followed, including morning testosterone level assessments and repeating the test at least once.

In closing, a larger study in the Journal of Clinical Endocrinology and Metabolism showed that among male veterans over 40, those on testosterone had lower rates of death than those that did not. This certainly makes sense, since hypogonadism is associated with metabolic syndrome, which is associated with an increased risk of heart attack, stroke, and death.

Finally, the International Consultation in Sexual Medicine (J Sex Med 2010;7:1608) concluded that:
• Low endogenous testosterone levels correlate with an increased risk for adverse cardiovascular events
• High endogenous testosterone levels appear to be beneficially associated with decrease mortality due to all causes, including cardiovascular disease and cancer
• Testosterone supplementation in men is relatively safe in terms of cardiovascular health
• Testosterone use in men with low testosterone leads to inconsequential changes in blood pressure, glycemic control and all lipid fractions.
Bottom Line: Low testosterone levels are associated with increased atherosclerosis. Most studies confirm that administration of testosterone to men has neutral effects on cardiovascular risk factors and cardiac events. For men with a history of heart disease, a careful discussion between the doctor and patient should take place.
*http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+(PLOS+ONE+Alerts%3A+New+Articles)