Deciding Upon Fast Solutions For trt

A Harvard Specialist shares his thoughts on testosterone-replacement Treatment

 

A meeting with Abraham Morgentaler, M.D.

It could be stated that testosterone is what makes guys, men. It gives them their characteristic deep voices, big muscles, and facial and body hair, differentiating them from girls. It stimulates the growth of the genitals at puberty, plays a role in sperm production, fuels libido, and leads to normal erections. Additionally, it boosts the production of red blood cells, boosts mood, and assists cognition.

Over time, the "machinery" that produces testosterone gradually becomes less effective, and testosterone levels begin to fall, by approximately 1 percent a year, starting in the 40s. As guys get into their 50s, 60s, and beyond, they may begin to have signs and symptoms of low testosterone like reduced sex drive and sense of energy, erectile dysfunction, decreased energy, decreased muscle mass and bone density, and nausea. Taken together, these signs and symptoms are often referred to as hypogonadism ("hypo" meaning low working and"gonadism" referring to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the USA. Yet it is an underdiagnosed problem, with just about 5% of those affected undergoing therapy.

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. Much of the current debate focuses on the long-held belief that testosterone may 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 difficulties. 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 why he believes experts should reconsider the possible link between testosterone-replacement therapy and prostate cancer.

Symptoms and diagnosis

What symptoms and signs of low testosterone prompt that the typical person to see a doctor?

As a urologist, I tend to see guys since they have sexual complaints. The main hallmark of reduced testosterone is reduced sexual desire or libido, but another can be erectile dysfunction, and some other guy who complains of erectile dysfunction must possess his testosterone level checked. Men can experience different symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a much lesser quantity of fluid out of ejaculation, and a sense of numbness in the manhood when they see or experience something which would usually be arousing.

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

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

Not precisely. There are quite a few drugs that may lessen sex drive, including the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs can also reduce the quantity of the ejaculatory fluid, no wonder. However a decrease in orgasm intensity normally doesn't go along with treatment for BPH. Erectile dysfunction does not usually go along with it , though certainly if somebody has less sex drive or less interest, it's more of a challenge to have a fantastic 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 one is by characteristic signs and symptoms, and the correlation between these two approaches is far from perfect. Generally men with the lowest testosterone have the most symptoms and guys with maximum testosterone possess the least. But there are some 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 to be a total testosterone level of less than 300 ng/dl, and I believe that is a reasonable guide. But no one really agrees on a few. It is similar to diabetes, where if your fasting glucose is above 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 Go Here recommendations for who should and should not receive testosterone therapy.

Is total 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 in the literature. When most physicians learned about testosterone in medical school, they learned about overall testosterone, or all of the testosterone in the body. However, about half of the testosterone that is circulating in the bloodstream isn't available to cells. It's closely bound to a carrier molecule called sex hormone--binding globulin, which we abbreviate as SHBG.

The available portion of total testosterone is known as free testosterone, and it's readily available to cells. Though it's just a small portion of the overall, the free testosterone level is a pretty good indicator of reduced testosterone. It's not ideal, but the correlation is greater compared to total testosterone.

Endocrine Society recommendations summarized

This professional organization urges testosterone therapy for men who have both

Therapy Isn't Suggested for men who have

  • Prostate or breast cancer
  • a nodule on the prostate that may be felt during a DRE
  • a PSA higher than 3 ng/ml without additional 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.

    Do time daily, diet, or other factors influence testosterone levels?

    For years, the recommendation has been to receive a testosterone value early in the morning since levels start to fall after 10 or 11 a.m.. However, the information behind that recommendation were attracted to healthy young men. Two recent studies showed little change in blood glucose levels in men 40 and older within the course of this day. One reported no change in average testosterone till after 2 Between 6 and 2 p.m., it went down by 13%, a small sum, and probably not enough to affect diagnosis. Most guidelines nevertheless say it is important to do the test in the morning, however for men 40 and over, it probably does not matter much, provided that they get their blood drawn before 6 or 5 p.m.

    There are a number of very interesting findings about diet. By way of instance, it appears that those that have a diet low in protein have lower testosterone levels than men who consume more protein. But diet has not been studied thoroughly enough to create any clear recommendations.

    Exogenous vs. endogenous testosterone

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

    Preliminary studies have proven that clomiphene citrate (Clomid), a drug generally prescribed to stimulate ovulation in women struggling with infertility, may boost the creation of natural testosterone, termed endogenous testosterone, in men. Within four to six weeks, all of the men had heightened levels of testosterone; none reported any side effects during the year they were followed.

    Because clomiphene citrate is not approved by the FDA for use in men, little information exists about the long-term effects of taking it (including the risk of developing prostate cancer) or if it's more capable of boosting testosterone compared to exogenous formulas. But unlike adrenal gland, clomiphene citrate maintains -- and potentially enriches -- sperm production. This makes medication such as clomiphene citrate one of only a few choices for men with low testosterone who want to father children.

    Formulations

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

    The earliest form is the injection, which we use because it's inexpensive and since we faithfully become good testosterone levels in nearly everybody. The disadvantage is that a man needs to come in every few weeks to find a shot. A roller-coaster effect may also happen as blood glucose levels peak and return to baseline.

    Topical treatments help preserve a more uniform level of blood testosterone. The first form of topical therapy has been a patch, but it has a quite large rate of skin irritation. In one study, as many as 40% of people that used the patch developed a reddish 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 within a special dispenser, and you rub it on your shoulders or upper arms once a day. Based on my experience, it has a tendency to be consumed to good levels in about 80% to 85% of men, but leaves a substantial number who do not absorb enough for this to have a favorable effect. [For specifics on several different formulations, see table ]

    Are there any drawbacks to using dyes? How long does it take for them to get the job done?

    Men who start using the implants need to come back in to have their testosterone levels measured again to make certain they're absorbing the right quantity. Our target is that the mid to upper range of normal, which usually means approximately 500 to 600 ng/dl. The concentration of testosterone in the blood really goes up quite quickly, within several doses. I usually measure it after 2 weeks, although symptoms may not change for a month or two.

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