Trouble-Free Products For trt - An Analysis
It could be stated that testosterone is the thing that makes men, guys. It gives them their characteristic deep voices, big muscles, and body and facial hair, differentiating them from women. It stimulates the development of the genitals at puberty, plays a role in sperm production, fuels libido, and leads to normal erections. It also fosters the creation of red blood cells, boosts mood, and assists cognition.
Over time, the "machinery" which makes testosterone slowly becomes less powerful, and testosterone levels begin to fall, by approximately 1% per year, beginning in the 40s. As guys get into their 50s, 60s, and beyond, they may start to have symptoms and signs of low testosterone such as reduced sex drive and sense of vitality, erectile dysfunction, diminished energy, decreased muscle mass and bone density, and anemia. Taken together, these symptoms and signs are often referred to as hypogonadism ("hypo" meaning low functioning and"gonadism" referring to the testicles). Yet it is an underdiagnosed problem, with just about 5% of those affected undergoing therapy.
Studies have revealed that testosterone-replacement therapy may offer a vast selection of benefits for men with hypogonadism, including enhanced 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.
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 reproductive and sexual problems. He's developed specific expertise 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 experts should reconsider the possible connection between testosterone-replacement therapy and prostate cancer.Symptoms read the articledirectory and site diagnosis
What symptoms and signs of low testosterone prompt that the typical person to find a doctor?
As a urologist, I have a tendency to see guys because they have sexual complaints. The main hallmark of reduced testosterone is low sexual desire or libido, but another may be erectile dysfunction, and some other guy who complains of erectile dysfunction must get his testosterone level checked. Men can experience other symptoms, like more trouble achieving an orgasm, less-intense orgasms, a smaller amount 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 you will find, the more likely it is that a man has low testosterone. Many physicians tend to discount those"soft symptoms" as a normal part of aging, but they're often treatable and reversible by normalizing testosterone levels.
Aren't those the very same symptoms that men have when they're treated for benign prostatic hyperplasia, or BPH?
Not exactly. There are a number of medications that may reduce libido, including the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs may also decrease the amount of the ejaculatory fluid, no question. But a reduction in orgasm intensity normally doesn't go along with therapy for BPH. Erectile dysfunction does not usually go together with it either, though certainly if somebody has less sex drive or less attention, it is more of a challenge to get a fantastic erection.
How can you determine if a man is a candidate for testosterone-replacement therapy?
There are two ways that 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 methods is far from perfect. Normally guys with the lowest testosterone have the most symptoms and men with maximum testosterone have the least. But there are a number of guys 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 entire testosterone level of less than 300 ng/dl, and I believe that's a sensible guide. However, no one really agrees on a few. It's similar to diabetes, in which if your fasting sugar is over 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 recommendations for who should and should not receive testosterone therapy. See"Endocrine Society recommendations summarized."|
Is complete testosterone the ideal thing to be measuring? Or should we be measuring something else?
Well, this is another area of confusion and good debate, but I do not think that it's as confusing as it is apparently from the literature. When most doctors learned about testosterone in medical school, they heard about overall testosterone, or all the testosterone in the body. However, about half of their testosterone that's circulating in the bloodstream isn't available to the cells. It's closely bound to a carrier molecule known as sex hormone--binding globulin, which we abbreviate as SHBG.
The biologically available portion of total testosterone is called free testosterone, and it's readily available to cells. Almost every laboratory has a blood test to measure free testosterone. Though it's only a little fraction of this overall, the free testosterone level is a pretty good indicator of reduced testosterone. It is not perfect, but the significance is greater compared to testosterone.
This professional organization urges 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've
- Prostate or breast cancer
- a nodule on the prostate which can be felt during a DRE
- a PSA greater than 3 ng/ml without further evaluation
- a hematocrit greater than 50 percent 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 elements influence testosterone levels?
For years, the recommendation has been to receive a testosterone value early in the morning since levels start to drop after 10 or even 11 a.m.. But the data behind this recommendation were drawn from healthy young men. Two recent studies demonstrated little change in blood testosterone levels in men 40 and mature within the course of this day. One reported no change in typical testosterone until after 2 Between 6 and 2 p.m., it went down by 13%, a small sum, and probably not enough to affect identification. Most guidelines still say it is important to perform the evaluation in the morning, but for men 40 and over, it likely does not matter much, provided that they get their blood drawn before 6 or 5 p.m.
There are some very interesting findings about dietary supplements. By way of instance, it appears that individuals 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.
In this article, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone -- testosterone that's produced outside the body. Depending on the formulation, treatment can lead to skin irritation, breast tenderness and enlargement, sleep apnea, acne, decreased 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, can foster the production of natural testosterone, also known as endogenous testosterone, in men. Within four to six months, each one the guys had increased levels of testosteronenone reported some side effects throughout the entire year they had been followed.
Since clomiphene citrate isn't approved by the FDA for use in males, little information exists regarding the long-term ramifications of carrying it (including the risk of developing prostate cancer) or whether it is more effective at boosting testosterone than exogenous formulas. But unlike exogenous testosterone, clomiphene citrate maintains -- and possibly enhances -- sperm production. That makes medication such as clomiphene citrate one of only a few options for men with low testosterone that want to father children.
What forms of testosterone-replacement treatment are available? *
The oldest form is the injection, which we use because it's inexpensive and because we faithfully get fantastic testosterone levels in almost everybody. The drawback is that a person should come in every couple of weeks to find a shot. A roller-coaster effect may also happen as blood testosterone levels peak and return to baseline. [See"Exogenous vs. endogenous testosterone," above.]
Topical treatments help maintain a more uniform level of blood glucose. The first kind of topical treatment has been 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 reddish area in their skin. That limits its use.
The most commonly used testosterone preparation in the United States -- and the one I begin almost everyone off -- is a topical gel. According to my experience, it has a tendency to be absorbed to good degrees in about 80% to 85 percent of guys, but leaves a significant number who do not absorb sufficient for it to have a positive effect. [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 gels have to come back in to have their own testosterone levels measured again to be sure they're absorbing the right quantity. Our target is the mid to upper range of normal, which usually means around 500 to 600 ng/dl. The concentration of testosterone in the 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.