Posts Tagged ‘testosterone replacement therapy’

Low T-Review of New York Times Editorial, March 28, 2017

March 29, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.

Testosterone Replacement-Relationship With Heart Disease

March 27, 2017

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

Non-Medical Solutions to Raising Your Low T Level

March 23, 2017

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.

  1. Reduce stress and cortisol levels

If you are suffering from long-term stress, it can increase the levels of cortisol hormone. If your cortisol levels are high, testosterone levels will decrease.

That’s why, you need to reduce stress as much as possible and which will also decrease the cortisol levels in your body. Regular exercise, whole foods, good sleep, balanced lifestyle and laughter can help you to reduce stress and also improve your overall health.

  1. Get more Vitamin D

Vitamin D offers several health benefits and it boosts testosterone naturally. If you consume just 3,000 IU of vitamin D3 per day, it can increase testosterone levels in the body by 25%.

You can get more vitamin D by increasing your exposure to sunlight regularly. You can also take a daily supplement of 3,000 IU of a vitamin D3 supplement.

4. Get Enough Sleep.

A lack of sleep affects a variety of hormones and chemicals in your body. This, in turn, can have a harmful impact on your testosterone.

The time honored goal is try for 7 to 8 hours per night.

5. Keep a Healthy Weight.

Obesity can have a deleterious effect on your testosterone levels.  Exercise and diet can improve your testosterone and also is good for your heart to avoid obesity.

6. Review Your Medications.

Some medicines can cause a drop in your testosterone level. These include: pain medications, steroids (prednisone), anabolic steroids such as those used by athletes and body builders, and anti-depressants.

7. Deep 6 the Supplements.

You may be bombarded with unsolicited snail mail and E –mail offering testosterone boosting supplements such as DHEA.  Let the truth be told, you are wasting your money as these supplements will not boost your testosterone.

Bottom Line:  Although these suggestions are helpful, they are just a step in the right direction.  For more information about testosterone replacement therapy, speak to your physician.

Testosterone Deficiency: Male Menopause Which Is HARDly The Pause That Refreshes!

November 21, 2015

Everyone has heard about menopause for women.  This is due to a decrease in estrogen production from the ovaries.  Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50.  The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression.  This blog will discuss the problem of male menopause or andropause.

Men losing testosterone is a steady decline, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.

The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.

The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.  Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.

Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies.

The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer and heart disease.

There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.

Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.

Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before.

Bottom Line: If you don’t feel the same way about yourself or your partner, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that with a brief history, physical exam and a testosterone blood test.

Natesto- Nasal Spray For the Treatment of Low T (testosterone)

August 26, 2015

Millions of American men suffer from low testosterone. Symptoms include decreased libido or sex drive, decrease erections, and lethargy or loss of energy. Treatment at this time consists of injections of testosterone, topical gels, and pellets inserted underneath the skin. Now there is a new delivery system using a nasal spray for treating this common medical problem affecting so many middle age and older men.

NATESTO™ is a prescription medicine that contains testosterone and is used to treat adult males who have low or no testosterone due to certain medical conditions. Your doctor will test the testosterone level in your blood before you start and while you are using NATESTO™.

Who should not use NATESTO™?

Do not use NATESTO™ if you:

  • Are a man who has breast cancer
  • Have or might have prostate cancer
  • Are pregnant or may become pregnant or are breastfeeding. NATESTO™ may harm your unborn or breastfeeding baby

Talk to your doctor before using NATESTO™ if you have any of the above conditions.

What should I tell my doctor before using NATESTO™?

Before using NATESTO™, tell your doctor about all of your medical conditions, including if you:

  • Have or have had nose (nasal) or sinus problems or nasal or sinus surgery
  • Have had a broken nose (fracture) within the past 6 months
  • Have or have had a fracture of your nose that caused the inside of your nose to be crooked (deviated anterior nasal septum)
  • Have or have had problems with swelling of the lining of your nose (mucosal inflammatory disorder)
  • Have breast cancer
  • Have or might have prostate cancer
  • Have urinary problems due to an enlarged prostate
  • Have heart problems
  • Have liver or kidney problems
  • Have problems breathing while you sleep (sleep apnea)

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, or herbal supplements.

Using NATESTO™ with certain other medicines can affect each other. Especially tell your doctor if you take:

  • Insulin
  • Medicines that decrease blood clotting
  • Corticosteroids

How should I use NATESTO™?

  • Use NATESTO™ exactly as your doctor tells you to. Your doctor will tell you how much NATESTO™ to use and when to use it
  • NATESTO™ is for use in your nose (intranasally) only
  • NATESTO™ can be used with a type of nasal spray called sympathomimetic decongestants such as oxymetazoline. NATESTO™ should not be used with other nasal sprays. It is not known if NATESTO™ is safe and effective when used with other nasal sprays

What are the possible side effects of NATESTO™?

NATESTO™ may cause serious side effects, including:

  • Nose (nasal) problems. Signs and symptoms of nasal problems may include runny nose, congestion, sneezing, nosebleed, nasal discomfort, nasal scabbing, or nasal dryness
  • If you already have enlargement of your prostate gland, your signs and symptoms can get worse while using NATESTO™. This can include: increased urination at night, trouble starting your urine stream, having to pass urine many times during the day, having an urge that you have to go to the bathroom right away, having a urine accident, being unable to pass urine or weak urine flow
  • Possible increased risk of prostate cancer. Your doctor should check you for prostate cancer or any other prostate problems before you start and while you use NATESTO™
  • Changes in red blood cells
  • Blood clots in your legs or lungs. Signs and symptoms of a blood clot in your legs can include leg pain, swelling, or redness. Signs and symptoms of a blood clot in your lungs can include difficulty breathing or chest pain
    • In large doses, NATESTO™ may lower your sperm count
  • Possible increased risk of liver problems. Signs and symptoms of liver problems may include: nausea or vomiting, yellowing of your skin or whites of your eyes, dark urine, or pain on the right side of your stomach area (abdominal pain)
  • Swelling of your ankles, feet, or body, with or without heart failure. This may cause serious problems for people who have heart, kidney, or liver disease
  • Enlarged or painful breasts
  • Problems breathing while you sleep (sleep apnea)

Call your doctor right away if you have any of the serious side effects listed above.

The most common side effects of NATESTO™ include:

  • Increased prostate specific antigen (a test used to screen for prostate cancer)
  • Headache
  • Runny nose
  • Nosebleeds
  • Nose pain
  • Sore throat, cough
  • Upper respiratory infection
  • Sinus infection
  • Nose scabs

Bottom Line: Natesto is a new treatment option for men with documented low testosterone levels. The drug helps restore testosterone to normal levels and help men with symptoms of low T levels.

Testosterone Safety In Men Receiving Hormone Replacement Therapy

August 10, 2015

The medical literature states that one of the adverse effects of testosterone replacement therapy is increased in the red blood cell count or polycythemia. The increased red blood cell count increases the viscosity or thickness of the blood and makes men amenable to clots forming in the lower extremities. These clots can break loose and go to the lungs and cause a medical emergency

Middle-aged and older men undergoing testosterone replacement therapy aren’t at increased risk of these fatal clots.

Researchers studied 30,572 men 40 years of age and older who were enrolled in one of the country’s largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. They identified 7,643 cases, defined as men diagnosed with deep vein clots or pulmonary embolism at any time during the study period who received at least one prescription for an anticoagulant to prevent clots from reforming.

Exposure to testosterone therapy within 15 days of the event/index date wasn’t associated with increased risk of VTE (adjusted odds ratio, 0.90), nor were any of the routes of administration that the authors examined—topical, transdermal, or intramuscular. The finding extended to men who received therapy 30 or 60 days before the VTE diagnosis.

Bottom Line: I still recommend that men who are receiving testosterone replacement therapy have their red blood cell count checked every six months. If the red cell count is too high, I suggest that the man cut his dosage or decrease the frequency of testosterone replacement therapy. I still believe that testosterone is effective in men who have symptoms of low testosterone and have documented evidence of a low blood level of testosterone.

Testosterone Deficiency – Natural Solutions For Testosterone Replacement

July 19, 2015

Around age 50 women have a drop in their hormones and enter into menopause. At about the same age men start experiencing a decrease in testosterone occurs. This is the male hormone that is responsible for sex drive, muscle mass, bone strength, and even erections. This condition in men is referred to as andropause and it affects millions of American men.

Treatment options include testosterone replacement with injections, topical gels, or pellets inserted underneath the skin. For those who have only mild symptoms such as lethargy or decrease in libido and slight decrease in the blood testosterone level, may consider natural solutions to this common problem.

Onions
Okay, while onion breath may not be sexy, onions strengthens reproductive organs and increases testosterone, which boosts libido in both men and women.

Garlic
Garlic contains allicin, which builds heat in the body and may increase testosterone. It’s useful for sexual stamina, and body builders use it for muscle growth.

Cayenne Pepper
Just like cayenne’s spicy on your tongue, it also may help add spice to your sex life. Hot peppers contain capsaicin, which creates heat and improves circulation and blood flow for erections. The peppers have an immediate effect, so try eating them when you’re for sexual intimacy. And maybe save dessert for later!

Dates
Dates are rich in amino acids , which are known to increase sexual stamina, and they’re a popular aphrodisiac in North African and has been used for sexual purposes for centuries.

Figs
Like dates, figs are rich in amino acids, and are also said to be an aphrodisiac because of the sexual appearance and flavor. A fig’s scent and texture is very aromatic and sensual.

Goji Berries
Goji berries have long been used as a sexual tonic in Asian countries because they’re said to increase testosterone. You can sprinkle these berries on your cereal, salads, or just eating a handful.

Fatty Fish
Salmon, tuna, and mackerel are high in omega-3 fatty acids, which elevates dopamine, the same hormone released in the brain during an orgasm. These omega-3 fatty acids also elevates mood, and more relaxed people are in the mood for sex more often. Fatty fish also contains L-arginine, an amino acid used to treat problems with erections. Think of it like a natural Viagra.

Bottom Line: Although none of these natural remedies will cure testosterone deficiency but they may help slow the progression of testosterone deficiency. And as my wise Jewish would say, “They may not help, but they voidn’t hoit!”

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.

Do Women Have Low T? The Role Of Testosterone in Women

July 28, 2014

Testosterone is the male hormone produced in the testicles that is responsible for sex drive or libido. Women also make testosterone in their ovaries. After menopause the amount of testosterone is decreased and will affect a woman’s sex drive and libido.
Testosterone, widely and misleadingly understood to be the “male” hormone. Men produce 10 times more testosterone than women, but in their early reproductive years women have 10 times more testosterone than estrogen coursing through their bodies. And many experts now believe that it’s the loss of testosterone, and not estrogen, that causes women in midlife to tend to gain weight, feel fatigue and lose mental focus, bone density and muscle tone — as well as their libido. Testosterone is a woman’s most abundant biologically active hormone. Adequate levels of testosterone are necessary for physical and mental health in both sexes.



Benefits for Women
 
Women, before, during and past menopause, and sometimes as early as in their mid-30s, invariably have low testosterone levels. Not all women will experience its wide variety of symptoms, like low libido, hot flashes, fatigue, mental fogginess and weight gain. For those who do, and who seek to avoid taking synthetic oral hormones (shown by National Institutes of Health findings to pose an increased risk for breast cancer, heart attack, stroke, blood clots and dementia), bioidentical testosterone (whose molecular structure is the same as natural testosterone) has been shown to be safe and effective.

Some testosterone is converted by the body into estrogen — which partly explains why it is useful in treating menopausal symptoms. For those at high risk for breast cancer, or who have had it, that conversion can be prevented by combining testosterone with anastrozole — an aromatase inhibitor that prevents conversion to estrogen. Nonetheless, testosterone has been shown to beneficial for patients with breast cancer. Preliminary data presented at the American Society of Clinical Oncology have shown that, in combination with anastrozole, testosterone was effective in treating symptoms of hormone deficiency in breast cancer survivors, without an increased risk of blood clots, strokes or other side effects of the more widely used oral estrogen-receptor modulators tamoxifen and raloxifene.

Other benefits cited for testosterone therapy include:

Relieving symptoms of menopause, like hot flashes, vaginal dryness, incontinence and urinary urgency.

Enhancing mental clarity and focus. Researchers at Utrecht University in Holland recently found that testosterone appears to encourage “rational decision-making, social scrutiny and cleverness.”

Reducing anxiety, balancing mood and relieving depression combined with fatigue. Dr. Stephen Center, a family practitioner in San Diego who has treated women with testosterone for 20 years, says the regimen consistently delivers “improvement in self-confidence, initiative and drive.”

Increasing bone density, decreasing body fat and cellulite, and increasing lean muscle mass. Testosterone is the best remedy available for eliminating midlife upper-arm batwings.

Offering protection against cardiovascular events, by increasing blood flow and dilating blood vessels, and against Type 2 diabetes, by decreasing insulin resistance.

Countering the Myths

Some women believe, also incorrectly, that testosterone therapy will produce “masculinizing” traits, like hoarseness and aggression. While the hormone may cause inappropriate hair growth and acne in some women, those side effects can be remedied by lowering the dose.

Testosterone therapy has been approved for a variety of conditions in women as well as men in Britain and Australia. But while the U.S. Food and Drug Administration has approved of testosterone for use in men whose natural levels are low, the agency has not sanctioned it for women, for any reason.

How Treatment Works

Women can take testosterone as a cream, through a patch or in the form of pellet implants, which have the highest consistency of delivery. Synthesized from yams or soybeans, and compounded of pure, bioidentical testosterone, the pellets, each slightly larger than a grain of rice, are inserted just beneath the skin in the hip in a one-minute outpatient procedure. They dissolve slowly over three to four months, releasing small amounts of testosterone into the blood stream, but speeding up when needed by the body — during strenuous activities, for example — and slowing down during quiet times, a feature no other form of hormone therapy can provide.

To determine a patient’s dosage, some doctors measure testosterone levels in the blood.

Side effects of the insertion procedure, which are rare, include infection, minor bleeding and the pellet working its way out or being extruded. Some patients notice improvements within a day or two; others do not perceive benefits for a couple of weeks.

Bottom Line: Since implantation is a surgical procedure, and the pellets are manufactured by a variety of pharmaceutical compounders, who may have varying safety standards, it’s important for women to consult with an experienced, board-certified physician about treatment. Ask your doctor if you feel you are having symptoms related to low testosterone and see if testosterone replacement would be right for you

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.