Thursday, March 16, 2017
It’s a Bird, It’s a Plane…… Nope, Just a Man on Testosterone
By: Dr. Brian Christine
You see it on television. You hear it on the radio. You read about it in men’s and sports magazines. I’m talking about men and hypogonadism or, as it’s more commonly referred to, “Low T.” There is no shortage of popular media concerning hypogonadism in men. Unfortunately, the information available to our patients is often incomplete or downright incorrect. Let’s look at the issue of low testosterone in the male population.
Testosterone is produced by the Leydig cells in the testes. Stimulated by luteinizing hormone (LH), the Leydig cells secrete testosterone, and that mechanism has profound effects upon men. Under the influence of testosterone, an embryo will become male. Because of testosterone, men generally have greater muscle mass, a deeper voice, and more body hair than women. Testosterone is also directly linked to a man’s libido, his desire for sexual activity.
Testosterone levels are highest during adolescence and early adulthood. After a man’s 20’s, his levels fall each year. As a man’s testosterone levels fall, he experiences progressive difficulty maintaining lean muscle mass, he may have less energy, and his libido decreases. Small wonder that pharma has seen a huge opportunity to market testosterone replacement products to a progressively aging population, and small wonder that men who see and hear commercials pushing treatment for “low T” as a panacea to restore desire, muscle, vigor, and youth flock to doctors expecting miracles. However, it’s not simply a matter of giving every guy who shows up at your office testosterone. There is a right way, and there is a wrong way.
At Urology Centers of Alabama, we have realized that many patients are not adequately educated about the potential benefits of testosterone, the risks of testosterone replacement therapy, and have not been given realistic expectations. In an effort to improve our screening of men who seek testosterone therapy and our management of men with true hypogonadism, we have established our Men’s Hormone Replacement Clinic. This clinic, focused exclusively on our male patients who are experiencing suboptimal serum testosterone levels, is managed on a day-to-day basis by Nurse Practitioner Eric Westerlund and supervised by me, Dr. Brian Christine.
We perform a complete history, pertinent physical exam, and obtain a detailed laboratory evaluation based on recommendations from the Sexual Medicine Society of North America and the American Urologic Association. We discuss a spectrum of treatment options, including oral clomiphene, topical testosterone gels, intramuscular testosterone injections, and subcutaneous testosterone pellet insertion, and we absolutely discuss potential complications. In the Men’s Hormone Replacement Clinic, periodic monitoring is required every 6 months. Perhaps most importantly, we tell men what testosterone cannot do: testosterone is not a time machine; it cannot turn back the clock and make a 50-year-old feel like a 20-year-old; it cannot magically turn fat to muscle, and it will not make a man with erectile dysfunction potent again.
Testosterone can truly help men feel and perform their best at their age. Careful evaluation and management are a must. Setting expectations is vital. Within these provisos, testosterone replacement therapy is a worthwhile undertaking and one that we as physicians are increasingly asked to perform. No, we cannot produce supermen, but we can benefit our male patients.
To learn more visit www.urologycentersalabama.com
Brian S. Christine, MD
Director of Erectile Restoration and Prosthetic Urology, Urology Centers of Alabama
Director of the Urology Centers of Alabama Fellowship in Prosthetic Urology and Men’s Sexual Health
The Sexual Medicine Society of North America
The Society of Prosthetic Urologic Surgeons
The International Continence Society
The European Association of Urology