The smart Trick of boulder trt That No One is Discussing

You believe full duty for that communications with any Service provider you Make contact with in the Provider Directory. WebMD shall in no function be liable for you or to anyone for just about any determination built or motion taken by you within the reliance on data delivered in the Supplier Directory.

ADIO Well being Chiropractic completely supplies neurologically-primarily based chiropractic treatment that can assist you perform at your exceptional degree. We use numerous really-powerful adjusting techniques to aid make improvements to spinal biomechanics and lessen anxious program interference.

Be sure to evaluate these essential money tax submitting necessities. If You aren't necessary to file an revenue tax return for 2016, make sure you total certainly one of the following:

Mike assesses when, the place and what to regulate as a way to reach the main induce inside the backbone. Study reveals that repeatedly anyone’s Major grievance isn’t essentially the main challenge within their spine and will be as a result of compensation. Torque Launch System, together with our pleasant staff members allows your Chiropractic expertise being pleasing.

The method we use is always according to our clinical judgment and experience. Dr. Mike specifically uses Torque Launch Strategy as well as other spinal corrective protocol’s making sure that you have the top final results feasible. Knowing what it's going to take to receive folks nicely and continue to be properly, we give attention to long term correction as opposed to short term speedy correct treatment.

In Adult men, testosterone concentrations are inversely connected with mortality on account of cardiovascular disease and all triggers. Reduced testosterone could be a predictive marker for the people at substantial threat of cardiovascular disease. 

Some Adult males notice that testosterone gels You should not deliver plenty of of a testosterone Increase, are worried about transfer to your member of the family or lover, or discover that gels and creams Do not take up very well into their skin.

Most importantly, normalizing testosterone stages may perhaps lessen the risks of building major healthcare problems. There may be mounting proof linking reduced testosterone amounts to prolonged-time period professional medical conditions.

Hypogonadism (Small T) could end in substantial lower in Standard of living and adversely affect the operate of many organ systems. Population-based mostly experiments carried out in the last 10 years show that lower testosterone degrees are associated with an increase in the risk read here for creating sort 2 diabetes, metabolic syndrome, heart disease and also a reduction in longevity.

Our MD and naturopathic Physicians operate along with Each individual affected person to supply the absolute best results to optimal well being. NatureMed is actually a naturopathic and integrative medication clinic located in Boulder/ Denver place just from the Boulder Turnpike in South East Boulder, Colorado presenting preventive, holistic, integrative, sporting activities and naturopathic drugs.

dwelling/sexual health and fitness Heart/sexual overall health a-z checklist/testosterone therapy to treat ed index/testosterone therapy to take care of ed report/locate a local health care provider/community assets boulder,co Erectile Dysfunction: Testosterone Replacement Therapy

Specific drugs, clinical situations and treatment plans might cause low testosterone. We have now noticed quite a few Males can be found in with normal testosterone which works A great deal reduce when cholesterol reducing therapy is begun. This is because cholesterol being a precursor for testosterone. 

Somatropin HGH is indicated for replacement of endogenous expansion hormone in adults with progress hormone deficiency (AGHD). Somatropin HGH brings about lowered Fats mass, elevated muscle mass, effective alterations in lipid metabolism, and normal IGF-I concentrations.

Testosterone Injections are classified as the most widely practised and value-effective signifies of testosterone therapy since they have various positive aspects around testosterone creams, testosterone gels and testosterone dermal patches.

Testosterone is really an anabolic steroid hormones and dosage have to be very carefully monitored to ensure the most straight from the source effective ahead of and right after Testosterone therapy results. Gals may additionally be prescribed testosterone to assist Strengthen lower libido as a result of hormone related feminine sexual dysfunction.

The smart Trick of stem cell therapy for knees That Nobody is Discussing

Stem cell injections Expense near to $9000 and personally I would not be investing that kind of money when there is absolutely no evidence that it'll correct my knee pain and reverse

The objective is six weeks of brace use devoid of knee bending or kicking exercise and then OK to move to extra to uncomplicated knee extension routines depending on therapeutic (i.e. For several patients this will likely be at 6 weeks, for a few at 12 weeks).

In this non-surgical technique, a very experienced doctor makes use of specific ultrasound assistance to inject possibly high dose platelet prosperous plasma or stem cells in to the torn or weakened parts of the lateral collateral and anterior lateral ligament (LCL and ALL). The integrity of your ligament is observed since the ligament is injected, allowing a Considerably larger depth review from the ligament structure than could well be feasible on MRI.

Stem cell therapy repairs Your entire body By natural means so you can take fewer medication, or none in the least. It’s time for you to rid your body of unsafe chemical substances as well as their Unintended effects.

Do you've got a beloved just one that you would like to receive more instruction on regenerative medicine And just how it may well help them?

Given that stem cells haven't any antigens, they are NOT acknowledged as overseas by the host physique. In keeping with Dr. Niehans’ confirmed idea, they circulate with the web page of ingestion (smaller intestines) till they identify and congregate at the human counterpart from the organ from which they were taken – pancreas cells Visit the pancreas, brain cells Visit the Mind, nerves cells Visit the nerves, cartilage cells Visit the cartilages, heart cells Visit the coronary heart, and many others. These younger stem cells, which are functionally organ distinct but not species particular, imprint their vigor on aged, worn out, and degenerating cells, stimulating them to function with renewed efficiency. The organ alone then retains its vigor and vitality.

As stem cells continue to be in reserve, from the marrow cavity of one's bones, we have found the simplest place to reap these stem cells is from the back with the hip region (iliac bone).

To make use of, start participating in the main movie. Then use the Playlist Dropdown Menu in the upper left corner with the video Exhibit to indicate all video clip titles. Use the Scroll Bar on the proper hand facet with the playlist to look through all video click over here now titles if demanded.

Below are common knee ailments we address at RMI. In the event your knee affliction isn't outlined, be sure to Call us to discover For anyone who is a candidate.

This is certainly contrasted with invasive knee surgical procedures, which often take away essential tissues or swap all the knee by itself when it becomes harmed. With hyperlinks to a lot more in-depth data, connected research, and commentary, this reserve condenses an unlimited level of details, illustrations or photos, and means into an pleasurable and insightful go through. Here is the initially edition on the Knee Owner’s Guide

Finally, people are significantly considerably less at risk of the dangers of surgeries, such as More about the author an infection and blood clots.

Prostaglandin inhibits inflammation, which takes place just after personal injury and marks the start of your therapeutic system. The faster we will tame this inflammation, the quicker your body can go forward to the following stage of healing, regeneration.

Adult stem cells are cells from your have physique that can renew on their own and develop into other cells (differentiate). They Reside within all of us in several tissues, more information poised to leap into action to repair injury as it takes place. As we age or have huge accidents, we might not be ready to recruit ample of such cells to the positioning to totally repair the world.

For instance, a individual may need loose bodies like cartilage or bone fragments inside their knee joint, which might bring about unpleasant inflammation, degeneration in the joint and “catching” in the knee.

A Background In Vital Factors Of trt

A Harvard expert shares his Ideas on testosterone-replacement therapy

 

 

It could be said that testosterone is what makes men, men. 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. Additionally, it fosters the production of red blood cells, boosts mood, and assists cognition.

As time passes, the testicular"machinery" which produces testosterone gradually becomes less effective, and testosterone levels begin to fall, by about 1 percent a year, beginning in the 40s. As guys get in their 50s, 60s, and beyond, they may begin to have symptoms and signs of low testosterone such as lower 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 referred to as hypogonadism ("hypo" significance low functioning and"gonadism" speaking to the testicles). Yet it is an underdiagnosed issue, with only about 5 percent of these affected receiving treatment.

But little consensus exists about what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face.

Dr. Abraham Morgentaler, an associate professor of surgery at Harvard Medical School and the director of Men's Health Boston, specializes in treating prostate ailments and male reproductive and sexual difficulties. He has developed specific expertise in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment plans he uses with his patients, and he thinks experts should reconsider the potential link between testosterone-replacement therapy and prostate cancer.

Symptoms and diagnosis

What symptoms and signs of low testosterone prompt the typical man 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 libido or desire, but another can be erectile dysfunction, and some other man who complains of erectile dysfunction should possess his testosterone level checked. Men can experience different symptoms, such as more trouble achieving an orgasm, less-intense orgasms, a lesser 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 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, but they're often treatable and reversible by decreasing testosterone levels.

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

Not exactly. There are a number of medications which may lessen sex drive, including the BPH medication finasteride (Proscar) and dutasteride (Avodart). Those drugs may also reduce the amount of the ejaculatory fluid, no question. However a decrease in orgasm intensity usually does not go along with treatment for BPH. Erectile dysfunction does not usually go together with it , though certainly if somebody 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 two ways that we determine whether somebody has reduced testosterone. One is a blood test and the other one 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 guys with maximum testosterone possess the least. But there are some men who have low levels of testosterone in their blood and have no symptoms.

Looking purely at the biochemical amounts, The Endocrine Society* believes low testosterone for a entire testosterone level of less than 300 ng/dl, and I believe that's a reasonable guide. But no one really agrees on a few. It is 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 apparent.

*Notice: The Endocrine Society recommends clinical practice guidelines with recommendations for who should and should not receive testosterone treatment.

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

This is just another area of confusion and good discussion, 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 the testosterone that is circulating in the blood isn't readily available to cells.

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

This professional organization recommends testosterone treatment for men who have

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

Therapy Isn't recommended for men who have

  • Breast or prostate cancer
  • a nodule on the prostate which may be felt during a DRE
  • 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 infections
  • class III advice or IV heart failure. you can try these out

    Do time daily, diet, or other elements affect testosterone levels?

    For years, the recommendation has been to get a testosterone value early in the morning since levels start to drop after 10 or even 11 a.m.. But the information behind this recommendation were drawn from healthy young men. Two recent studies showed little change in blood glucose levels in men 40 and older within the course of this day. One reported no change in average testosterone till after 2 p.m. Between 6 and 2 p.m., it went down by 13 percent, a modest sum, and probably not enough to affect identification. Most guidelines still say it is important to do the evaluation in the morning, but for men 40 and over, it likely doesn't matter much, provided that they get their blood drawn before 6 or 5 p.m.

    There are some rather interesting findings about diet. By way of example, it seems that individuals that have a diet low in protein have lower testosterone levels than men who consume more protein. But diet hasn't been researched thoroughly enough to make any recommendations that are clear.

    Exogenous vs. endogenous testosterone

    In the following article, testosterone-replacement treatment refers to the treatment of hypogonadism with exogenous testosterone -- testosterone that's manufactured outside the body. Based on the formula, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, decreased sperm count, increased red blood cell count, and other side effects.

    Preliminary studies have shown that clomiphene citrate (Clomid), a drug generally prescribed to stimulate ovulation in women struggling with infertility, may foster the creation of natural testosterone, also termed nitric oxide, in men. Within four to six months, all the guys had increased levels of testosterone; none reported some side effects throughout the year they had been followed.

    Since clomiphene citrate is not accepted by the FDA for use in males, little information exists about the long-term effects of carrying it (such as the probability of developing prostate cancer) or whether it's more effective at boosting testosterone compared to exogenous formulations. But unlike exogenous testosterone, clomiphene citrate maintains -- and possibly enhances -- sperm production. This makes medication like clomiphene citrate one of just a few choices for men with low testosterone who wish to father children.

    Formulations

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

    The oldest form is an injection, which we 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 get a shot. A roller-coaster effect can also occur as blood glucose levels peak and return to baseline. [Watch"Exogenous vs. endogenous testosterone," above.]

    Topical treatments help preserve a more uniform level of blood testosterone. 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 percent of people that 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 the one I start almost everyone off with -- is a topical gel. The gel comes from tiny tubes or within a unique dispenser, and you rub it on your shoulders or upper arms once a day. According to my experience, it has a tendency to be consumed to great degrees in about 80% to 85 percent of guys, but leaves a significant number who do not consume sufficient for this to have a favorable impact. [For details on several different formulations, see table ]

    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 testosterone levels measured again to make certain they're absorbing the right quantity. Our goal 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 quickly, within several doses. I normally measure it after 2 weeks, even although symptoms may not change for a month or two.

Root Criteria For hrt - The Facts

A Harvard Specialist shares his thoughts on testosterone-replacement therapy

 

A meeting with Abraham Morgentaler, M.D.

It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large 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. Additionally, it fosters the creation of red blood cells, boosts mood, and aids cognition.

Over time, the "machinery" that produces testosterone slowly becomes less effective, and testosterone levels begin to fall, by approximately 1% per year, beginning in the 40s. As men get in their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as reduced libido and sense of energy, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and nausea. Taken together, these signs and symptoms are often called hypogonadism ("hypo" significance low working and"gonadism" referring to the testicles). Yet it's an underdiagnosed issue, with only about 5% of those affected undergoing therapy.

Various studies have shown that testosterone-replacement therapy can provide a vast range of benefits for men with hypogonadism, including enhanced libido, mood, cognition, muscle mass, bone density, and red blood cell production.

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 difficulties. He has developed specific expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment plans he uses with his patients, and he thinks experts should reconsider the potential connection between testosterone-replacement therapy and prostate cancer.

Symptoms and diagnosis

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

As a urologist, I tend to observe guys since they have sexual complaints. The main hallmark of low testosterone is low sexual libido or desire, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should possess his testosterone level checked. Men may experience other symptoms, such as more trouble achieving an orgasm, less-intense climaxes, a smaller amount 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 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, but they're often treatable and reversible by decreasing testosterone levels.

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

Not precisely. There are quite a few drugs which may lessen sex drive, including the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs may also decrease the amount of the ejaculatory fluid, no wonder. However a reduction in orgasm intensity normally does not go along with therapy for BPH. Erectile dysfunction does not ordinarily go along with it , though certainly if somebody has less sex drive or less attention, it is more of a challenge to have a fantastic erection.

How do you decide whether 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 signs and symptoms, and the correlation between those two approaches is far from perfect. Normally men with the lowest testosterone have the most symptoms and guys with highest testosterone possess the least. However, there are some men who have low levels of testosterone in their blood and have no signs.

Looking at the biochemical numbers, The Endocrine Society* considers low testosterone for a entire testosterone level of less than 300 ng/dl, and I think that's a reasonable guide. However, no one really agrees on a few. It's not like diabetes, in which 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 publishes clinical practice guidelines with recommendations for who should and shouldn't receive testosterone treatment.

Is total testosterone the ideal thing to be measuring? Or should we be measuring something else?

Well, this is just another area of confusion and good debate, but I don't think that it's as confusing as it appears to be from the literature. When most physicians learned about testosterone in medical school, they heard about overall testosterone, or all of the testosterone in the human body. However, about half of their testosterone that is circulating in the blood isn't readily available to cells. It's tightly 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 this total, the free testosterone level is a pretty good indicator of low testosterone. It's not ideal, but the correlation is greater than with testosterone.

Endocrine Society recommendations outlined

This professional organization urges testosterone treatment for men who have

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

Therapy is not recommended for men who have

  • Breast or prostate cancer
  • a nodule on the prostate which may be felt during a DRE
  • a PSA greater than 3 ng/ml without further analysis
  • that a hematocrit greater than 50% or thick, viscous blood
  • untreated obstructive sleep apnea
  • severe lower urinary tract symptoms
  • class III you could look here or IV heart failure.

    Do time daily, diet, or other elements influence testosterone levels?

    For years, the recommendation has been to get a testosterone value early in the morning because levels start to fall after 10 or even 11 a.m.. But the data behind this recommendation were drawn from healthy young men. Two recent studies showed little change in blood glucose levels in men 40 and mature over the course of this day. One reported no change in typical testosterone until after 2 p.m. Between 6 and 2 p.m., it went down by 13 percent, a modest sum, and probably insufficient to influence diagnosis. Most guidelines still say it is 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 5 or 6 p.m.

    There are some very interesting findings about diet. By way of example, it seems that individuals that 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 make any clear recommendations.

    Within this article, testosterone-replacement treatment refers to the treatment of hypogonadism with exogenous testosterone -- testosterone that's manufactured outside the body. Depending upon the formulation, therapy can lead to skin irritation, breast tenderness and enlargement, sleep apnea, acne, decreased sperm count, increased red blood cell count, along with other side effects.

    In a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six months, each one of the guys had increased levels of testosteronenone reported any side effects throughout the entire year they had been followed.

    Since clomiphene citrate is not approved by the FDA for use in men, little information exists about the long-term effects of carrying it (such as the probability of developing prostate cancer) or if it is more effective at boosting testosterone than exogenous formulas. But unlike exogenous testosterone, clomiphene citrate preserves -- and possibly enhances -- sperm production. That makes medication like clomiphene citrate one of only a few choices for men with low testosterone that want to father children.

Formulations

What forms of testosterone-replacement treatment are available? *

The oldest form is the injection, which we still use because it is inexpensive and since we faithfully get fantastic testosterone levels in nearly everybody. The disadvantage is that a person 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 baseline.

Topical therapies help preserve 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 one study, as many as 40 percent of people that used the patch developed a red area in their skin. That limits its usage.

The most commonly used testosterone preparation from the United States -- and the one I begin almost everyone off with -- is a topical gel. There are just two brands: AndroGel and Testim. The gel comes in miniature tubes or in a special 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 great levels in about 80% to 85 percent of men, but that leaves a substantial number who don't consume enough for this to have a positive effect. [For details on various formulations, see table below.]

Are there any drawbacks to using gels? How long does it require them to get the job done?

Men who begin using the implants need to return in to have their testosterone levels measured again to make certain they're absorbing the proper quantity. Our target is that the mid to upper range of normal, which usually means approximately 500 to 600 ng/dl. The concentration of testosterone in the blood really goes up quite fast, within a few doses. I normally measure it after 2 weeks, though symptoms may not alter for a month or two.

Effective Secrets In hrt - An A-Z

A Harvard Specialist shares his Ideas on testosterone-replacement therapy

 

 

It might be stated that testosterone is what makes men, men. It gives them their characteristic deep voices, big muscles, and body and facial hair, differentiating them from girls. It stimulates the development of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids 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 guys get in their 50s, 60s, and beyond, they might begin 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 symptoms and signs are often referred to as hypogonadism ("hypo" significance low working and"gonadism" speaking to the testicles). Researchers estimate that the illness affects anywhere from two to six million men in the USA. Yet it's an underdiagnosed issue, with just about 5% of those affected receiving treatment.

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 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 sexual and reproductive difficulties. He has developed particular experience in treating lower testosterone levels. In this interview, Dr. Morgentaler shares his perspectives on current controversies, the treatment strategies he uses with his own patients, and he thinks experts should reconsider the possible connection between testosterone-replacement therapy and prostate cancer.

Symptoms and diagnosis

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

As a urologist, I tend to see guys since they have sexual complaints. The primary hallmark of low testosterone is reduced 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 difficulty achieving an orgasm, less-intense climaxes, a much smaller amount of fluid out of 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 there are, the more probable it is that a man has low testosterone. Many physicians often dismiss these"soft symptoms" as a normal part of aging, however, they are 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 precisely. There are a number of drugs which 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. But a decrease in orgasm intensity usually doesn't go together with treatment for BPH. Erectile dysfunction does not ordinarily go together with it either, though surely if a person has less sex drive or less attention, it's more of a struggle to get a fantastic erection.

How do you decide whether a person is a candidate for testosterone-replacement therapy?

There are just two ways that we determine whether someone has low testosterone. One is a blood test and the other one 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 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 numbers, The Endocrine Society* believes low testosterone to be a entire testosterone level of less than 300 ng/dl, and I think that's a sensible guide. However, no one quite agrees on a few. It is not like diabetes, where if your fasting sugar is above a certain level, they will say,"Okay, you've got it." With testosterone, that break point isn't quite as clear.

*Notice: The Endocrine Society recommends clinical practice guidelines with recommendations for who should additional resources and shouldn't receive testosterone therapy. Watch"Endocrine Society recommendations summarized." For these details a complete copy of the instructions, log on to More hints www.endo-society.org.

Is complete testosterone the ideal thing to be measuring? Or should we be measuring something different?

This is another area of confusion and great discussion, but I do not 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 of the testosterone in the human body. However, about half of the testosterone that's circulating in the bloodstream isn't readily available to the cells.

The biologically available part of overall testosterone is known as free testosterone, and it is readily available to the cells. Almost every lab has a blood test to measure free testosterone. Though it's just a little portion of the total, the free testosterone level is a pretty good indicator of low testosterone. It's not ideal, but the significance is greater than with total testosterone.

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 Suggested 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 symptoms
  • class III or IV heart failure.

Do time of day, diet, or other factors affect testosterone levels?

For years, the recommendation has been to get a testosterone value early in the morning because levels start to drop after 10 or 11 a.m.. But the information behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and older over the course of the day. One reported no change in average testosterone until after 2 Between 2 and 6 p.m., it went down by 13%, a modest amount, and probably not enough to influence identification. Most guidelines nevertheless say it is important to perform the evaluation in the morning, however for men 40 and above, it probably doesn't matter much, as long as they get their blood drawn before 5 or 6 p.m.

There are some very interesting findings about diet. By way of instance, it seems that those who have a diet low in protein have lower testosterone levels than men who consume more protein. But diet hasn't been studied thoroughly enough to make any clear recommendations.

In the following guide, testosterone-replacement treatment refers to the treatment of hypogonadism with adrenal gland -- testosterone that's produced outside the body. Based on the formulation, therapy can lead to skin irritation, breast tenderness and enlargement, sleep apnea, acne, reduced sperm count, increased red blood cell count, and additional side effects.

At a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six months, all of the guys had increased levels of testosterone; none reported some side effects during the year they had been followed.

Because clomiphene citrate is not accepted by the FDA for use in men, little information exists about the long-term ramifications of taking it (including the probability of developing prostate cancer) or if it is more capable of boosting testosterone compared to exogenous formulations. But unlike adrenal gland, clomiphene citrate preserves -- and potentially enhances -- sperm production. That makes medication like clomiphene citrate one of only a few options for men with low testosterone who wish to father children.

Formulations

What forms of testosterone-replacement treatment are available? *

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 should come in every few weeks to find a shot. A roller-coaster effect may also occur as blood glucose levels peak and then return to research.

Topical treatments help maintain a more uniform amount of blood testosterone. The first kind of topical therapy has been a patch, but it has a very 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 use.

The most widely used testosterone preparation in the United States -- and also the one I begin almost everyone off with -- is a topical gel. There are just two brands: AndroGel and Testim. The gel comes in tiny tubes or in a special dispenser, and you rub it on your shoulders or upper arms once a day. According to my experience, it tends to be consumed to great levels in about 80% to 85 percent of guys, but that leaves a significant number who don't consume sufficient for it to have a favorable effect. [For specifics on various formulations, see table ]

Are there any drawbacks to using gels? How long does it take for 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 certain they are absorbing the proper quantity. Our goal is that the mid to upper range of normal, which usually means around 500 to 600 ng/dl. The concentration of testosterone in blood actually goes up quite fast, in just a few doses. I usually measure it after 2 weeks, though symptoms may not alter for a month or two.

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