Vital Factors For trt In The Uk

An interview with Abraham Morgentaler, M.D.

It might be stated 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. It also fosters the creation of red blood cells, boosts mood, and aids cognition.

Over time, the "machinery" which makes testosterone gradually becomes less powerful, and testosterone levels start to fall, by approximately 1% per year, starting in the 40s. As men get in their 50s, 60s, and beyond, they may begin to have symptoms and signs of low testosterone such as reduced libido and sense of vitality, erectile dysfunction, diminished energy, reduced muscle mass and bone density, and nausea. Taken together, these symptoms and signs are often called hypogonadism ("hypo" significance low functioning and"gonadism" speaking to the testicles). Researchers estimate that the illness affects anywhere from two to six million men in the United States. Yet it's an underdiagnosed problem, with just about 5% of these affected receiving treatment.

Studies have revealed that testosterone-replacement therapy may provide a wide selection of benefits 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. 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 diseases and male sexual and reproductive problems. He has developed particular experience in treating low testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment strategies he utilizes his patients, and he believes experts should reconsider the potential connection between testosterone-replacement therapy 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 see guys because they have sexual complaints. The main hallmark of reduced testosterone is low sexual libido or desire, but another can be erectile dysfunction, and any guy who complains of erectile dysfunction must get his testosterone level checked. Men can experience different symptoms, such as more trouble achieving an orgasm, less-intense climaxes, a lesser quantity 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 discount these"soft symptoms" as a normal part of aging, however, they're often treatable and reversible by normalizing testosterone levels.

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

Not precisely. There are a number of drugs that may lessen sex drive, such as the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs can also decrease the quantity of the ejaculatory fluid, no wonder. However a reduction in orgasm intensity usually does not go together with therapy for BPH. Erectile dysfunction does not ordinarily go together with it , though certainly if a person has less sex drive or less attention, it is more of a struggle to get a good erection.

How do you decide if or not 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 methods is far from perfect. Generally men with the lowest testosterone have the most symptoms and guys with maximum testosterone possess the least. However, there are a number of guys who have reduced levels of testosterone in their blood and have no symptoms.

Looking purely at the biochemical numbers, The Endocrine Society* considers low testosterone to be a total 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 glucose is above a certain level, they'll say,"Okay, you've got it." With testosterone, that break point is not quite as clear.

*Note: The Endocrine Society recommends clinical practice guidelines with recommendations for who should and should not receive testosterone treatment. See"Endocrine Society check my reference recommendations look at this website summarized." For a complete copy of the guidelines, 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 another area of confusion and great debate, but I do not think that it's as confusing as it is apparently from the literature. When most physicians learned about testosterone in medical school, they heard about total testosterone, or all the testosterone in the body. But about half of their testosterone that is circulating in the blood is not available to the cells.

The available portion of overall testosterone is called free testosterone, and it's readily available to the cells. Nearly every laboratory has a blood test to measure free testosterone. Even though it's only a small portion of this total, the free testosterone level is a pretty good indicator of low testosterone. It's not ideal, but the significance is greater compared to total testosterone.

Endocrine Society recommendations summarized This professional organization recommends testosterone therapy for men who have Therapy Isn't Suggested for men who have Prostate or breast cancer a nodule on the prostate which can be felt during a DRE a PSA higher than 3 ng/ml without further evaluation 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 of day, diet, or other elements 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 that recommendation were attracted to healthy young men. Two recent studies demonstrated little change in blood testosterone levels in men 40 and mature over the course of this day. One reported no change in average testosterone until after 2 Between 6 and 2 p.m., it went down by 13%, a small amount, and probably insufficient to influence diagnosis. Most guidelines nevertheless say it's important to perform the test in the morning, however for men 40 and above, it likely doesn't matter much, provided that they obtain their blood drawn before 5 or 6 p.m. There are a number of very interesting findings about dietary supplements. For instance, it appears that those who 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. Within this guide, testosterone-replacement therapy refers to the treatment of hypogonadism with adrenal gland -- testosterone that is produced outside the body. Based on the formula, treatment can lead to skin irritation, breast enlargement and tenderness, sleep apnea, acne, decreased sperm count, increased red blood cell count, and additional side effects. Preliminary studies have proven that clomiphene citrate (Clomid), a drug generally prescribed to stimulate ovulation in women struggling with infertility, can boost the production of natural testosterone, also known as endogenous testosterone, in men. Within four to six months, each one of the guys had increased levels of testosterone; none reported some side effects during the year they had been followed. Because clomiphene citrate isn't accepted by the FDA for use in men, little information exists regarding the long-term effects of carrying it (such as the risk of developing prostate cancer) or if it is more effective at 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 who want to father children. What kinds of testosterone-replacement treatment are available? * The earliest form is the injection, which we still use because it is cheap and because we reliably become fantastic testosterone levels in almost everybody. The disadvantage is that a man should come in every couple of weeks to find a shot. A roller-coaster effect can also occur as blood glucose levels peak and return to research. [Watch"Exogenous vs. endogenous testosterone," above.] Topical therapies help maintain a more uniform amount of blood glucose. The first kind of topical therapy was a patch, but it has a very 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 also the one I begin almost everyone off -- is a topical gel. Based on my experience, it tends to be absorbed to great 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 various formulations, see table below.] Are there any drawbacks to using gels? How long does it take for them to work? Men who start using the gels have to come back in to have their testosterone levels measured again to make sure they're absorbing the right amount. Our goal is 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, within a few doses. I usually measure it after two weeks, though symptoms may not change 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