Major Elements Of testosterone therapy - An Intro

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 contributes to normal erections. Additionally, it boosts the production of red blood cells, boosts mood, and assists cognition.

As time passes, the testicular"machinery" which makes testosterone gradually becomes less powerful, and testosterone levels start to fall, by about 1 percent per year, starting in the 40s. As men get into their 50s, 60s, and beyond, they might begin to have symptoms and signs of low testosterone such as lower sex drive and sense of energy, erectile dysfunction, diminished energy, reduced muscle mass and bone density, and nausea. Taken together, these symptoms and signs are often referred to as hypogonadism ("hypo" meaning low functioning and"gonadism" speaking to the testicles). Yet it is an underdiagnosed problem, with only about 5% of these affected undergoing therapy.

Studies have shown that testosterone-replacement therapy can provide a wide selection of advantages for men with hypogonadism, including enhanced 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 dangers patients face.

He's developed specific experience in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment plans he utilizes his patients, and he believes experts should reconsider the potential connection between testosterone-replacement treatment and prostate cancer.

Symptoms and diagnosis

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

As a urologist, I tend to observe men because they have sexual complaints. The main hallmark of reduced testosterone is reduced sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should possess his testosterone level checked. Men can experience other symptoms, such as more trouble achieving an orgasm, less-intense climaxes, a much lesser amount of fluid from ejaculation, and a sense of numbness in the manhood when they see or experience something that would normally be arousing.

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

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

Not precisely. There are a number of medications that may reduce libido, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs can also reduce the amount of the ejaculatory fluid, no wonder. However a reduction in orgasm intensity normally does not go together with treatment for BPH. Erectile dysfunction does not usually go together with it either, though certainly if somebody has less sex drive or less attention, it's more of a struggle to get a fantastic erection.

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

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

Looking at the biochemical amounts, The Endocrine Society* considers low testosterone to be a entire 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's not like 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 is not quite as apparent.

*Notice: The Endocrine Society recommends clinical practice guidelines with recommendations for who should and should not click to investigate receive testosterone therapy. See"Endocrine Society recommendations summarized." For a complete copy of these instructions, log 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 just another area of confusion and good debate, but I do not think that it's as confusing as it appears to be from the literature. When most physicians learned about testosterone in medical school, they heard about total testosterone, or all the testosterone in the human body. However, about half of their testosterone that's circulating in the blood is not readily available to the cells. It's closely bound to a carrier molecule known as sex hormone--binding globulin, which we abbreviate as SHBG.

The biologically available part of total testosterone is known as free testosterone, and it's readily available to cells. Though it's just a small fraction of the total, the free testosterone level is a fairly good indicator of low testosterone. It is not ideal, but the correlation is greater than with total testosterone.

Endocrine Society recommendations summarized This professional organization urges testosterone treatment for men who have Therapy Isn't recommended for men who've Breast or prostate cancer a nodule on the prostate that may be felt during a DRE that a PSA greater than 3 ng/ml without additional evaluation that a hematocrit greater than 50 percent or thick, viscous blood untreated obstructive sleep apnea severe lower urinary tract infections class III or IV heart failure. Do time of day, diet, or other elements affect testosterone levels? For years, the recommendation has been to get a testosterone value early in the morning since levels begin to drop after 10 or 11 a.m.. But the data behind this recommendation were drawn from healthy young men. Two recent studies demonstrated little change in blood glucose levels in men 40 and mature over the course of this day. One reported no change in average testosterone until after 2 p.m. Between 6 and 2 p.m., it went down by 13 percent, a small sum, and probably not enough to influence identification. Most guidelines still say it is important to do the evaluation in the morning, however for men 40 and over, it probably does not matter much, provided that they obtain their blood drawn before 5 or 6 p.m. There are some rather interesting findings about dietary supplements. By way of instance, it appears that those who have a diet low in protein have lower testosterone levels than males who consume more protein. But diet hasn't been researched thoroughly enough to make 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 lead to skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count, and other side effects. Within four to six months, each one the men had increased levels of testosterone; none reported any side effects during the entire year they were followed. Because clomiphene citrate isn't accepted by the FDA for use in men, little information exists about the long-term effects of carrying it (including the probability of developing prostate cancer) or if it's more capable of boosting testosterone compared to exogenous formulas. But unlike adrenal gland, clomiphene citrate preserves -- and potentially enhances -- sperm production. This makes drugs such as clomiphene citrate one of only a few options for men with low testosterone who want to father children. What forms of testosterone-replacement treatment can be found? * The oldest form is the injection, which we still use because it is cheap and because we faithfully become good testosterone levels in nearly everybody. The drawback is that a man needs to come in every couple of weeks to get a shot. A roller-coaster effect can also occur as blood glucose levels peak and then return to baseline. [See"Exogenous vs. endogenous testosterone," above.] Topical therapies help maintain a more uniform level of blood glucose. The first kind of topical therapy has been a patch, but it has a quite high rate of skin irritation. In one study, as many as 40 percent of men who used the patch developed a red area on their skin. That limits its use. The most commonly used testosterone preparation from the United States -- and also the one I begin almost everyone off -- is a topical gel. The gel comes in 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 tends to be absorbed to good levels in about 80% to 85 percent of men, but leaves a significant number who don't absorb enough for this to have a positive impact. [For specifics on several different formulations, see table ] Are there any drawbacks to using gels? How much time does it require them to work? Men who begin using the implants need to return in to have their testosterone levels measured again to make sure they are absorbing the right quantity. Our target is that the mid to upper range of normal, which generally means around 500 to 600 ng/dl. The concentration of testosterone in blood really goes up quite fast, within several doses. I usually measure it after two weeks, even though symptoms may not alter 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