A Background In Rapid Secrets Of testosterone therapy

A Harvard Specialist shares his Ideas on testosterone-replacement therapy

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

Over time, the testicular"machinery" that makes testosterone gradually becomes less effective, and testosterone levels start to fall, by about 1% a year, beginning in the 40s. As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower 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 called hypogonadism ("hypo" significance low working and"gonadism" speaking to the testicles). Researchers estimate that the illness affects anywhere from two to six million men in the USA. Yet it's an underdiagnosed issue, with only about 5% of those affected receiving treatment.

Studies have revealed that testosterone-replacement therapy can provide a wide range of benefits for men with hypogonadism, such as enhanced libido, mood, cognition, muscle mass, bone density, and red blood cell production. But little consensus exists on what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face. Much of the current debate focuses on the long-held belief that testosterone may stimulate prostate cancer.

He has developed specific experience in treating low testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment strategies he uses with his patients, and 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 average person to find a doctor?

As a urologist, I have a tendency to observe men since they have sexual complaints. The primary hallmark of low testosterone is reduced sexual libido or desire, but another can be erectile dysfunction, and some other man who complains of erectile dysfunction should get his testosterone level checked. Men may experience different symptoms, such as more difficulty achieving an orgasm, less-intense climaxes, a lesser quantity of fluid from ejaculation, and a sense of numbness in the penis when they see or experience something that would usually be arousing.

The more of the symptoms there are, the more probable it is that a man has low testosterone. Many physicians tend to dismiss those"soft symptoms" as a normal part of aging, but they're often treatable and reversible by normalizing testosterone levels.

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

Not exactly. There are quite a few drugs which may reduce libido, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs can also reduce the quantity of the ejaculatory fluid, no wonder. But a decrease in orgasm intensity usually doesn't go along with therapy for BPH. Erectile dysfunction does not usually go along with it , though surely if somebody has less sex drive or less attention, it's more of a struggle to get a fantastic erection.

How do you decide whether or not a man is a candidate for testosterone-replacement treatment?

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

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

*Note: The Endocrine Society recommends clinical practice guidelines with recommendations for who should and should not receive testosterone therapy. For look what i found a complete copy these details of these guidelines, log on to www.endo-society.org. More hints

Is total testosterone the right point to be measuring? Or if we are measuring something else?

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

The available part of total testosterone is called free testosterone, and it is readily available to cells. Even though it's only a little portion of this overall, the free testosterone level is a fairly good indicator of reduced testosterone. It is not ideal, but the correlation is greater than with total testosterone.

Endocrine Society recommendations outlined

This professional organization urges testosterone treatment for men who have

Therapy Isn't Suggested for men who've

  • Breast or prostate cancer
  • a nodule on the prostate which may be felt during a DRE
  • that a PSA higher than 3 ng/ml without additional analysis
  • 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 factors affect testosterone levels?

    For years, the recommendation has been to get a testosterone value early in the morning because levels start to drop after 10 or 11 a.m.. But the data behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and older over the course of the day. One reported no change in typical testosterone till after 2 Between 2 and 6 p.m., it went down by 13%, a modest amount, and probably insufficient to affect identification. Most guidelines nevertheless say it is important to perform the evaluation in the morning, however for men 40 and over, it likely doesn't matter much, as long as they obtain their blood drawn before 6 or 5 p.m.

    There are some rather interesting findings about dietary supplements. By way of instance, it seems that those that have a diet low in protein have lower testosterone levels than males who consume more protein. But diet hasn't been studied thoroughly enough to make any recommendations that are clear.

    Exogenous vs. endogenous testosterone

    In this guide, testosterone-replacement treatment refers to the treatment of hypogonadism with adrenal gland -- testosterone that is manufactured 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, along with additional side effects.

    Within four to six months, each one of the men had increased levels of testosterone; none reported any side effects throughout the year they were followed.

    Since clomiphene citrate isn't accepted by the FDA for use in men, little information exists regarding the long-term ramifications of taking it (including the probability of developing prostate cancer) or whether it is more capable of boosting testosterone than exogenous formulas. But unlike adrenal gland, clomiphene citrate preserves -- and potentially enhances -- sperm production. This makes medication like clomiphene citrate one of just a few choices for men with low testosterone that want to father children.

    Formulations

    What kinds of testosterone-replacement therapy can be found? *

    The earliest form is an injection, which we use since it's cheap and because we faithfully become good testosterone levels in almost everybody. The disadvantage is that a person needs to come in every couple of weeks to get a shot. A roller-coaster effect may also occur as blood glucose levels peak and then return to research. [See"Exogenous vs. endogenous testosterone," above.]

    Topical treatments help preserve a more uniform level of blood glucose. The first form of topical treatment was a patch, but it has a very large rate of skin irritation. In one study, as many as 40 percent of men who used the patch developed a reddish area in their skin. That limits its usage.

    The most commonly used testosterone preparation from the United States -- and the one I begin almost everyone off -- is a topical gel. According to my experience, it tends to be consumed to great levels in about 80% to 85% of guys, but that leaves a significant number who don't consume sufficient for this to have a positive effect. [For details on various formulations, see table below.]

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

    Men who begin using the gels have to come back in to have their own testosterone levels measured again to be sure they're absorbing the proper quantity. Our target is 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 fast, within a few doses. I usually measure it after 2 weeks, even though symptoms may not alter for a month or two.

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