A Harvard expert shares his thoughts on testosterone-replacement therapy

A Harvard expert shares his thoughts on testosterone-replacement therapy

Read the whole  interview with Abraham Morgentaler, M.D. READ MORE

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 40s. As men get into their 50s, 60s, and beyond, they may start 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 signs and symptoms are often called hypogonadism (“hypo” meaning low functioning 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% 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.

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.

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Rhode Island Testosterone Clinics For Low T and Comprehensive Testosterone Replacement Therapy TRT

Rhode Island Testosterone Clinics For Low T and Comprehensive Testosterone Replacement Therapy TRT

 

Symptoms of Low Testosterone

Run-down Feeling
Guys like to make jokes about testosterone, but testosterone deficiency is no laughing matter. The latest research suggests that guys without enough of the hormone face a higher risk of several serious illnesses, including diabetes, osteoporosis, and cardiovascular disease. A simple blood test can reveal whether a guy has low testosterone but there are plenty of other clues that a problem exists, as you’ll see. It may start with that feeling like you are carrying the weight of the world on your shoulders.

Low Sex Drive
Testosterone is what fuels a man’s sex drive. If he’s low on “T,” he’s likely to become less interested in having sex. “Testosterone is what’s responsible for ‘the g factor,” says Dr. Abraham Morgentaler, associate clinical professor of medicine at Harvard Medical School and the author of “Testosterone for Life.” He says men differ in how frequently they like to have sex. But for men with low testosterone, he says, “it’s completely absent.”

Erectile Dysfunction
Erections are triggered by the body’s release of a tiny molecule called nitric oxide. But testosterone is what’s needed to trigger this release, and if there’s not enough of it, well, nothing much happens down below. Either erections are impossible or they are not firm enough intercourse.

Orgasm Trouble
A Testosterone Deficiency can cause big medical problems, including Diabetes, Osteoporosis and Heart Disease.

Low Fluid Level
Three parts of a man’s body work together to produce the sperm-containing fluid that’s released when he ejaculates: the prostate, the seminal vesicles and the testicles. Each of these parts needs a good supply of testosterone to produce a normal ejulatory volume of 1.5 to 5 cubic centimeters. A man with waning testosterone may notice a sharp decline in his “volume.”

Genital Numbness
Guys with low testosterone often complain of feeling numb down below. They may not be completely numb, but a touch of the penis or scrotom fails to elicit that feeling of “electricity” needed to spark sexual encounters – and make sex so pleasurable, says Dr. Abraham Morgentaler, associate clinical professor of medicine at Harvard Medical School and the author of “Testosterone for Life,” touching the area “just feels wrong to them.”

Fatigue
It’s perfectly normal for a guy to feel tired at the end of a busy day. But guys with low “T” feel completely depleted. These guys complain of being more tired than they think they ought to be. “My tank is empty,” is how some guys put it.

Decreased Energy
In addition to feeling severe fatigue, guys with low testosterone often lose their drive and initiative. Guys who used to be up and at ’em all day long are sidelined on the sofa.

Mood Problems
Even if they’re not experiencing clinical depression, men with low testosterone often feel down or blue. They feel less optimistic than they used to feel.

Irritability
Low testosterone can cause guys to be grouchy and irritable. Sometimes the problem is more apparent to friends, family members and colleagues – than to the men themselves. “A guy might say he’s fine,” says Dr. Abraham Morgentaler, associate clinical professor of medicine at Harvard Medical School and the author of “Testosterone for Life,” but the people around him know otherwise.

Reduced Muscle Mass
It’s not like they become weaklings, but guys with low testosterone often feel that they’re not as strong as they once were. Some men actually notice shrinkage in their arm and leg muscles, and in their chest. And if they try to build muscles with weight-lifting, they often find it frustratingly difficult to build muscle mass.

More Body Fat
Low testosterone often results not only in reduced muscle mass, but also in increased body fat. Some guys add weight around the middle. Others develop gynecomastia, a.k.a “man boobs. “Treating testosterone deficiency is not about improving men’s lives at a superficial level, as some people mistakenly believe, but plays a crucial role in the management of chronic diseases. Many men start experiencing a dip in their testosterone levels when they hit their 40s. This syndrome manifests as lethargy, moodiness and irritability, weight gain, low libido, abdominal obesity and erectile dysfunction.

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