Root Criteria For hrt - The Facts

It could be said that testosterone is the thing that makes guys, guys. It gives them their characteristic deep voices, big muscles, and facial and body hair, distinguishing them from women. It stimulates the growth of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to normal erections. It also boosts the creation of red blood cells, boosts mood, and assists cognition.

As time passes, the "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" meaning low working and"gonadism" speaking to the testicles). Researchers estimate that the condition affects anywhere from two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment.

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's developed specific experience in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his patients, and he thinks specialists should rethink the potential connection between testosterone-replacement therapy and prostate cancer.

Symptoms and diagnosis

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

As a urologist, I tend to observe guys because they have sexual complaints. The primary hallmark of reduced testosterone is reduced sexual desire or libido, but another can be erectile dysfunction, and some other man who complains of erectile dysfunction should possess his testosterone level checked. Men may experience other symptoms, like more trouble achieving an orgasm, less-intense orgasms, a much smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something which would normally be arousing.

The more of the symptoms you will find, 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 are often treatable and reversible by decreasing testosterone levels.

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

Not precisely. There are a number of drugs which may lessen sex drive, such as the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs may also reduce the amount of the ejaculatory fluid, no wonder. But a decrease in orgasm intensity usually doesn't go along with treatment for BPH. Erectile dysfunction does not ordinarily go together with it either, 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 symptoms and signs, and the correlation between these two methods is far from perfect. Normally men with the lowest testosterone have the most symptoms and guys with highest testosterone possess the least. But there are some guys who have low levels of testosterone in their blood and have no signs.

Looking purely 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 reasonable guide. However, no one really agrees on a number. It is similar to diabetes, where 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 shouldn't receive more tips here testosterone therapy. For a complete copy of you can look here the instructions, log on to www.endo-society.org.

Is total testosterone the ideal point to be measuring? Or should we be measuring something different?

Well, this is just another area of confusion and great debate, but I do not think that it's as confusing as it is apparently in 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 is circulating in the blood isn't 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 available part of overall testosterone is known as free testosterone, and it is readily available to the cells. Though it's just a little portion of the total, the free testosterone level is a pretty 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 both Therapy is not recommended for men who've Breast or prostate cancer a nodule on the prostate which may be felt during a DRE that a PSA greater than 3 ng/ml without further evaluation a hematocrit greater than 50% or thick, viscous blood untreated obstructive sleep apnea severe lower urinary tract infections class III continue reading this or IV heart failure. Do time of day, diet, or other factors affect testosterone levels? For many years, the recommendation was to receive a testosterone value early in the morning since levels begin to drop after 10 or 11 a.m.. However, 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 mature within the course of this day. One reported no change in typical testosterone until after 2 p.m. 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, but for men 40 and above, it probably doesn't matter much, as long as they obtain their blood drawn before 6 or 5 p.m. There are a number of rather interesting findings about diet. For example, it appears that individuals who have a diet low in protein have lower testosterone levels than males who eat more protein. But diet has not been researched thoroughly enough to create any recommendations that are clear. In the following guide, testosterone-replacement treatment refers to the treatment of hypogonadism with adrenal gland -- testosterone that is manufactured outside the body. Based upon the formula, treatment 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 weeks, each one the guys had heightened levels of testosteronenone reported any side effects throughout the year they were followed. Since clomiphene citrate is not accepted by the FDA for use in males, little information exists about the long-term ramifications of carrying it (including the probability of developing prostate cancer) or if it's more effective at boosting testosterone compared to exogenous formulations. But unlike exogenous testosterone, clomiphene citrate maintains -- and possibly enriches -- sperm production. This makes drugs such as clomiphene citrate one of only a few options for men with low testosterone who wish to father children. 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 get fantastic 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 may also occur as blood glucose levels peak and then return to research. [See"Exogenous vs. endogenous testosterone," above.] Topical therapies help preserve a more uniform level of blood glucose. The first form of topical treatment was a patch, but it has a quite high rate of skin irritation. In 1 study, as many as 40% of people that used the patch developed a red area in their skin. That limits its usage. The most widely used testosterone preparation in the United States -- and also the one I start almost everyone off -- is a topical gel. The gel comes from tiny tubes or in a unique dispenser, and you rub it on your shoulders or upper arms once a day. Based on my experience, it has a tendency to be absorbed to good degrees in about 80% to 85% of guys, but that leaves a significant number who don't consume sufficient for it to have a favorable impact. [For specifics on several different formulations, see table ] Are there any downsides to using gels? How much time does it require them to work? Men who begin using the implants need 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 blood actually goes up quite fast, within a few doses. I normally measure it after 2 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