No-Hassle Systems Of testosterone therapy Around The Usa

A meeting with Abraham Morgentaler, M.D.

It might be said that testosterone is what makes men, guys. It gives them their characteristic deep voices, big muscles, and facial and body hair, distinguishing them from girls. It stimulates the development of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to regular erections. Additionally, it fosters the production of red blood cells, boosts mood, and assists cognition.

As time passes, the testicular"machinery" which produces testosterone slowly becomes less effective, and testosterone levels start to drop, by approximately 1% a year, starting in the 40s. As men get in their 50s, 60s, and beyond, they might start to have signs and symptoms of low testosterone like reduced sex drive and sense of energy, erectile dysfunction, diminished energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called hypogonadism ("hypo" significance low functioning and"gonadism" referring to the testicles). Yet it is an underdiagnosed issue, with just about 5% of these affected receiving treatment.

Studies have revealed that testosterone-replacement therapy may provide a wide selection of advantages for men with hypogonadism, such as improved libido, mood, cognition, muscle mass, bone density, and red blood cell production. But little consensus exists about what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face.

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 reproductive and sexual difficulties. He has developed specific expertise in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he utilizes his patients, and he thinks 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 person to find a doctor?

As a urologist, I have a tendency to see guys because they have sexual complaints. The main hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and some other man who complains of erectile dysfunction should possess his testosterone level checked. Men may experience other 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 manhood 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 normalizing testosterone levels.

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

Not exactly. There are quite a few medications that 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 question. However a decrease in orgasm intensity usually does not go along with therapy for BPH. Erectile dysfunction does not ordinarily go together with it , though surely if a person has less sex drive or less attention, it's more of a challenge to get a fantastic erection.

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

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

Looking at the biochemical amounts, The Endocrine Society* believes low testosterone for a entire testosterone level of less than 300 ng/dl, and I believe 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 apparent.

*Notice: The Endocrine Society recommends clinical practice guidelines with recommendations for who should and should not receive testosterone treatment. Watch"Endocrine Society recommendations summarized." For a complete copy of visit this site right here these instructions, log on to www.endo-society.org.

Is complete testosterone the ideal thing to be measuring? Or should we be measuring something else?

This is just another area of confusion and good discussion, but I don't think it's as confusing as it appears to be in the literature. When most doctors learned about testosterone in medical school, they heard about overall testosterone, or all of the testosterone in the human body. But about half of the testosterone that's circulating in the bloodstream is not available to cells. It's tightly bound to a carrier molecule known as sex hormone--binding globulin, which we abbreviate as SHBG.

The available part of overall testosterone is known as free testosterone, and it's readily available to the cells. Though it's just 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 urges testosterone treatment for men who have both Low levels of testosterone in the blood (less than 300 ng/dl) symptoms of low testosterone. Therapy is not Suggested for men who have Prostate or breast cancer a nodule on the prostate which may be felt during a DRE a PSA greater than 3 ng/ml without additional analysis a hematocrit greater than 50 percent or thick, viscous blood untreated obstructive sleep apnea severe lower urinary tract infections class III or check IV heart failure. Do time daily, diet, or other factors affect testosterone levels? For many years, the recommendation has been to get a testosterone value early in the morning since levels start to fall after 10 or even 11 a.m.. But the information behind this recommendation were drawn from healthy young men. Two recent studies demonstrated little change in blood testosterone levels in men 40 and older within the course of the day. One reported no change in typical testosterone till after 2 p.m. Between 6 and 2 p.m., it went down by 13%, a small amount, and probably not enough to affect diagnosis. Most guidelines nevertheless say it's important to perform the evaluation in the morning, but for men 40 and over, it probably does not matter much, as long as they obtain their blood drawn before 6 or 5 p.m. There are some rather interesting findings about diet. By way of example, it seems that individuals that have a diet low in protein have lower testosterone levels than men 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 exogenous testosterone -- testosterone that is manufactured outside the body. Depending upon the formulation, therapy can cause skin irritation, breast tenderness and enlargement, sleep apnea, acne, reduced sperm count, increased red blood cell count, along with other side effects. Within four to six months, all the guys had increased levels of testosterone; none reported some side effects during the entire year they had been followed. Because clomiphene citrate is not accepted by the FDA for use in males, little information exists about the long-term ramifications of taking it (including the probability of developing prostate cancer) or whether it is more capable of boosting testosterone compared to exogenous formulations. But unlike adrenal gland, clomiphene citrate maintains -- and possibly enhances -- sperm production. This makes medication like clomiphene citrate one of only a few options for men with low testosterone that want to father children.

Formulations

What kinds of testosterone-replacement therapy are available? *

The earliest form is the injection, which we still use because it is cheap and because we reliably get fantastic testosterone levels in almost everybody. The disadvantage is that a man needs to come in every couple of weeks to find a shot. A roller-coaster effect may also occur as blood testosterone levels peak and then return to research. [Watch"Exogenous vs. endogenous testosterone," above.]

Topical therapies help preserve a more uniform amount of blood testosterone. The first form of topical therapy was a patch, but it has a very large rate of skin irritation. In 1 study, as many as 40 percent of people that used the patch developed a red area on their skin. That limits its use.

The most widely used testosterone preparation from the United States -- and also the one I begin almost everyone off -- 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. Based on my experience, it tends to be absorbed to good 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 several different formulations, see table ]

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 approximately 500 to 600 ng/dl. The concentration of testosterone in blood actually goes up quite quickly, in just several doses. I normally measure it after 2 weeks, even though symptoms may not change for a month or two.