Real-World Programs For trt Around The Usa

An interview with Abraham Morgentaler, M.D.

It might be stated that testosterone is the thing that makes men, men. It gives them their characteristic deep voices, big muscles, and body and facial hair, distinguishing them from women. It stimulates the development of the genitals , plays a role in sperm production, fuels libido, and leads to normal erections. It also boosts the production of red blood cells, boosts mood, and aids cognition.

As time passes, the "machinery" that makes testosterone slowly becomes less effective, and testosterone levels start to drop, by about 1 percent per year, beginning in the 40s. As guys get into their 50s, 60s, and beyond, they may begin to have signs and symptoms of low testosterone such as reduced sex drive and sense of energy, erectile dysfunction, diminished energy, reduced muscle mass and bone density, and nausea. Taken together, these signs and symptoms are often called hypogonadism ("hypo" significance low functioning and"gonadism" speaking to the testicles). Researchers estimate that the illness affects anywhere from two to six million men in the United States. Yet it's an underdiagnosed problem, with just about 5% of these affected receiving treatment.

Much of the current debate focuses on the long-held belief that testosterone can stimulate prostate cancer.

Dr. Abraham Morgentaler, an associate professor of surgery at Harvard Medical School and the director of Men's Health Boston, specializes in treating prostate ailments and male sexual and reproductive problems. He has developed specific expertise in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment plans he uses with his patients, and why he believes experts should reconsider the potential link between testosterone-replacement treatment and prostate cancer.

Symptoms and diagnosis

What signs and symptoms of low testosterone prompt that the average man to find a doctor?

As a urologist, I have a tendency to see men since they have sexual complaints. The primary hallmark of low testosterone is reduced sexual desire or libido, but another may be erectile dysfunction, and some other man who complains of erectile dysfunction must possess his testosterone level checked. Men may experience different symptoms, like more difficulty achieving an orgasm, less-intense climaxes, a much smaller quantity of fluid out of ejaculation, and a feeling of numbness in the penis when they see or experience something which would normally be arousing.

The more of these symptoms you will find, the more likely it is that a man has low testosterone. Many physicians often discount these"soft symptoms" as a normal part of aging, but they're often treatable and reversible by decreasing testosterone levels.

Aren't those the same symptoms that guys have when they are treated for benign prostatic hyperplasia, or BPH?

Not exactly. There are a number of medications which may lessen sex drive, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs may also decrease the amount of the ejaculatory fluid, no wonder. However a reduction in orgasm intensity usually doesn't go along with therapy for BPH. Erectile dysfunction does not ordinarily go along with it either, though certainly if a person has less sex drive or less attention, it is more of a challenge to get a good erection.

How can you decide whether a man is a candidate for testosterone-replacement therapy?

There are just two ways we determine whether somebody has low testosterone. One is a blood test and the other is by characteristic signs and symptoms, and the correlation between these two approaches is far from ideal. Generally men with the lowest testosterone have the most symptoms and men with highest testosterone have the least. But there are some men who have reduced levels of testosterone in their blood and have no signs.

Looking at the biochemical numbers, The Endocrine Society* considers low testosterone to be a total testosterone level of less than 300 ng/dl, and I think that is a sensible guide. However, no one really agrees on a few. It is similar to diabetes, in which if your fasting sugar is over a certain level, they will say,"Okay, you've got it." With testosterone, that break point isn't quite as clear.

*Note: The Endocrine Society publishes clinical practice guidelines with recommendations for who should and shouldn't receive testosterone therapy. For a complete copy of the guidelines, log Discover More on to www.endo-society.org.

Is total testosterone the right thing to be measuring? Or should we be measuring something else?

Well, this is another area of confusion and good discussion, but I do not think that it's as confusing as it is apparently in the literature. When most doctors learned about testosterone in medical school, they learned about total testosterone, or all of the testosterone in the human body. However, about half of their testosterone that is circulating in the bloodstream is not available to the cells. It is closely bound to a carrier molecule known as sex hormone--binding globulin, which we abbreviate as SHBG.

The available portion of overall testosterone is known as free testosterone, and it's readily available to the cells. Though it's only a small fraction of this overall, the free testosterone level is a pretty good indicator of low testosterone. It's not ideal, but the significance is greater than with total testosterone.

Endocrine Society recommendations summarized This professional organization recommends testosterone treatment for men who have Therapy Isn't Suggested for men who have Prostate or breast cancer a nodule on the prostate that may be felt during a DRE that a PSA greater than 3 ng/ml without further analysis that a hematocrit greater than 50% or thick, viscous blood untreated obstructive sleep apnea severe lower urinary tract infections class her latest blog III or IV heart failure. Do time of day, diet, or other elements influence testosterone levels? For years, the recommendation was to get a testosterone value early in the morning because levels begin to drop after 10 or 11 a.m.. However, the data behind this recommendation were attracted to healthy young men. Two recent studies showed little change in blood glucose levels in men 40 and mature over the course of this day. One reported no change in average testosterone till after 2 p.m. Between 2 and 6 p.m., it went down by 13 percent, a modest sum, and probably not enough to affect identification. Most guidelines still say it is important to perform the test in the morning, however for men 40 and above, it likely doesn't matter much, provided that they get their blood drawn before 5 or 6 p.m. There are a number of very interesting findings about dietary supplements. By way of instance, it appears that those that have a diet low in protein have lower testosterone levels than males who eat more protein. But diet hasn't been researched thoroughly enough to make any recommendations that are clear. Within this guide, testosterone-replacement therapy refers to the treatment of hypogonadism with adrenal gland -- testosterone that is produced outside the body. Depending upon the formulation, treatment can lead to skin irritation, breast enlargement and tenderness, sleep apnea, acne, decreased sperm count, increased red blood cell count, and additional side effects. In a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six months, all of the guys had heightened levels of testosterone; none reported some side effects throughout the year they were followed. Since clomiphene citrate is not approved by the FDA for use in males, little information exists about the long-term effects of carrying it (such as the risk of developing prostate cancer) or whether it's more capable of boosting testosterone than exogenous formulations. But unlike adrenal gland, clomiphene citrate maintains -- and possibly enhances -- sperm production. This makes medication such as clomiphene citrate one of only a few choices for men with low testosterone that wish to father children. What kinds of testosterone-replacement treatment are available? * The oldest form is an injection, which we still use since it is cheap and because we reliably get fantastic testosterone levels in almost everybody. The drawback is that a person needs to come in every few weeks to get a shot. A roller-coaster effect can also occur as blood glucose levels peak and return to baseline. Topical treatments help preserve a more uniform amount of blood glucose. The first kind of topical treatment has been a patch, but it has a very high rate of skin irritation. In one study, as many as 40% of men who used the patch developed a red area on their skin. That limits its use. The most commonly used testosterone preparation in the United States -- and the one I begin almost everyone off with -- is a topical gel. The gel comes from tiny tubes or within a unique dispenser, and you rub it on your shoulders or upper arms once a day. According to my experience, it has a tendency to be consumed to great degrees in about 80% to 85 percent of guys, but leaves a substantial number who don't absorb enough for it to have a positive effect. [For specifics on various formulations, see table below.] Are there any drawbacks to using gels? How long does it take for them to work? Men who begin using the implants need to return in to have their own testosterone levels measured again to be certain they are absorbing the proper quantity. Our goal is that the mid to upper assortment of normal, which generally means around 500 to 600 ng/dl. The concentration of testosterone in the blood actually goes up quite quickly, within several doses. I normally measure it after 2 weeks, even though symptoms may not change for a month or two. 123456789101112131415 Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment Name * Email * Website