The Options For Effortless hrt Plans

A Harvard expert shares his thoughts on testosterone-replacement Treatment

It might be stated that testosterone is what makes men, men. 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 leads to regular erections. It also fosters the creation of red blood cells, boosts mood, and aids cognition.

As time passes, the "machinery" which makes testosterone gradually becomes less powerful, and testosterone levels begin to drop, by about 1% a year, beginning in the 40s. As men get in their 50s, 60s, and beyond, they might start to have symptoms and signs of low testosterone like reduced sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often referred to as hypogonadism ("hypo" significance low functioning and"gonadism" speaking to the testicles). Yet it's an underdiagnosed issue, with just about 5 percent of these affected undergoing therapy.

Various studies have revealed that testosterone-replacement therapy can provide a wide range of benefits for men with hypogonadism, including enhanced libido, mood, cognition, muscle mass, bone density, and red blood cell production.

He has developed specific expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment plans he uses with his own patients, and why he believes specialists should rethink the potential link between testosterone-replacement treatment and prostate cancer.

Symptoms and diagnosis

What symptoms and signs of low testosterone prompt the typical man to see a physician?

As a urologist, I tend to observe men since they have sexual complaints. The primary hallmark of low testosterone is reduced sexual libido or desire, but another may be erectile dysfunction, and any guy who complains of erectile dysfunction should possess his testosterone level checked. Men may experience different symptoms, such as more trouble achieving an orgasm, less-intense orgasms, a much smaller quantity of fluid from ejaculation, and a sense of numbness in the penis when they see or experience something which would usually be arousing.

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

Are not those the very same symptoms that men have when they're treated for benign prostatic hyperplasia, or BPH?

Not precisely. There are a number of drugs that may reduce libido, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs may also reduce the amount of the ejaculatory fluid, no question. But a decrease in orgasm intensity normally does not go along with treatment for BPH. Erectile dysfunction does not ordinarily go along with it either, though surely if somebody has less sex drive or less interest, it is more of a struggle to have a fantastic erection.

How do you determine whether a man is a candidate for testosterone-replacement treatment?

There are just two ways that we determine whether somebody has reduced testosterone. One is a blood test and the other one is by characteristic symptoms and signs, and the correlation between those two methods is far from perfect. 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 symptoms.

Looking purely at the biochemical amounts, The Endocrine Society* believes low testosterone for a total testosterone level of less than 300 ng/dl, and I believe that's a reasonable guide. But no one quite agrees on a few. It is similar to diabetes, in which if your fasting sugar is above a certain level, they will say,"Okay, you've got it." With testosterone, that break point is not quite as apparent.

*Note: The Endocrine Society publishes clinical practice guidelines with recommendations for who should and shouldn't receive testosterone treatment. Watch"Endocrine Society recommendations summarized."

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

Well, this is another area of confusion and good debate, but I don't think that it's as confusing as it appears to be from the literature. When most doctors learned about testosterone in medical school, they learned about overall testosterone, or all the testosterone in the body. However, about half of the testosterone that's circulating in the blood isn't available to cells. It's tightly bound to a carrier molecule known as sex hormone--binding globulin, which we abbreviate as SHBG.

The biologically available portion of total testosterone is known as free testosterone, and it's readily available to cells. Even though it's only a small fraction of the overall, the free testosterone level is a fairly good indicator of low testosterone. It is not perfect, but the significance is greater compared to total testosterone.

This professional organization urges testosterone treatment for men who have both

Therapy is not recommended 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 symptoms
  • class III or IV heart failure. hop over to here

    Do time of day, diet, or other factors affect testosterone levels?

    For years, the recommendation was to receive a testosterone value early in the morning because levels start to drop after 10 or 11 a.m.. But the information behind this recommendation were attracted to healthy young men. Two recent studies demonstrated little change in blood glucose levels in men 40 and older over the course of the day. One reported no change in average testosterone until after 2 Between 2 and 6 p.m., it went down by 13%, a modest amount, and probably not enough to influence diagnosis. Most guidelines still say it's important to do the test in the morning, however for men 40 and over, it likely does not matter much, provided that they get their blood drawn before 5 or 6 p.m.

    There are some very interesting findings about diet. For example, it appears that those that have a diet low in protein have lower testosterone levels than males who consume more protein. But diet has not been studied thoroughly enough to create any recommendations that are clear.

    Exogenous vs. endogenous testosterone

    In the following guide, testosterone-replacement treatment refers to the treatment of hypogonadism with exogenous testosterone -- testosterone that is produced outside the body. Depending on the formula, therapy can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, decreased sperm count, increased red blood cell count, and additional side effects.

    Within four to six months, all the guys had heightened levels of testosteronenone reported some side effects during the year they had been followed.

    Because clomiphene citrate isn't accepted by the FDA for use in males, little information exists about the long-term ramifications of taking it (including the risk of developing prostate cancer) or whether it's more effective at boosting testosterone compared to exogenous formulas. But unlike exogenous testosterone, clomiphene citrate maintains -- and possibly enhances -- sperm production. This makes drugs like clomiphene citrate one of just a few options for men with low testosterone that want to father children.

    What forms of testosterone-replacement treatment can be found? *

    The oldest form is an injection, which we still use since it is cheap and because we reliably get good testosterone levels in almost everybody. The disadvantage is that a man should come in every couple of weeks to get a shot. A roller-coaster effect can also occur as blood testosterone levels peak and then return to research.

    Topical treatments help preserve a more uniform amount of blood glucose. The first form of topical therapy was a patch, but it has a quite large rate of skin irritation. In 1 study, as many as 40% of men who 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 the one I start almost everyone off with -- is a topical gel. There are just two brands: AndroGel and Testim. The gel comes from tiny tubes or in a special 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 levels in about 80% to 85 percent of guys, but leaves a substantial number who don't consume sufficient for this to have a favorable effect. [For specifics on various formulations, see table ]

    Are there any drawbacks to using dyes? How much time does it take for them to work?

    Men who start using the gels have to return in to have their own testosterone levels measured again to be certain they're absorbing the right quantity. Our target is that the mid to upper assortment of normal, which usually means approximately 500 to 600 ng/dl. The concentration of testosterone in the blood actually goes up quite fast, within several doses. I usually measure it after 2 weeks, though symptoms may not change for a month or two.

    Leave a Reply

    Your email address will not be published. Required fields are marked *