Criteria Of trt - Insights

A Harvard Specialist shares his thoughts on testosterone-replacement Treatment

 

 

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

As time passes, the "machinery" which makes testosterone gradually becomes less powerful, and testosterone levels begin to drop, by approximately 1 percent a year, beginning in the 40s. As guys get in their 50s, 60s, and beyond, they might begin to have symptoms and signs of low testosterone like 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 referred to as hypogonadism ("hypo" significance low working and"gonadism" referring to the testicles). Yet it is an underdiagnosed problem, with just about 5% of those affected receiving treatment.

Studies have shown 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.

He has developed specific experience in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment plans he utilizes his own patients, and he believes experts should reconsider the potential link between testosterone-replacement therapy and prostate cancer.

Symptoms Click Here and this website diagnosis

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

As a urologist, I tend to observe men since they have sexual complaints. The primary hallmark of reduced testosterone is reduced sexual desire or libido, but another may be erectile dysfunction, and any guy who complains of erectile dysfunction must get his testosterone level checked. Men can experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a much smaller amount of fluid from ejaculation, and a feeling of numbness in the manhood when they see or experience something which would usually be arousing.

The more of the symptoms you will find, the more probable it is that a man has low testosterone. Many physicians often discount those"soft symptoms" as a normal part of aging, however, they are often treatable and reversible by normalizing testosterone levels.

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

Not precisely. There are quite a few drugs that may lessen sex drive, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs can also reduce the amount of the ejaculatory fluid, no wonder. However a reduction in orgasm intensity normally doesn't go together with therapy for BPH. Erectile dysfunction does not usually go together with it either, though surely if somebody has less sex drive or less interest, it's more of a struggle to have a fantastic erection.

How can you decide if or not a person is a candidate for testosterone-replacement therapy?

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 methods is far from perfect. Generally guys with the lowest testosterone have the most symptoms and men with highest testosterone have the least. However, there are some guys who have low levels of testosterone in their blood and have no signs.

Looking purely at the biochemical amounts, The Endocrine Society* considers low testosterone for a entire testosterone level of less than 300 ng/dl, and I believe that is a sensible guide. But no one really agrees on a number. It's not like diabetes, where if your fasting glucose is above a certain level, they will 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 treatment. Watch"Endocrine Society recommendations summarized."

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

Well, this is another area of confusion and great debate, but I don't think it's as confusing as it is apparently from the literature. When most doctors learned about testosterone in medical school, they heard about total testosterone, or all the testosterone in the human body. But about half of their testosterone that is circulating in the bloodstream is not available to cells.

The available part of overall testosterone is known as free testosterone, and it's readily available to cells. Almost every lab has a blood test to measure free testosterone. Even though it's just a small portion of this overall, the free testosterone level is a fairly good indicator of reduced testosterone. It's not perfect, but the significance is greater than with testosterone.

Endocrine Society recommendations outlined

This professional organization recommends testosterone therapy for men who have both

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

Therapy Isn't recommended for men who have

  • Prostate or breast cancer
  • a nodule on the prostate which can be felt during a DRE
  • a PSA greater than 3 ng/ml without additional analysis
  • 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 of day, diet, or other factors influence testosterone levels?

For years, the recommendation was to receive a testosterone value early in the morning because levels begin to drop after 10 or even 11 a.m.. But the information behind that recommendation were drawn from healthy young men. Two recent studies demonstrated little change in blood glucose levels in men 40 and older within the course of this day. One reported no change in typical testosterone till after 2 Between 6 and 2 p.m., it went down by 13%, a small amount, and probably not enough to influence identification. Most guidelines nevertheless say it's important to do the test in the morning, however for men 40 and over, it probably doesn't matter much, as long as they get their blood drawn before 6 or 5 p.m.

There are a number of very interesting findings about dietary supplements. By way of instance, it appears that those that have a diet low in protein have lower testosterone levels than men who consume more protein. But diet has not been researched thoroughly enough to make any recommendations that are clear.

Within this article, testosterone-replacement treatment refers to the treatment of hypogonadism with adrenal gland -- testosterone that's manufactured outside the body. Based on the formula, treatment can lead to skin irritation, breast tenderness and enlargement, sleep apnea, acne, reduced 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 boost the production of natural testosterone, also known as endogenous testosterone, in men. Within four to six weeks, each one of the guys had heightened levels of testosteronenone reported any side effects throughout the year they had been followed.

Since clomiphene citrate is not accepted by the FDA for use in men, little information exists about the long-term effects of carrying it (such as the risk of developing prostate cancer) or if it's more effective at boosting testosterone compared to exogenous formulations. But unlike adrenal gland, clomiphene citrate maintains -- and possibly enhances -- sperm production. This makes drugs like clomiphene citrate one of only a few options for men with low testosterone that want to father children.

Formulations

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

The earliest form is the injection, which we use because it's inexpensive and because we reliably get good testosterone levels in nearly everybody. The drawback is that a man needs to come in every few weeks to find a shot. A roller-coaster effect may also occur as blood testosterone levels peak and return to research.

Topical treatments help maintain a more uniform amount of blood glucose. The first kind of topical therapy was a patch, but it has a quite high rate of skin irritation. In 1 study, as many as 40 percent of people that used the patch developed a reddish area on their skin. That limits its use.

The most commonly used testosterone preparation in the United States -- and the one I start almost everyone off with -- is a topical gel. There are just two brands: AndroGel and Testim. Based on my experience, it tends to be consumed to great levels in about 80% to 85 percent of guys, but leaves a substantial number who do not absorb sufficient for this to have a favorable impact. [For specifics on several different formulations, see table below.]

Are there any downsides to using dyes? How long does it take for them to work?

Men who start using the implants need to come back in to have their own testosterone levels measured again to be sure they're absorbing the proper amount. Our goal is that the mid to upper assortment of normal, which usually means approximately 500 to 600 ng/dl. The concentration of testosterone in blood really goes up quite quickly, in just a few doses. I normally measure it after two weeks, even although symptoms may not alter for a month or two.

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