Testosterone is the primary male sex hormone and an anabolic steroid. In men, testosterone plays a key role in the development of male reproductive tissues such as. Search Harvard Health Publications. What can we help you find? Enter search terms and tap the Search button. Both articles and products will be searched. MSN Health and Fitness has fitness, nutrition and medical information for men and women that will help you get active, eat right and improve your overall wellbeing. Harvard Medical Healthy Testosterone Diet BookA Harvard expert shares his thoughts on testosterone- replacement therapy - Harvard Prostate Knowledge. An interview 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. It also fosters the production of red blood cells, boosts mood, and aids cognition. Over time, the testicular “machinery” that makes testosterone gradually becomes less effective, and testosterone levels start to fall, by about 1% a year, beginning in the 4.
As men get into their 5. Taken together, these signs and symptoms are often called hypogonadism (“hypo” meaning low functioning and “gonadism” referring to the testicles). Harvard Medical Healthy Testosterone Diet WeightResearchers 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. Studies have shown that testosterone- replacement therapy may offer a wide range of benefits for men with hypogonadism, including improved libido, mood, cognition, muscle mass, bone density, and red blood cell production. 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. At some point in their 40s, men’s testosterone production begins to slow. By some estimates, levels of this hormone drop by about 1% a year. As men get into their. A cup of coffee in the morning may pack more than just an energy boost. More and more research is emerging to suggest that there may be several health benefits. 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 expertise in treating low testosterone levels. In this interview, Dr. Morgentaler shares his views on current controversies, the treatment strategies he uses with his own patients, and why he thinks experts should reconsider the possible link between testosterone- replacement therapy and prostate cancer. Symptoms and diagnosis. What signs and symptoms of low testosterone prompt the average man to see a doctor? As a urologist, I tend to see men because they have sexual complaints. The primary hallmark of low testosterone is low sexual desire or libido, but another can be erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked. Men may experience other symptoms, such as more difficulty achieving an orgasm, less- intense orgasms, a smaller amount of fluid from ejaculation, and a feeling of numbness in the penis when they see or experience something that would normally be arousing. The more of these symptoms there are, the more likely it is that a man has low testosterone. Many physicians tend to dismiss these “soft symptoms” as a normal part of aging, but they are often treatable and reversible by normalizing testosterone levels. Aren’t those the same symptoms that men have when they’re treated for benign prostatic hyperplasia, or BPH? Not exactly. There are a number of drugs that may lessen sex drive, including the BPH drugs finasteride (Proscar) and dutasteride (Avodart). Those drugs can also decrease the amount of the ejaculatory fluid, no question. But a reduction in orgasm intensity usually does not go along with treatment for BPH. Erectile dysfunction does not usually go along with it either, though certainly if somebody has less sex drive or less interest, it’s more of a challenge to get a good erection. How do you determine whether a man is a candidate for testosterone- replacement therapy? There are two ways that we determine whether somebody has low testosterone. One is a blood test and the other is by characteristic symptoms and signs, and the correlation between those two methods is far from perfect. Generally men with the lowest testosterone have the most symptoms and men with highest testosterone have 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 numbers, The Endocrine Society* considers low testosterone to be a total testosterone level of less than 3. I think that’s a reasonable guide. But no one quite agrees on a number. It’s not like diabetes, where if your fasting glucose is above a certain level, they’ll say, “Okay, you’ve got it.” With testosterone, that break point is not quite as clear.*Note: The Endocrine Society publishes clinical practice guidelines with recommendations for who should and shouldn’t receive testosterone therapy. See “Endocrine Society recommendations summarized.” For a complete copy of the guidelines, log on to www. Is total testosterone the right thing to be measuring? Or should we be measuring something else? Well, this is another area of confusion and great debate, but I don’t think it’s as confusing as it appears to be in the literature. When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body. But about half of the testosterone that’s circulating in the bloodstream is not available to the cells. It’s tightly bound to a carrier molecule called sex hormone–binding globulin, which we abbreviate as SHBG. The biologically available part of total testosterone is called free testosterone, and it’s readily available to the cells. Almost every lab has a blood test to measure free testosterone. Even though it’s only a small fraction of the total, the free testosterone level is a pretty good indicator of low testosterone. It’s not perfect, but the correlation is greater than with total testosterone. Endocrine Society recommendations summarized. This professional organization recommends testosterone therapy for men who have bothlow levels of testosterone in the blood (less than 3. Therapy is not recommended for men who haveprostate or breast cancera nodule on the prostate that can be felt during a DREa PSA greater than 3 ng/ml without further evaluationa hematocrit greater than 5. 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 1. But the data behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 4. One reported no change in average testosterone until after 2 p. Between 2 and 6 p. Most guidelines still say it’s important to do the test in the morning, but for men 4. There are some very interesting findings about diet. For example, it appears that individuals 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. Exogenous vs. Depending on the formulation, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count, and other side effects. Preliminary research has shown that clomiphene citrate (Clomid), a drug generally prescribed to stimulate ovulation in women struggling with infertility, can foster the production of natural testosterone, termed endogenous testosterone, in men. In a recent prospective study, 3. Within four to six weeks, all of the men had heightened levels of testosterone; none reported any side effects during the year they were followed. Because clomiphene citrate is not approved by the FDA for use in men, little information exists about the long- term effects of taking it (including the risk of developing prostate cancer) or whether it is more effective at boosting testosterone than exogenous formulations. But unlike exogenous testosterone, clomiphene citrate preserves — and possibly enhances — sperm production. That makes drugs like clomiphene citrate one of only a few choices for men with low testosterone who want to father children. Formulations. What forms of testosterone- replacement therapy are available?*The oldest form is an injection, which we still use because it’s inexpensive and because we reliably get good testosterone levels in nearly everybody. The disadvantage is that a man needs to come in every few weeks to get a shot. A roller- coaster effect can also occur as blood testosterone levels peak and then return to baseline. The first form of topical therapy was a patch, but it has a very high rate of skin irritation. In one study, as many as 4. 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 two brands: Andro. Gel 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 tends to be absorbed to good levels in about 8. How long does it take for them to work? Men who start using the gels have to come back in to have their testosterone levels measured again to make sure they’re absorbing the right amount. Our target is the mid to upper range of normal, which usually means around 5. The concentration of testosterone in the blood actually goes up quite quickly, within a few doses. I usually measure it after two weeks, though symptoms may not change for a month or two. Comparison of forms of testosterone therapy. Formulation. Generic (brand)Regimen. Advantages. Disadvantages. Testosterone enanthate (Delatestryl) and testosterone cypionate (Depo- testosterone) injections. Relatively inexpensive. Peaks and valleys in blood testosterone levels; frequent office visits for injections. Scrotal testosterone patch (Testoderm)One 6- mg patch/day. May be less irritating to skin than nonscrotal patches. Scrotum must be shaved in order for patch to adhere to skin. Nonscrotal testosterone patch (Testoderm TTS and Androderm)One or two patches/day, depending on strength (2.
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