Vital Factors For testosterone therapy In The Uk

A Harvard expert shares his Ideas on testosterone-replacement therapy

 

 

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

Over time, the testicular"machinery" which produces testosterone gradually becomes less powerful, and testosterone levels start to fall, by approximately 1% a year, starting in the 40s. As guys get in their 50s, 60s, and beyond, they might start to have symptoms and signs of low testosterone like reduced libido and sense of vitality, erectile dysfunction, decreased energy, decreased muscle mass and bone density, and anemia. Taken together, these signs and symptoms are often called 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 United States. Yet it is an underdiagnosed problem, with only about 5 percent of those affected receiving treatment.

Various studies have shown 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. Much of the current debate focuses on the long-held belief that testosterone can stimulate prostate cancer.

He's developed particular 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 thinks specialists should rethink the potential connection between testosterone-replacement treatment and prostate cancer.

Symptoms and diagnosis

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

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

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

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

Not precisely. There are a number of medications that may reduce libido, such as the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs may also reduce the quantity of the ejaculatory fluid, no question. However a reduction in orgasm intensity normally does not go together with treatment for BPH. Erectile dysfunction does not ordinarily go along with it either, though surely if somebody has less sex drive or less attention, it is more of a struggle to have a fantastic erection.

How do you determine whether a man is a candidate for testosterone-replacement therapy?

There are just two ways we determine whether someone 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 ideal. Generally men 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 signs.

Looking purely at the biochemical amounts, The Endocrine Society* considers low testosterone for a total testosterone level of less than 300 ng/dl, and I think that's a sensible guide. However, no one really agrees on a few. It's not like diabetes, in which if your fasting sugar is above a certain level, they will 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 shouldn't receive testosterone therapy. For a complete check this site out copy of these instructions, log on wikipedia reference to www.endo-society.org.

Is total testosterone the right thing to be measuring? Or if we are measuring something different?

This is another area of confusion and great discussion, but I don't think it's as confusing as it appears to be in the literature. When most physicians learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body. But about half of their testosterone that's circulating in the blood is not available to the cells.

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

Endocrine Society recommendations outlined

This professional organization recommends testosterone therapy for men who have

  • Reduced levels of testosterone in the blood (less than 300 ng/dl)
  • symptoms of low testosterone.

Therapy is not Suggested for men who have

  • Prostate or breast cancer
  • a nodule on the prostate that may be felt during a DRE
  • that a PSA greater than 3 ng/ml without additional analysis
  • 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 factors influence 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 even 11 a.m.. But the information behind that recommendation were attracted to healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and mature within the course of the day. One reported no change in typical testosterone till after 2 Between 6 and 2 p.m., it went down by 13%, a small sum, and probably insufficient to affect diagnosis. Most guidelines nevertheless say it's important to perform the test in the morning, but for men 40 and over, it probably does not matter much, as long as 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 that have a diet low in protein have lower testosterone levels than men who eat more protein. But diet hasn't been researched thoroughly enough to make any recommendations that are clear.

    Within this guide, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone -- testosterone that is produced outside the body. Depending upon the formulation, therapy can cause skin irritation, breast tenderness and enlargement, 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 approved by the FDA for use in men, little information exists regarding the long-term ramifications of carrying it (such as the risk of developing prostate cancer) or if it's more effective at boosting testosterone than exogenous formulas. But unlike adrenal gland, clomiphene citrate preserves -- and possibly enriches -- sperm production. This makes medication like clomiphene citrate one of only a few options for men with low testosterone that want to father children.

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

    The oldest form is an injection, which we still use since it is cheap and because we reliably get fantastic testosterone levels in almost everybody. The disadvantage is that a man needs to come in every few weeks to get a shot. A roller-coaster effect may also happen as blood glucose levels peak and return to research. [Watch"Exogenous vs. endogenous testosterone," above.]

    Topical therapies help maintain a more uniform level of blood glucose. The first kind of topical treatment has been a patch, but it has a quite large rate of skin irritation. In one 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. There are just two brands: AndroGel and Testim. Based on my experience, it tends to be absorbed to good levels in about 80% to 85% of men, but that leaves a substantial number who do not absorb enough for it to have a favorable impact. [For details on several different formulations, see table ]

    Are there any downsides to using dyes? How much time does it require them to get the job done?

    Men who begin using the implants need to return in to have their own testosterone levels measured again to be sure they're absorbing the right amount. Our target is that 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 fast, in just several doses. I normally measure it after two weeks, though symptoms may not change for a month or two.

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