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Low Testosterone Levels In Men – An Untreated Epidemic

Some doctors are clueless about low testosterone

Low testosterone levels in men are an untreated epidemic and many doctors are clueless about the problem.

Most doctors have only seen a handful of testosterone lab results and the tests they tend to order are too basic for such an important problem.

They think if you don’t have ED (erectile dysfunction) then there is no way you could have low testosterone levels.

There are many myths about low testosterone. The truth is that men in the United States 20 years ago had much higher testosterone levels on average than men today.

Aging is one factor that can increase your chances of having low testosterone since testosterone levels tend to decline with age (just like many things tend to decline with age) but we are seeing men at all ages having lower testosterone levels than we would expect (and want for optimal health).

Testosterone Declining More Than Expected - Travison et al.

Testosterone Declining More Than Expected – Travison et al.

In one study of 1,532 men in 2002, Travison et al. show a massive decline in Massachusetts’s men’s testosterone levels over the past 20 years that is not related to “normal” aging or other health and lifestyle factors that can effect testosterone levels.

We do know that environmental pollution can decrease testosterone levels and that the higher your testosterone levels the lower your risk of death by ALL causes.

In a study of 3,942 men, the risk of death by ANY cause was decreased in men with higher testosterone AND growth hormone (igf-1) levels. IGF-1 is one of the blood markers we use to evaluate growth hormone levels. So the higher your growth hormone and testosterone levels the longer you’ll live! (Steroids Journal, 2012)

HPA Axis for Testosterone Control in the Body

HPA Axis for Testosterone Control in the Body

Environmental pollution is likely to increase as the world becomes more crowded and new chemicals are created with little understanding of their long-term consequences. The body has a complex system to control testosterone levels and this system can be affected many different ways.

What is aging?

Many doctors consider low testosterone part of “normal aging”, but what is aging? There are a number of factors that influence how we age, including nutrition, lifestyle, exercise, AND hormone levels. In women, menopause is very obvious. You’re menstruating and then you’re not menstruating.

After a woman goes through menopause many things change. Her risk of stroke increases. Her ability to become pregnant ceases. Her risk of osteoporosis increases along with increased risks for certain cancers. Thus, there is a very clear point in woman’s life when things shift and this can lead to many problems including divorce!

In women, we will get to men soon, before menopause there is a monthly cycle. During this monthly cycle hormones are increases and decreases as part of a monthly rhythm. Each hormone has many different effects in the female body. For example, estrogen rises during days 1-25 of a monthly cycle and estrogen helps to increase mental clarity. In addition, progesterone rises in the second half of the cycle and helps increase the feeling of mental calm. Thus, if certain hormones drop too low you get PMS.

So imagine what happens after menopause with almost NO estrogen and progesterone! This can lead to many different marital problems such as feeling more distanced, low libido, and feelings of being misunderstood. And I digress.

For MEN, there is something similar that happens as we age called andropause. Andropause is the male version of menopause but is much more insidious (happens slowly over time) and it can happen slowly enough that you only notice it after several years or someone else points out there you seem different. Some guys seem to hit a breaking point where their low testosterone level seems to catch up with them and they all of a sudden start having symptoms, such as erectile dysfunction.

Stress increases cortisol levels in the body. Cortisol is part of the “fight or flight” system and if cortisol remains elevated due to ongoing stressors this can further suppress testosterone levels. I have had a number of men come to our clinic that report their low testosterone symptoms started after a stressful event.

The grumpy old man syndrome is an example of how important adequate testosterone is for brain function. It is like PMS for men but it is ALL the time! Interestingly, the men in the movie “Grumpy Old Men” are chasing after a woman. The grumpy part is realistic but since most older men who are experience grumpiness as a result of low testosterone tend a have lower libidos.

Testosterone has an affect on brain function and low testosterone increases your risk of getting Alzheimer’s disease.

I have had a number of patients with low testosterone who say their libido is great but they have all the other symptoms of low testosterone. While it is certainly possible they have a “healthy” libido (sex drive) it very likely that their drive is less than when they were 25 years old. When you’re 25 years old your testosterone production is at its peak. The fact that the decline happens so slowly is part of why guys may notice the decline in their libido less. When I ask how their libido compares to when they were 25 years old the response is usually that it is now less. It is all relative.

The solution to fixing the problem of low testosterone in the individual is generally quite simple. We use a combination of medications that increase your natural production of testosterone while adding additional testosterone in the form of a cream or injection along with medication that reduces the conversion of testosterone to estrogen if needed. Most guys are unaware that they naturally produce a little estrogen. The only problem is when they produce too much.

This approach to testosterone therapy is used widely in Florida and Southern California at men’s health spas and tends to get the best results with the least amount of work required by the patient so they can focus on living their life to fullest and we take care of ensuring good results with the treatment.

The first year of treatment we typically do about 5 very comprehensive lab tests and after the first year we only need to do labs every 6 months for most patients. The cost of testosterone therapy is about $200 per month and is priceless for most men with low testosterone, which based on new research is most men over 35 years of age.

I personally have seen thousands of comprehensive hormone evaluations are we routinely order these tests for our patients in order to increase safety as well as benefits of the treatment. On our standard follow up labs for testosterone therapy we check about 30 different markers.

We understand you may have some questions after reading this and we’re happy to help. Please call 425-455-1700 for your FREE phone consult to see how we can help you get the “old” you back.

Becoming a patient is easy & your first visit is just $99. This includes lab tests to check your testosterone levels and test medication. Call (425) 455-1700 or schedule online!


References
“A Population-Level Decline in Serum Testosterone Levels in American Men” Thomas G. Travison et al. The Journal of Clinical Endocrinology & Metabolism January 1, 2007 vol. 92 no. 1 196-202

{ 28 comments… read them below or add one }

Greg February 25, 2014 at 6:30 am

SInce starting T therapy at your clinic, my life has been transformed in a very positive way. Coincidentally my wife started having a period every 2 weeks since starting the month after I started therapy and it has continued for the past several months. Is there any research or case reports of female partners of patients on T therapy experiencing this? Do you have any thoughts on a possible causal relationship? She is going to her regular doctor for evaluation soon, but we were wondering if my treatment could be effecting her in this way. Thanks for any insight!

Reply

Dr. Barry Wheeler March 2, 2014 at 8:57 pm

Hi Greg,

If you are using topical testosterone it is possible to transfer it to those around you. Please contact our clinic to discuss further.

Also, being more sexually active could possibly effect your partner’s cycle. Most likely it is totally unrelated but you should contact our clinic to discuss in more detail.

Cheers,
Dr. Barry

Reply

Cheryl December 17, 2013 at 2:17 pm

Dear Doctor,
My husband who is 35 is extremely healthy, he eats a clean diet, exercises every day, doesn’t drink or smoke. In the past 1.5 years he has shown signs of depression, fatigue, lack of libido. He went to the doctor and his T is 329. While his Doctor admits it is “on the low end”, he stated he didn’t believe T therapy was necessary and he wanted to “discuss the depression and treatment” (ie: medication for depression). I am having a difficult time that the Doctor would rather put him on an anti-depressant rather than treat his real symptom (the Low T). If Low T therapy doesn’t work than I have no issue with looking at another issue but I am very concerned about not treating this beforehand.

Please advise.

Thank you,
Cheryl

Reply

Dr. Barry Wheeler December 22, 2013 at 11:03 pm

Hi Cheryl,

I totally understand your frustration. While anti-depressants have their place in medicine, a very likely cause of his symptoms is a deficiency of testosterone, not an anti-depressant medication deficiency. If he were my patient I would certainly consider treating the obvious before jumping to anti-depressant therapy which is likely to have a number of side effects. I have heard this story from a number of patients who were treated for low mood with anti-depressants when the low mood was really just a symptom of low testosterone.

I am unable to advise you specifically but I suggest you ask him to get a second opinion. Perhaps you should have your doctor read the following research article:

“Testosterone deficiency is associated with numerous non-specific symptoms including decline in libido, erectile dysfunction, increased fat deposition, decreased muscle mass, decreased energy and depression.”

“Men with depressive symptoms and testosterone deficiency syndrome should be given a trial of testosterone replacement therapy for at least 3 months as TRT alone may improve clinical symptoms of depression. Furthermore, men already on SSRIs may also experience further improvement in depressive symptoms after initiating TRT.”

Patients with testosterone deficit syndrome and depression. Khera M. Arch Esp Urol. 2013 Sep;66(7):729-36. http://www.ncbi.nlm.nih.gov/pubmed/24047633

Best of luck,
Dr. Barry

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Michelle November 14, 2013 at 9:13 am

My husband was diagnosed with a pituitary tumor (prolactinoma) in august and when his testosterone levels were initially checked his testosterone levels were 0. He has been taking cabergoline to shrink the tumor and we originally had chosen to not try to treat the low t levels in hope that they would improve on their own. We want to have kids and want to minimize the risk to fertility. However after 2 months his t levels have only gone up to 18. We are seeing our doctor next week and want to go in prepared with better information and questions to ask.

What problems can having low to no testosterone cause?

Are there any vitamins or other natural supplements that he should take?

Should we have his estrogen tested or look at options to lower his estrogen to hopefully increase his testosterone?

Can testosterone therapy be done short term to boost his back up to at least a low normal range?

He has sleep apnea due to the bone structure in his face. I read somewhere that it can make a difference in the treatment selected.

We re also seeing an endocrinologist but his focus is the brain tumor, which of course is our primary concern, how involved should he be with the testosterone treatment we decide.

What questions and tests should ask and request to be run and results to be concerned about?

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Dr. Barry Wheeler November 18, 2013 at 11:58 pm

Hi Michelle,

Please see my responses to your questions below. Keep in mind, fertility is not directly correlated to testosterone levels. While low testosterone production in the testicles can be a possible sign of decreased fertility, the only way to check fertility is with semen analysis. There are two signals from the brain to the testicles. FSH stimulates sperm production and LH stimulated testosterone production. Fertility is somewhat complicated so discussing this further with your doctor is important.

What problems can having low to no testosterone cause?
You can read about some of the effects testosterone and estrogen have on the male body here: Testosterone Benefits and Side Effects

Low testosterone can lead to number of health problems and likely contributes to a number of health problems we have yet to discover. There are risks with any treatment and there are risks with not treating low testosterone as well.

Are there any vitamins or other natural supplements that he should take?
That is a question that is a question that he should ask his doctor.

Should we have his estrogen tested or look at options to lower his estrogen to hopefully increase his testosterone?
I always check my male patient’s estrogen levels. Low estrogen can cause health problems and high estrogen levels can cause problems as well.

You can read a little more about low testosterone and high estrogen here: Testosterone and Heart Disease, Heart Attacks, and Stroke Risk

Can testosterone therapy be done short term to boost his back up to at least a low normal range?
It depends on the type of therapy and the cause of the problem. Some doctors use clomiphene or HCG to try and stimulate more testosterone production. Generally, when a man has low testosterone he can expect to be on it long-term in order to maintain the benefits. He would really need to talk to his doctor about his specific situation though.

He has sleep apnea due to the bone structure in his face. I read somewhere that it can make a difference in the treatment selected.
Some men may notice that their sleep apnea gets worse or better with testosterone therapy. It really just depends on the person. If it gets worse for any reason he should tell his doctor. There is some research that sleep apnea may even cause testosterone levels to be reduced. I have had a number of patients who treated their sleep apnea but still had low testosterone. He should definitely tell his doctor about the sleep apnea though.

We’re also seeing an endocrinologist but his focus is the brain tumor, which of course is our primary concern, how involved should he be with the testosterone treatment we decide.
It is important for him to tell his doctors what medications he’s taking. How involved each doctor gets will really depend on the situation so that’s a conversation he’ll have to have with them.

What questions and tests should ask and request to be run and results to be concerned about?
There are many tests that may be of use. Here are a few that I would run if he came into my clinic:

  • FSH
  • LH
  • Total Testosterone
  • Free Testosterone
  • SHBG
  • Estradiol
  • Prolactin
  • TSH
  • Free T3
  • PSA
  • CBC
  • IGF-1
  • IGF-BP3

His doctor may want to run other tests as well but hopefully that list helps you guys have a discussion. Checking growth hormone levels can also be useful (IGF-1 and IGF-BP3).

Best of luck,
Dr. Barry

Reply

Donna October 29, 2013 at 7:32 pm

My husband has all the signs of low T. Falling asleep after dinner, please, he is asleep all the time. He gets up to pee, and sometimes eat. Every ten days or so, he’ll get up for about 10 hours. He was in a life threatening motorcycle accident at 39, in 2009, and hasnt been the same since. I don’t know if it makes a difference, he is also a disabled desert storm combat vet. He is grumpy almost all the time, and blames the sleeping on extreme back pain, and believes its sciatica. He used to hunt, coach baseball, ride motorcycles, and sex was phenomenal. None of that now. He can go to the VA and get all this tested, but refuses. He keeps saying it’ll pass. I’m losing my mind, and am ready to kick him out. Even that threat wont get him to go to doctor. I think he must think it’ll make him less of a man, if he finds out its low t. His brother has it, and is treating a brain tumor with success with testosterone. My husband also has a pineal brain tumor they say is inoperable. Do u have any advice on how to convince him how important getting tested is? I’m desperate.

Reply

Dr. Barry Wheeler November 4, 2013 at 7:16 am

Hi Donna,

Here are a few tips that may help:

  • Call his doctor. Ask your husband to see a medical professional and offer to make the appointment, and make sure to go with him or call the medical professional in advance to state his symptoms.
  • It’s just information. Remind him that if his levels come back normal then at least he can cross it off his list.
  • Reach out. If you know any other men who have had benefit from testosterone therapy maybe if he hears their experience he’ll be more inclined (ie his brother).
  • Talk about how his symptoms impact you. Your relationship, including intimacy, household responsibilities, and finances, are also adversely affected when your husband is so affected.
  • Get educated. It sounds like you’re already doing this but the more you know the better.
  • Use the low testosterone symptoms questionnaire. You can find the question list here: Low T Levels and Symptoms

Also, he needs to tell his doctor about the pain he is experiencing as it may be something other than sciatica. It is important to get this diagnosed as soon as possible.

Dr. Barry

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Rhonda October 9, 2013 at 12:41 am

Hello,
I am convinced my husband is suffering from Low t. He has pretty much all of the symptoms and has for quite some time. The falling asleep as soon as he sits down is really affecting our family. (He is 46 works in a corporate office, gets approx. 7.5-8 hours of sleep per night) He is grumpy, irritable, storing extra fat around the middle and breast area, low sex drive (its been months!), and erections do not seem as strong. He did have the serum test and it registered 535, but it was almost 2 years ago.. that is the only number I see on the test. ANy thoughts??

Reply

Dr. Barry Wheeler October 11, 2013 at 11:54 pm

Hi Rhonda,

There is a book called “Testosterone For Life”, by Abraham Morgentaler, MD that discusses the symptoms of low testosterone. One of the symptoms he discusses is feeling tired after meals and being a couch potato also known as “the couch is calling”.

The total testosterone can often times be “normal” and then soon decline or it can be too bound up by protein in the blood making it less effective. To measure the available amount of testosterone there is a test called “free testosterone” and his doctor should be able to order this for him if he asks. It can also be calculated by measuring the total testosterone level and a protein called sex hormone binding globulin (SHBG). SHBG increases as men age and makes the testosterone we produce less effective.

It may be important to check estrogen (estradiol) levels as well. Estrogen can cause increases in breast size and is produced in fat cells found in the midsection. Other useful tests include prolactin, thyroid (TSH and free T3), and luteinizing hormone (LH). Many doctors just check total testosterone once and call it a day. If only it were so simple…

If his doctor is inexperienced with low testosterone treatment he may want to get a second opinion from another more experienced doctor. Either way I would encourage your husband to meet with his doctor and discuss his symptoms.

Cheers,
Dr. Barry

Reply

Hasan October 5, 2013 at 5:13 am

I am 43 years old male and dignosted with low t level and my doctor prescribed me an injection of t. Is the t level would go up normaly after a few months of treatment and I don’t need the injection any more. Thanks hasan

Reply

Dr. Barry Wheeler October 11, 2013 at 11:48 pm

Hi Hasan,

If you take supplemental testosterone injections it is likely that your natural testosterone production will decrease. The answer to your questions is no and you will likely need to continue testosterone injections to maintain your levels. There are other medications that can help stimulate natural testosterone production such as HCG and clomid. You should discuss all this with your doctor.

Dr. Barry

Reply

Justin October 3, 2013 at 12:31 am

Hi Dr. Barry,
I am 18 years old and i just got back from the doctors. It seems i have low testosterone level (165 L or 241-827 ng/dL). What will testosterone pills/treatment help me with ? I have a small body frame (5’2 105 lb) , feminine-ish face, kinda small down there. Will it help me gain muscle mass and look more masculine?
Thanks,
Justin

Reply

Dr. Barry Wheeler October 5, 2013 at 5:32 pm

Hi Justin,

You need to ask your doctors why you have low testosterone in the first place. At your age, the “why” is an important question and the answer will help determine the most effective treatment as well. There are other hormones that can be effected such as prolactin, estrogen, growth hormone, and thyroid (TSH).

Testosterone therapy can certainly help improve masculine characteristics such as beard growth, facial features, muscle size, and vocal tone. It also tends to make guys a little more expressive and improves libido.

I suggest you ask your doctor to explain what they think is causing your low testosterone and consider getting a second opinion.

Cheers,
Dr. Barry

Reply

Shawn September 26, 2013 at 4:09 am

I am 49 and my doctor just started me on replacement therapy. My test. level was 185. i am taking 100 mg injections weekly however my doctor has not done any other tests that you mention here on your site. Could I have high estrogen as well? I live in Puyallup and could come to the clinic.

Reply

Dr. Barry Wheeler September 26, 2013 at 8:00 pm

Hi Shawn,

Some guys do convert too much testosterone to estrogen and some guys don’t. We always keep an eye on things with lab testing because too much estrogen can cause side effects and decrease the benefits of your testosterone therapy. Learn more: testosterone side effects

You’re welcome to come into our clinic to discuss lab testing. Please call us at (425) 455-1700 to set up a visit and discuss this further.

Cheers,
Dr. Barry

Reply

michael September 2, 2013 at 3:16 am

Hi. i am 46. for what i have read and feel like. i am sure i have lowt. do you treat people that are not local?

Reply

Dr. Barry Wheeler September 3, 2013 at 3:10 am

Hi Michael,

We only treat patients who physically come to our clinic.

Best of luck,
Dr. Barry

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Margaret August 12, 2013 at 6:55 pm

Dr,
My husband is 56 and his libido has dropped, he has become grumpy, has hot flashes, and is depressed. He does everything he can to isolate himself from everyone. A friend told me it is possibly low testosterone. I have talked to my husband about telling his dr. He promised he would last visit (he goes twice a year for blood work). It is frustrating for me, but a friend told me I should tell his doctor, as it is something that shouldn’t go untreated.
Can you give me any advice with such little information?
Thank you.

Reply

Dr. Barry Wheeler August 13, 2013 at 12:14 am

Hi Margaret,

It sounds like your husband needs to have an informed discussion with his primary care provider. Low mood, hot flashes, and reduced libido are all symptoms of the male version of menopause, andropause. There are certainly other medical conditions that can cause those symptoms and his doctor should rule out other causes.

Some doctors with less experience in men’s health will just say its “aging”. I have heard stories from some patients who told their doctor about their symptoms and their doctor has trouble making sense of the situation. The doctor needs to “connect the dots”. Some doctors will only consider low testosterone if the patient has erectile dysfunction. Some guys don’t even know if they have erectile dysfunction or not so it is important to ask the questions correctly. Many men have low testosterone and still have normal erections.

Lab testing is important. Important labs to check for low testosterone include total AND free testosterone levels. Some doctors only check total testosterone levels and often times the total level is “normal” while the free testosterone level is low. Lab testing for testosterone levels is not standard of care at most clinics so it is important for guys to request this test.

It is up to men to request that their doctor check their levels as they are the ones who will be receiving the treatment. Another option is for him to find another doctor who test his levels. Unfortunately, their are no do it yourself at home tests that are accurate.

Best of luck,
Dr. Barry

Reply

Stephen July 9, 2013 at 3:57 am

35 year old Caucasian male. Sx’s of fatigue, no morning erections and using Viagra. Minimal desire for intercourse. Testosterone 380, free testosterone 75. TSH, T4, lipids, CRP all good range. HIV negative. Thalassemia trait hit with Hb 11.9 which is normal for me. Would you treat with Testosterone replacement or not? I was told this is “low normal” and not in range to treat. Thanks for your input.

Reply

Dr. Barry Wheeler July 12, 2013 at 5:22 pm

Hi Stephen,

There are a few other lab tests that I would want to see, including LH, Estradiol, and Free T3. Of course, I’d need to see you in my clinic and ask you several other questions. The goal being to identify the cause of your low testosterone and rule out any other possible causes. Yes, your free testosterone level shows a partial androgen deficiency. Any treatment should be done by a licensed physician and you need to get it diagnosed first. There are a number of ways to increase testosterone levels.

I suggest you talk to your primary care physician or whoever prescribed your Viagra®. There is no such thing as a Viagra® deficiency but low testosterone is a common cause of erection problems in my experience. Have they identified the cause of your erection problem? This is important because erectile dysfunction can be related to increased risk of heart attack. Please discuss this with your doctor or come into our clinic.

Cheers,
Dr. Barry

Reply

David June 27, 2013 at 5:33 am

I am a 32 year old male in a terrible situation. When I was 4 years old I had a problem with one of my testicles and it had to be removed. I went through my life without any testosterone supplements. In 2008 I went to the hospital with a hernia and went into surgery to fix it. When I was discharged I was told to follow up with a recommended Urologist in 1 week. My groin was extremely swollen and in pain. When I got to the Urologist he took one look and immediately sent me to the hospital for a ultrasound. They found the “screen” used had cut off blood flow to my remaining testicle. I was rushed to emergency surgery to get it fixed. However, the damage was done and the testicle died.

Months later and after a series of tests, it was confirmed that I had no functioning testicles, and was not producing no testosterone. At the time I had insurance and was adhering to daily doses of Androgel and other topical Testosterone Replacement Therapies and was feeling “good” as the doctor was adjusting my doses to get proper T levels. But in the fall of last year I lost my job and medical insurance and am unable to pay for prescriptions, as they are very expensive.

My question(s) to you is:

Am I at risk for any life threatening effects of not having testosterone in my body? I am experiencing all the typical side effects at an extreme levels ( depression, mood swings, fatigue, ED, loss of body hair/ muscle tone) and has me to a point where I do not/ can not get out of bed to work, have a social life, or even have energy to play with my 6 year old son! I feel like an 80 year old man!

Do you know of any Doctors or clinics in the Ft.myers, Florida area that maybe able to help at a very cheap rate or perhaps pro-bono? I am stuck in a cycle of not being able to find work to pay for doctors and medication, because of the effects of NO testosterone.

Do you know of any places in S.florida that conduct clinical trials with TRT? and would I be a candidate for an “extreme case of low t”?
Please let me know if you can help point me somewhere to get help, as it would be greatly appreciated by my family and I!
I hope to hear from you soon.
Thanks,
David

Reply

Dr. Barry Wheeler July 8, 2013 at 10:16 pm

Hi David,

You would need to come into our clinic for me to comment specifically on your situation. You should talk to your urologist about your specific risks.

Low testosterone is not usually an immediate health risk as the body can survive with low testosterone levels for a long time. Our bodies can make some testosterone from other hormones such as DHEA. The biggest risk of low testosterone is long term, such as increased risk of heart disease and diabetes type 2. It is likely your body will adjust to your new reduced level of testosterone somewhat.

You may be experiencing a rebound spike in estrogen levels so its important you contact your doctor to have your estradiol levels checked and discuss more cost effective treatments besides Androgel® and consider contacting a community health clinic.

There are many doctors in Florida that provide testosterone therapy but you would need to call around to find a pro bono clinic.

Be Well,
Dr. Barry

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JUAN March 17, 2013 at 2:33 pm

I AM 79, MY TESTOSTERONA LEVELS IS 243, I AM TAKING PROSCAR 5 mg. since one year ago due BPH, my libido has decreased and my semen amount too, I need take Viagra 50 mg. for have sex. May I take Testofen to improve my libido?
Thanks,
Juan

Reply

Dr. Barry Wheeler March 21, 2013 at 8:47 pm

Hi Juan,

First, let me apologize if the following is too technical. The answer to your question is rather complex.

The problem with Proscar® is that it decreases DHT (dihydrotestosterone) levels too much in many men and then they get symptoms of low testosterone (ie low libido) despite having “normal” testosterone levels. Proscar® is made of the drug finasteride. Finasteride is linked to increased risk of more aggressive prostate cancer. While it can reduce prostate size, and this can be an emergency in some men, there are alternatives.

5mg finasteride per day is, in my opinion, a dangerously high dose due to the risk of more aggressive prostate cancer. Of course, your doctor made his decision based on your medical history and the standard of care that many doctors follow in terms of BPH. Flomax® is another medication that is likely to help with BPH but unfortunately also is likely to cause ED.

Some doctors are concerned about the use of testosterone in men with prostate problems. For sure, if you have prostate cancer you cannot receive testosterone therapy and your oncologist may actually want to reduce your testosterone level in some situations. However, in the case of benign prostate enlargement, it is much more likely that you have elevated levels of estrogen in your prostate causing enlargement. Estradiol, a form of estrogen, stimulates growth and differentiation in the prostate through estrogen receptors.

Testosterone can help “flush” the estrogen out of the prostate and reverse its effects. In men who convert too much of their testosterone to estrogen or have low progesterone levels, testosterone therapy without the use of anti-estrogen treatments and/or treatments to increase progesterone can lead to prostate size increases indirectly. There is NO evidence testosterone causes prostate cancer.

Read more about testosterone therapy and its side effects and benefits

In some of my patients with low testosterone who take Proscar®, when we treat their low testosterone their libido improves. Finasteride seems to have long lasting effects in some men but for most these eventually improve based on my observations and reading the forums where guys talk about Propecia%reg; side effects. Propecia® is the lower dose version of Proscar® used for hair loss treatment. You need to ask your doctor about testosterone therapy but it certainly may help your libido because higher levels of testosterone can sometimes compensate for the lower levels of DHT.

In Europe, many doctors use an herb, saw palmetto, to treat BPH and in my opinion is a safer and potentially equally as effective approach. I suggest you ask your doctor about saw palmetto.

Another newer approach to BPH is daily low dose Cialis®. Some men can’t take Cialis® due to heart conditions or other health problems so ask your doctor first. A low dose of 2.5mg to 5mg daily can improve urination problems related to enlarged prostates AND it improves erections! The more sex you have the longer you’ll live! It’s true.

Read about sex and longevity here

My opinions are NOT medical advice and you should discuss this with your doctor before making any changes to your treatment.

Cheers,
Dr. Barry

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John March 11, 2013 at 2:35 pm

My recent blood test showed my hormone level to be just a little on the low side. I have erectile dysfunction. My GP has suggested medication. But I would really like to get my erection back naturally. I’m a young sixtyish.

Reply

Dr. Barry Wheeler March 11, 2013 at 7:42 pm

Hi John,

Determining the cause of your ED is very important. Without knowing your entire medical history it is difficult to comment on what that cause may be but certainly low testosterone levels can have a major impact on erections.

Having erections problems puts you at a much higher risk for a heart attack or related health problem. When we treat the cause of an erection problem we can help reduce the risks of other health problems.

For example, a man with diabetes is likely to over-convert his testosterone to estrogen and this can lead to lower testosterone levels. Some doctors may prescribe testosterone injections or topical cream to treat the low testosterone level and never even check estrogen levels. This is very risky because when we increase testosterone levels the estrogen levels are likely to increase as well and if you read the side effects of testosterone injections or cream they are almost all related to excess estrogen (ie breast enlargement and prostate problems). Thus, to get the most benefit and truly treat the cause safely and effectively, estrogen levels must be addressed and monitored as well.

Hopefully, your doctor is aware of the fact that testosterone can convert to estrogen and what to do improve testosterone levels and estrogen levels. Excess estrogen is bad for erections and can cause you to get too in touch with your “feminine side”.

The above comments are for information purposes only and all treatments should be supervised by a licensed physician.

Cheers,
Dr. Barry

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