Monday, September 30, 2013

Lake Mary, FL: Rejuve Health Clinics opens first clinic in your area

Rejuve Health Clinics (RHC), Inc., ( Orlando's Premier Testosterone Replacement Therapy Center is pleased to announce the grand opening of its first location at 766 N. Sun Drive Suite 1060 Lake Mary, FL 32746 (Fifth 3rd Bank Building).

"At Rejuve Health Clinic, we are focused on improving the quality of men's lives," says Dr. Chester Miltenberger, Medical Director at Rejuve Health Clinics, Inc., who is not only an advocate of testosterone replacement therapy (TRT), but has experienced the benefits of this technology for 10 years. "Many people associate low T with only sexual dysfunction, when in fact, men suffering from low testosterone can experience a number of physical and psychological symptoms." Dr. Miltenberger is certified by the American Board of Internal Medicine and has been practicing medicine for more than 25 years.

Adequate levels of testosterone help maintain adequate levels of reproductive tissues, energy levels, fat distribution, muscle mass and good bone health. When these levels fall below a certain level, men can experience fatigue, irritability, decreased energy, loss of muscle mass, weight gain, diminished sex drive, depression and sleep disorders. Replacement of Testosterone may improve some or all of these symptoms.

Currently, 13 million men in the U.S. over the age of 40 have low testosterone (low T) levels. Levels typically decline at age 40 at a 1-2 % annually with a marked decline after the age of 60.

"We are thrilled about the opening of our first Central Florida location and are confident that men are going to benefit from our knowledge and experience in the area of testosterone replacement therapy (TRT)," says Rejuve Health Clinic's President and CEO, James Skalko. "Our clinic is set up so men can walk in, take a simple blood test, and know the following day whether or not they are a candidate for testosterone replacement therapy (TRT). Men who qualify for TRT will be given their first injection the same day and can expect to see results in as little as two weeks."

Rejuve Health Clinics (RHC), Inc., Orlando's Premier Testosterone Replacement Therapy Center, was established by President and CEO James Skalko in June 2013. Brian P. Black is the Executive Vice President and Dr. Chester Miltenberger is the lead doctor and medical director of RHC. Rejuve Health Clinics, Inc. diagnoses and treats male patients with symptoms of hypogonadism (low T). We are dedicated to helping men with low testosterone regain their vitality and achieve optimal health. Our doctors and experienced medical professionals help address the many symptoms caused by this medical condition including fatigue, decreased energy, low motivation, weight gain and diminished sex drive. For more information, visit or call (407) 331-LowT.

Male menopause: the lay term for andropause - what you need to know now to diagnose and treat it

Courtesy of

Is the male menopause myth or reality? When men reach their late forties to early fifties, some may experience a reduction in libido (sex drive), erectile dysfunction, weight gain, fatigue, depression, and other emotional symptoms which bear some similarities to the female menopause.

However, the female menopause is completely different. In a woman the menopause marks the time when her menstrual periods stop and she is no longer able to become pregnant. Her levels of female hormones - estrogen and progesterone - decline considerably.

Among males, the male menopause is much less abrupt. The signs and symptoms emerge more gradually and subtly, and the decrease in male hormone (testosterone) levels is nowhere near as steep as it is for women.

Do doctors use the term "male menopause"? - No. A health care professional may use the term andropause, testosterone deficiency, or late-onset hypogonadism. Hypogonadism refers to a deficiency in male hormones, where levels are too low even for an aging man. The meaning of late-onset hypogonadism is more similar to what lay people and the media refer to when discussing "male menopause".

Some lay people use the colloquial term "man-opause".

The World Health Organization does not recognize the term "andropause", but does recognize "menopause" (in women).

According to the Cleveland Clinic, health care professionals are currently debating whether males really do go through a well-defined menopause?

Researchers at Northwestern Memorial Hospital estimated that in the USA five million men are affected by male menopause.

What are the signs and symptoms of male menopause?


Research teams, experts and health authorities appear to have different views when identifying the signs and symptoms of male menopause.

According to the National Health Service, UK, the following are the most common signs and symptoms of male menopause:

  • Hot flashes (UK: flushes)
  • Moodiness and irritability
  • Fat redistribution
  • Loss of muscle mass
  • Dry skin
  • Thin skin
  • Hyperhidrosis - excessive sweating
  • Reduced concentration span
  • Loss of enthusiasm

A European study led by researchers at The University of Manchester, Imperial College London, and University College London identified the most common symptoms of male menopause, the study was published in NEJM (New England Journal of Medicine):

  • Decreased frequency of morning erection
  • Erectile dysfunction - impotence, problems in getting or maintaining an erection
  • Decreased sex drive

The same study also identified the following symptoms as (weakly) related to male menopause:

  • Inability to walk more than 1 kilometer (0.62 miles)
  • Inability to engage in vigorous activity, such as running or lifting heavy objects
  • Inability to bend, kneel or stoop
  • Loss of energy
  • Sadness
  • Fatigue

The researchers also ruled out the following (not related to male menopause): problems getting up from a chair, anxiety, nervousness, poor concentration, feeling of worthlessness, and changes in sleeping patterns.

What are the causes of male menopause?

After the age of 30 years, a man's testosterone levels start to drop, about 1% each year. Most men in their seventies have at least 40% less testosterone in their system than they did when they were 30.

However, the normal decline of testosterone levels that comes with age is not believed to be the cause of male menopause. If it were, every man would experience it, and this is not the case.
According to the British Association of Urological Surgeon (BAUS), who refer to the male menopause as Androgen Deficiency in the Ageing Male (ADAM), "The overall picture associated with ADAM is, therefore, very complex."

Although male menopause occurs in older men whose testosterone levels have declined, it tends to affect older males with heart disease, obesity, hypertension (high blood pressure) and/or type 2 diabetes.

In other words, unlike the female menopause, several factors together contribute to the development of male menopause.

Some underlying health problems, lack of exercise, smoking, alcohol consumption, stress, anxiety, and sleep deprivation could also be key factors.

Psychologists suggest the male "midlife crisis", when men are supposed to wonder what they have accomplished so far professionally and personally, can be a cause of depression and might possibly trigger a cascade of factors that lead to male menopause.

Could low estrogen be linked to male menopause?

Researchers at Massachusetts General Hospital wrote in NEJM that a proportion of testosterone in men is usually converted into estrogen by a type of enzyme (aromatase).

Men with higher testosterone levels therefore have more estrogen, compared to men with low testosterone. Since those with low testosterone also have low estrogen, it is unclear which hormones support certain functions.

Professor Joel Finklestein and colleagues set out to determine whether changes that occur in middle-aged and older men are due to low testosterone, estrogen or both hormones.

They randomly selected 300 men into two groups of about 150. In one group, men were given daily doses of testosterone gel at four levels of dosage, or a placebo gel for 16 weeks. In the other group, the participants were given testosterone gel plus an aromatase inhibitor, which stops testosterone from being converted into estrogen.

They found that the participants on testosterone without the aromatase inhibitor showed similar increases in body fat to what one would expect in a male with mild testosterone deficiency.

What surprised the researchers, though, was that some of the symptoms doctors usually attributed to testosterone deficiency were partly or nearly exclusively caused by a drop in estrogen levels.

Diagnosing male menopause?

The doctor is not going to say "You are going through the male menopause and the treatments for this are...."

Male menopause is a term used by lay people, and represents a set of symptoms (which experts seem unable to agree on) which may be due to low testosterone (and consequently low estrogen), some underlying diseases, mental issues, obesity, and several lifestyle factors.

The doctor will ask the patient about symptoms, lifestyle and check his medical history.

If the doctor suspects there may be signs of depression or anxiety, he or she may recommend that the patient sees a psychologist or psychiatrist.

The patient may be advised to have a thorough check up that may include blood tests and diagnostic tests to check for cardiovascular disease.

What are the treatment options for male menopause?

Treatment for male menopause depends on what is causing it.

  • Depression or anxiety - the patient may benefit from behavioral therapy, antidepressant medications, or both.

  • Obesity - the patient will be advised to lose weight, become more physically active and eat a well balanced and healthy diet.

  • Heart and cardiovascular disease - the disease will have to be treated.

  • Diabetes type 2 - as with heart disease, it will require proper treatment. Patients with good glucose control tend to have fewer problems and complications.

  • Low testosterone - the doctor may recommend testosterone therapy. An article published in Drug Therapeutics Bulletin questions whether testosterone therapy is effective in treating male menopause. Testosterone therapy also raises the risk of blockage of the urinary tract and prostate cancer. It may also aggravate ischemic heart disease, epilepsy, and sleep apnea.

Elizabeth Siegel Watkins, at the faculty of History and Social Medicine, University of California, wrote an article published in the journal Social History of Medicine titled "The Medicalization of Male Menopause in America.".

Watkins explained that male menopause was a much-discussed topic from the late 1930s to mid-1950s. During the following four decades the topic virtually disappeard.

In the late 1990s, popular American newspapers and magazines began discussing the subject more keenly.

Watkins' study described how the male menopause became medicalized. It was not the result of scientific research or a push from eminent clinicians, it was encouraged "instead by a model perpetuated by lay people and medical popularisers."

In an Abstract in the same journal, Watkins concluded "This framework, rather than persuasive evidence from the research laboratory or clinic, helped to medicalise male menopause and provided the basis for its eventual pharmaceuticalisation at the end of the twentieth century."

Written by Christian Nordqvist

Thursday, September 26, 2013

Study shows women can "smell" their competition's ovulation estrogen; in reaction, they increase their own testosterone level to aggressively shut them out

Courtesy of

Jennifer Viegas
Discovery News
Just a whiff of a woman close to ovulation is enough to stimulate another woman's testosterone levels, along with her desire to compete.

"It's well known that testosterone is linked to aggression and competitiveness," says lead author Jon Maner, a Florida State University psychologist. "Based on our testosterone findings, one could speculate that women exposed to the scent of ovulation might become more antagonistic or competitive."

For the study, published in the latest issue of the journal Evolution and Human Behavior, Maner and co-author James McNulty measured the testosterone levels of women before and after they smelled t-shirts that were previously worn by other women aged 18-21. The latter group wore the shirts when they were at high fertility - days 13, 14 and 15 of the menstrual cycle - and at low fertility- days 20, 21 and 22.

For the duration of the study, the t-shirt wearers refrained from engaging in sexual activity. They also showered with unscented soap and shampoo, did not use any perfumes or deodorants, didn't smoke, and avoided eating odor-producing foods, such as garlic and asparagus.

The sniffers were told that the study concerned "how much we can tell about another person without even meeting them," but had no idea about how and when the t-shirts were collected.

Women exposed to the scent of high fertility females displayed greater levels of testosterone. The smell of a low fertility woman actually caused testosterone levels in the sniffers to significantly drop.

We are not consciously noting the smells of other people all day long, unless a particularly good or bad smell hits us, but odors are working on us, even when we don't realize it.

"Humans are influenced much more strongly by ovulatory cues than we tend to think," says Maner. "For the most part, people aren't likely to be consciously aware of the effects ovulatory cues have over them."

"There is solid evidence that people find the scent of ovulation to be pleasant and attractive (relative to the scent of a woman who is far from ovulation), but beyond that, most of the behavioral and hormonal effects are likely to occur below the conscious radar."


Under the radar

Prior research found that men's testosterone levels are also sensitive to female ovulation. For example, in one of Maner's earlier studies, men who interacted with a female research assistant became more risk-taking and flirtatious when the assistant was in the high fertility stage of her menstrual cycle.

Such under-the-radar hormone dynamics might even influence what men and women wear.
Daniel Farrelly of the University of Sunderland and colleagues found that men who chose to wear red when competing had higher levels of testosterone than men who chose to wear blue.

"The research shows that there is something special about the colour red in competition, and that it is associated with our underlying biological systems," says Farrelly.

In all cases, it appears that today's human social interactions can be driven by how we've evolved as primates.

"Some people might like to believe that people aren't animals, or at least that our behavior isn't beholden to the same biological processes as other species," says Maner.

"But humans," he adds, "are very similar to other species in many ways, and those similarities are no more apparent than when it comes to sexuality."

Study shows reducing testosterone levels through hormone therapy for prostate cancer after radiation offers no longevity advantages

Courtesy of  Urology Care Foundation

For men with intermediate-risk prostate cancer, long-term hormone therapy after radiation therapy provides no survival advantages compared with short-term hormone therapy, according to a new study.

Hormone therapy is used to reduce the levels of male hormones (androgens) such as testosterone, which can stimulate the growth of prostate cancer cells.

Researchers examined data from 133 men with intermediate-risk prostate cancer who underwent either long-term hormone therapy (59 patients) or short-term hormone therapy (74 patients) after receiving external beam radiation therapy.

Ten-year overall survival was 61 percent in the short-term group and 65 percent in the long-term group, which is not a statistically significant difference. Disease-specific survival was 96 percent in both groups.

The study was scheduled for presentation Monday at the annual meeting of the American Society for Radiation Oncology, in Atlanta.

"Most clinicians have felt that 'more was better' when it came to blocking testosterone in prostate cancer patients, however, results for the specific endpoints we focused on, OS [overall survival] and DSS [disease-specific survival], indicate that this was clearly not the case," study lead author Dr. Amin Mirhadi, a radiation oncologist at Cedars-Sinai Medical Center in Los Angeles, said in a society news release.

"This data supports administering less treatment, which will result in fewer side effects and reduce patients' overall health care costs," Mirhadi added.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The Urology Care Foundation has more about hormone therapy for prostate cancer.

US researchers found a correlation between testis size and a father's propensity towards instrumental care, such as changing diapers, preparing meals, bathing and being present during doctor visits

Courtesy of

A study released this month suggests men with small testicles are more likely to take on a care-giving role when it comes to raising their kids.

Published in Proceedings of the National Academy of Sciences, the report by US researchers out of Emory University in Atlanta, Georgia, found a correlation between testis size and a father's propensity towards instrumental care, such as changing nappies, preparing meals, bathing and being present during doctor visits.

“Children with involved fathers have better developmental outcomes; they do better socially, they do better psychologically, and they do better educationally,” said study author James Rilling.

“We're interested in trying to identify variables that help to predict how involved fathers are in raising their children. We're certain that there must be many very important social influences — things like was your own father around when you were a child, what are the societal and cultural expectations, what are the demands of your job and so forth — but in this study we wanted to look specifically at biological variables that might explain some of the variation.”
Sampling 70 biological fathers living with children aged one to two and the birth mother, researchers measured testicle size and testosterone levels before conducting MRIs to monitor brain activity as the men looked at photos of their own child and unfamiliar children.

They also asked the men's spouses to fill out questionnaires about their partner's parenting habits.
What they found is that fathers with smaller gonads showed increased brain activity in the ventral tegmental area – a group of neurons responsible for motivation and reward – when looking at pictures of their own children.

“We know that when men become fathers, if they become involved fathers, their testosterone decreases. That's pretty well established,” said Rilling.

“But by looking at testis size we're getting at something different, because most of the volume of testes is dedicated to sperm production. The testes also produce testosterone, but the correlations between testis volume and sperm production are higher than the correlations between testis size and testosterone levels.

"So we think we're getting at something different and the reason that we're looking at testis size is we're testing a hypothesis that comes out of a branch of evolutionary theory known as life history theory.

"The prediction is that organisms face a trade-off between energy that they invest in mating versus energy that they invest in parenting, and that if you invest more in one of those categories you have less available for the other and vice versa.”

Drawing on further evidence from closely related primates such as chimpanzees and baboons, Rilling and fellow researchers Jennifer Mascaro and Patrick Hackett used testis size as an indirect measure of mating effort — because testes produce sperm, men with larger testicles invest more in mating effort in a physiological sense because they're producing more sex cells.

Data from these other species show a direct correlation between this and parental bonds; namely that primates like chimpanzees, who live in promiscuous societies and have large testes for their body size, are less likely to be concerned with childrearing.

Whereas species whose fathers are more involved live in monogamous, two-parent social settings and have a lower testicle-to-body ratio.

Speaking of earlier studies related to testosterone production, Rilling offers up a potential explanation for the decreased levels seen in fathers.

“There is some evidence that testosterone can interfere with empathy and so you can imagine when you have a helpless infant that demands a lot of care it would be important to maintain an empathic stance towards the infant,” he said.

“The other thing is the inconsolable crying on the part of the infant can often be a really frustrating stimulus for parents and it's also thought that testosterone impairs frustration tolerance and impulse control.

"So it may be that when testosterone levels decrease it makes men a little more tolerant of some of the frustrations that go along with parenthood.

"The third prediction would be that it lowers libido and makes men less interested in mating, so that they're more focused on the parenting aspect and not distracted by sexual stimuli, either within or outside the confines of marriage.”

Rilling, however, is at pains to express that these new findings shouldn't be misconstrued to suggest all men with small testicles make great fathers and their big-balled brethren are automatically lousy parents.

Acknowledging that there are variations left unaccounted for in the study — such as personal morals and how committed one is to parenting — he also notes that some of those in the data set with large testes were demonstrably involved with their offspring; though they were in the minority.

He is also uncertain about the direction of causality. Like the decrease seen in testosterone production after the birth of a child, researchers don't yet know whether men with small testicles are natural caregivers or if their testes shrink as a result of their increased parental involvement.

“There are a lot of different ways to be a good father. Not only through this instrumental care-giving but by providing for your family economically, by being a playmate, by coaching and mentoring your kids, helping with homework, all those sorts of things.

"I don't think it's fair to say that men with large testes are bad fathers,” he said, adding he also didn't want men with big testicles to have a convenient get-out-of-jail-free card.

“It's important to recognise that not all men are built the same and it may actually be more challenging for some men to get involved. But we certainly don't want to suggest that men should use having large testes as an excuse for not being involved … all men are capable of being involved fathers.”

Low testosterone levels predicted a greater risk of acute myocardial infarction (MI) in Swedish men with type 2 diabetes, researchers found.

Courtesy of

 Low testosterone levels predicted a greater risk of acute myocardial infarction (MI) in Swedish men with type 2 diabetes, researchers found.

After adjustment for potential confounders, higher total testosterone levels were associated with a 25% reduced risk of acute MI in that group (HR 0.75, P=0.006), according to Bledar Daka, MD, of the University of Gothenburg in Sweden.

But no such relationship was seen in men without diabetes or in women regardless of diabetes status, Daka reported at the European Association for the Study of Diabetes meeting here.

"In the future, we probably could use serum testosterone for the assessment of cardiovascular risk in men with type 2 diabetes," he said, noting that the findings should be validated in other studies before drawing a definitive conclusion.

Previous studies have revealed a relationship between low testosterone and the development of type 2 diabetes in men, as well as with a greater risk of cardiovascular mortality in otherwise healthy men.
The current analysis used data from 538 men and 571 women 40 and older (mean age 62) who were living in Skara in southwest Sweden and responded to a survey conducted in 1993 to 1994. All had total testosterone and sex hormone-binding globulin (SHBG) measured with radioimmunoassays; free testosterone was calculated using the Vermeulen method.

At baseline, the level of total testosterone was 13.5 mmol/L in men and 1.00 mmol/L in women.

Corresponding levels of free testosterone were 0.26 and 0.014 ng/mL.

The rate of type 2 diabetes was 9.8% in men and 7.3% in women.

Through an average follow-up of 14.1 years, there was a significantly higher rate of acute MI in men versus women among the non-diabetic individuals (14.2% versus 9.7%, P=0.02), but not among those with type 2 diabetes (20.8% versus 24.3%, P=0.45).

Having a serum total testosterone level in the highest quartile was associated a lower rate of acute MI, but only among men with type 2 diabetes (P=0.02). The difference remained significant after adjustment for age, waist-to-hip ratio, smoking, physical activity, LDL cholesterol, and systolic blood pressure. The finding was similar when free testosterone was used.

The test for an interaction between diabetes status and the relationship between testosterone and acute MI achieved only borderline statistical significance, however (P=0.051).

In comments following Daka's presentation, one of the co-chairs of the session, Naveed Sattar, MD, PhD, of the University of Glasgow in Scotland, called the study hypothesis-generating and said that it remains unclear whether testosterone has a direct effect on the risk of acute MI or is simply a marker of risk, even though there are some plausible direct links. Those include testosterone's effects on blood flow and vascular function.

"We're a long way from proving that it's causal," he said in an interview, adding that larger and more comprehensive studies that incorporate genetic information are needed.

"Because if the genes are related, that would suggest it's causal," Sattar said. "And only then should we do some intervention studies, but do them very very carefully."

He noted that a case-control study in the U.K. that includes 10,000 patients with MI and is measuring levels of testosterone and SHBG should be able to provide a definitive answer.

"I think we're kind of early on in the game of testosterone and cardiovascular events in men," Sattar said, "and my gut feeling is it probably won't be the answer."

The study was supported by grants from the Swedish Institute and the FoU VGR. Daka did not make any additional disclosures.

Mass Gen Hospital (MGH) researchers find link in men's aging involving estrogen, as well as testosterone

Courtesy of

Just as the symptoms of menopause in women are attributed to a sharp drop in estrogen production, symptoms often seen in middle-aged men – changes in body composition, energy, strength and sexual function – are usually attributed to the less drastic decrease in testosterone production that typically occurs in the middle years.  However, a study by Massachusetts General Hospital (MGH) researchers finds that insufficient estrogen could be at least partially responsible for some of these symptoms.

"This study establishes testosterone levels at which various physiological functions start to become impaired, which may help provide a rationale for determining which men should be treated with testosterone supplements," says Joel Finkelstein, MD, of the MGH Endocrine Unit, corresponding author of the study in the Sept. 12 New England Journal of Medicine.  "But the biggest surprise was that some of the symptoms routinely attributed to testosterone deficiency are actually partially or almost exclusively caused by the decline in estrogens that is an inseparable result of lower testosterone levels."

Traditionally a diagnosis of male hypogonadism – a drop in reproductive hormone levels great enough to cause physical symptoms – has been based on a measure of blood testosterone levels alone.  Although such diagnoses have increased dramatically – leading to a 500 percent increase in U.S. testosterone prescriptions between 1993 and 2000, the authors note – there has been little understanding of the levels of testosterone needed to support particular functions.

In addition to its direct action on some physical functions, a small portion of the testosterone that men make is normally converted into estrogen by an enzyme called aromatase.  The higher the testosterone level in a normal man, the more is converted into estrogen.  Since any drop in testosterone means that there is less to be converted into estrogen, men with low testosterone also have low estrogen levels, making it unclear which hormones support which functions.  The MGH team set out to determine the levels of hormone deficiency at which symptoms begin to occur in men and whether those changes are attributable to decreased levels of testosterone, estrogens or both.

The study enrolled two groups of men with normal reproductive function, ages 20 to 50, and all participants were first treated with a drug that suppresses normal production of all reproductive hormones.  Men in the first group were randomly assigned to receive daily doses of testosterone gel at one of four dosage levels or a placebo gel for 16 weeks.  Men in the second group received the same testosterone doses along with an aromatase inhibitor which markedly suppressed conversion of testosterone into estrogen. More than 150 men in each group completed the study, including monthly visits for blood tests and questionnaires about their overall health and sexual function. Body composition and leg strength were assessed at the beginning and end of the study period.

Among participants in whom estrogen production was not blocked, increases in body fat were seen at what would be considered a mild level of testosterone deficiency.  Decreases in lean body mass, the size of the thigh muscle and leg strength did not develop until testosterone levels became quite low.  In terms of sexual function, sexual desire was reported to decrease progressively with each drop in testosterone levels, whereas erectile function was preserved until testosterone levels were extremely low.

In participants also receiving the aromatase inhibitor, increases in body fat were seen at all testosterone dose levels, but suppressing estrogen production had no effect on lean mass, muscle size or leg strength.   Adverse effects on sexual function were much more obvious when estrogen synthesis was suppressed regardless of participants' testosterone levels.  Overall the results imply that testosterone levels regulate lean body mass, muscle size and strength, while estrogen levels regulate fat accumulation.  Sexual function – both desire and erectile function –  is regulated by both hormones.

Finkelstein notes that this study artificially induced the kind of hormone deficiency usually seen in aging men to provide a controlled model.  He and his colleagues hope to do follow-up studies in older men to confirm the accuracy of the model.  Right now, decisions about whether an individual is a candidate for testosterone replacement should be made based on his symptoms and not just his testosterone level.  The findings regarding estrogen's effects suggest that the forms of testosterone used for therapy should be capable of being aromatized into estrogen, he adds.

"We also need to look into how testosterone replacement therapy would effect prostate health – both prostate cancer and the prostate enlargement that causes unpleasant symptoms in many older men – and heart disease," says Finkelstein, who is an associate professor of Medicine at Harvard Medical School.  "In light of what the Women's Health Initiative discovered about the unexpected effects of estrogen replacement therapy in women, we need a Men's Health Initiative to investigate those questions before large-scale testosterone replacement can be recommended."

Additional co-authors of the NEJM paper are Sherri-Ann Burnett-Bowie, MD, MPH, Carl Pallais, MD, MPH, Elaine Yu, MD, Lawrence Borges, MD, Brent Jones, MD, Christopher Barry, MPH, Kendra Wulczyn, Benjamin Leder, MD, MGH Endocrinology; Hang Lee, PhD, MGH Biostatistics Center, and Bijoy Thomas, MD, MGH Radiology.  The study was supported by National Institutes of Health grants R01 AG030545, K24 DK02759 and RR-1066 and a grant from Abbott Laboratories.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $775 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.
Media Contacts: Mike Morrison,  (617) 724-6425 ,

Men who have low testosterone levels may have a slightly elevated risk of developing or dying from heart disease

Courtesy of

Men who have low testosterone levels may have a slightly elevated risk of developing or dying from heart disease, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Testosterone is a key male sex hormone that helps maintain sex drive, sperm production and bone health. Over time, low testosterone may contribute to an increase in body fat, loss of body hair and muscle bulk.

“When we reviewed the existing research into testosterone and cardiovascular disease, a growing body of evidence suggested a modest connection between the two. A specific pathogenesis did not come forward, but perhaps less frequently investigated events may play a role, such as thrombosis where a blood clot develops in the circulatory system or arrhythmia, where there is a problem with the heart beat or rate,” said the study’s lead author, Johannes Ruige, MD, PhD, of Ghent University Hospital in Belgium. “Based on current findings, though, we cannot rule out that low testosterone and heart disease both result from poor overall health.”

Treating low testosterone with replacement therapy did not have any beneficial effect on cardiovascular health, Ruige said. Although the number of older and middle-aged men who are being prescribed testosterone replacement therapy is rising rapidly, there is debate about whether the practice is too widespread. In its testosterone therapy clinical practice guidelines, The Endocrine Society recommends treating only men who have unequivocally low testosterone levels and consistent symptoms.

The clinical review examined findings from studies on cardiovascular disease and testosterone published between 1970 and 2013. Although the studies suggested some sort of relationship, existing research found little evidence of a connection between low testosterone and arteriosclerosis, the hardening and narrowing of arteries that can cause heart attacks and strokes. The reviewed studies also found no relationship between testosterone levels and heart attacks.

Many of the studies had cross-sectional designs that do not provide information about causality, but the review also looked at 19 prospective observational studies that can provide additional information about whether one condition causes another. Because these studies did not completely rule out some potential preceding causes of both low testosterone and cardiovascular disease, additional research is needed to confirm the relationship between the two conditions, Ruige said.

“Gaps still remain in our understanding of low testosterone and cardiovascular disease,” he said. “Ultimately, the goal is to more accurately assess the impact testosterone substitution therapy may have on the heart health of men who qualify for the treatment.”

Other researchers working on the study include D.M. Ouwens and J.-M. Kaufman of Ghent University Hospital.

The article, “Beneficial and Adverse Effects of Testosterone on the Cardiovascular System in Men,” was published online, ahead of print.

# # #

Founded in 1916, The Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology.  Today, The Endocrine Society’s membership consists of over 16,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society and the field of endocrinology, visit our site at Follow us on Twitter at!/EndoMedia.

Data points to Nocturia-Hypogonadism link

Courtesy of

Desmopressin treatment appears to reduce nocturia ( the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly. Nocturia could result simply from too much liquid intake before going to bed (usually the case in the young), or it could be a symptom of a larger problem, such as sleep apnea, hyperparathyroidism,[1] chronic renal failure, urinary incontinence, bladder infection, interstitial cystitis, diabetes, congestive heart failure, benign prostatic hyperplasia, ureteral pelvic junction obstruction,[2] uterine fibroids, eating disorders, diabetes insipidus or prostate cancer ) and other lower urinary tract symptoms while also significantly increasing testosterone levels in men with late-onset hypogonadism. These new results from a 62-patient prospective trial suggest that nocturia may be related to hypogonadism in this population.

The study, by Jong Wook Kim, MD, PhD, of the Korea University Guro Hospital, Seoul, South Korea, and colleagues, analyzed the parameters of men treated with demopressin in an open-label trial that ran from April 2011 to November 2012. The men were older than 40 years, had at least two nocturia episodes per night, and serum total testosterone levels below 3.5 ng/mL or a positive score on the Androgen Deficiency in Aging Men scale. The investigators excluded individuals with cardiovascular disease, hyponatremia, primary hypogonadism, hypogoandotropic hypogonadism, or who were using hypnotics or desmopressin for treatment of other diseases such as diabetes. The subjects received desmopressin 0.1 mg once daily.

The study population had an average age of 68.4 years and average body mass index of 24 kg/m2.  Their mean total testosterone at baseline was 4.28 ng/mL, their mean free testosterone was 5.47 pg/mL, and their mean PSA level was 1.4 ng/mL.

The total and free testosterone levels increased significantly in men with baseline total testosterone levels below 3.5 ng/mL, researchers reported at the 33rd Congress of the Societé Internationale d'Urologie. Their mean total testosterone levels increased from 2.85 to 3.97 ng/mL and their mean free testosterone levels increased from 3.84 to 4.86 pg/mL.

In addition, the patients' average scores on the overall International Prostate Symptom Score (IPSS) scale dropped significantly, as did their scores on question 7 of the IPSS (which probes nocturia), the IPSS subscores of voiding and storage symptoms, and the IPSS quality of life question. The patients' nocturnal urine volume levels also fell significantly, as did their nocturnal polyuria index scores, their actual number of nightly voids, the nocturia index scores and their nocturnal bladder capacity index scores.

“Although the mechanism of action is still unknown, we suggest that desmopressin could correct disturbances of the circadian regulation of testosterone secretion,” the authors concluded in their poster presentation.

Parameters not changed by desmopressin treatment included blood urea and nitrogen level, creatinine level, potassium and chloride levels, overall International Index of Erectile Function score, and Aging Male Symptom score.

Obese hypogonadal men who received long-term testosterone injections experience a gradual decline in weight and waist circumference

Courtesy of


Obese hypogonadal men who received long-term testosterone injections experience a gradual decline in weight and waist circumference, according to study findings presented at the 33rd Congress of the Societé Internationale d'Urologie.

This effect, researchers concluded, may be beneficial for cardio-metabolic and urological outcomes.
Abdulmaged Traish, MBA, PhD, professor of biochemistry and urology at Boston University School of Medicine, led the prospective, Bayer-funded registry study of 181 men who, at baseline, had a testosterone level below 12.1 nmol/L and a body mass index (BMI) of at least 30 kg/m2. Subjects' mean age was 59.1 years (range 33-69 years). Each received one 1,000-mg testosterone undecanoate parenteral injection and, starting six weeks later, received this same dose every 12 weeks for up to five years.

All of the men had dyslipidemia, 97% had hypertension, 39% had type 2 diabetes, 22% had coronary artery disease, and 19% had experienced a previous myocardial infarction. One patient was diagnosed with prostate cancer after 10 months of treatment.

The researchers tracked subjects' testosterone trough levels and found that, starting at 12 months of treatment and going out to 60 months, the levels were significantly higher than baseline levels. At the same time, subjects' body weights and waist circumferences fell significantly. They lost an average of 18.83 kg from a baseline average weight of 114 kg, and 9.87 cm from an average baseline waist circumference of 111 cm. The men's mean BMI also declined significantly, from 36.72 kg/m2 at baseline to 30.22 kg/m2 at the 60-month mark.

These changes took place gradually, with the men experiencing significant year-to-year weight, waist circumference, and BMI losses each year. Ninety-nine percent of the men lost at least 5 kg over the five-year period, while 70% lost at least 15 kg and 40% lost at least 20 kg.

About 3%-5% of the men gained weight, averaging 1-2 kg. “Most of these men have some inflammatory diseases, and the weight gain is explained by the fact that their inflammation got better and they were able to gain some weight,” Dr. Traish said.

Other changes the men experienced over the duration of the study included a:

·         gradual and steady drop in average residual bladder volume, starting at 52 mL and falling to 20.5 mL by 57 months;

·         gradual increase in average prostate volume, starting at 31 mL, rising to 34 mL at three years and falling again to 32 mL at 60 months;

·         slight but statistically significant increase in average PSA levels, starting at 1.8 ng/mL and rising to 1.95 ng/mL at the five-year mark;

·         steady drop in average International Prostate Symptom Score, falling from 7.8 at baseline to 3.5 at three years and 2.9 at five years;

·         sharp fall in average C-reactive protein levels, from 4.0 mg/dL at baseline to 0.8 mg/dL at five years; and,

·         gradual increase in average score on the International Index of Erectile Function-Erectile Function subscale, starting at 21.1 at baseline and reaching 25.25 at the 60-month mark.

Long-term testosterone treatment also produced positive effects on lipid profiles (reduction in total and LDL cholesterol, increased HDL cholesterol, and reduction in triglycerides), and decreases in fasting blood glucose, hemoglobin A1c, and inflammation. The study has been accepted for publication in the International Journal of Clinical Practice.

Wednesday, September 25, 2013

Before starting testosterone therapy, men and women should get tested for blood clotting potential

Courtesy of

Staff reporter- Cincinnati Business Courier
Email  | Twitter  | Google+

Testosterone replacement therapy can improve a man’s sex life, or it could lead to the loss of vision in one eye or even death because of blood clots, warns a doctor at Jewish Hospital–Mercy Health.

All men should have a simple blood test to determine whether they are at high risk for blood clots before starting testosterone replacement therapy, according to Dr. Charles Glueck of the Jewish Hospital Cholesterol and Metabolism Center in Cincinnati.

Postmenopausal women also should be tested in advance before taking testosterone to treat low libido, depression or fatigue. The U.S. Food and Drug Administration hasn’t approved such use out of concern about the hormone’s long-term adverse effects in women, according to Mercy Health.

Dangerous blood clots can develop as soon as one month after testosterone replacement therapy begins, according to a study by Glueck published Aug. 7 in the medical journal Clinical and Applied Thrombosis/Hemostasis.

“Our research found that 1.2% of men who landed in the hospital with dangerous and potentially lethal blood clots in the deep veins of the legs or in the lungs developed these clots within three months of starting testosterone therapy,” Glueck said. “Not one of these men knew previously that they had an inherited clotting disorder that put them at greater risk for developing clots, nor did their providers test them before putting them on testosterone therapy.”

Testosterone levels decrease as men age, and more men are turning to replacement therapy to try to regain their feelings of youthful vitality, according to a Mercy Health spokeswoman. Naturally occurring testosterone has a role in sex drive, and it helps men maintain muscle mass, red blood cell production, fat distribution and bone density.

To try to determine how often external testosterone use led to blood clots in deep veins or in the lungs or both, Glueck studied 596 men who had been hospitalized in the last three years.

Glueck and his research colleagues, all medical residents at Jewish Hospital, reported 18 cases in men and four in women of blood clots in the lungs or blood clots in the bones after patients started testosterone therapy. All of the men and women had a previously undiagnosed inherited tendency for increased blood clots.

Other complications suffered by some of the patients studied included loss of vision in one eye because of a temporary lack of blood flow to the retina. Others suffered osteonecrosis of the hip, which can lead to the destruction of the hip joint because of a disruption of the blood supply to the bone.

“Before starting testosterone, men and women should get a blood test for common inherited risk factors for clotting, including the Factor V Leiden mutation, homocysteine and high Factors VIII and XI,” Glueck said

Women: Taking testosterone may boost your memory and help avoid dementia

Courtesy of

By Pat Hagan

Giving women the male hormone testosterone could boost their memory and may even help ward off dementia.

New research shows women who rubbed testosterone gel on their skin every day for six months performed better in brain function tests than those who were given a dummy gel.

Researchers tested the treatment on a group of 96 healthy post-menopausal women.
The hormone group performed significantly better at verbal learning, where they listened to dozens of different words and had to recall as many as they could.

They also scored higher in tests designed to assess the efficiency of their short-term memory.

Boosting brain function is thought to be one of the most effective ways of warding off dementia, as it helps strengthen connections between brain cells.

Experts advise doing this through a healthy diet, regular exercise and 'brain training' routines such as crosswords and puzzles.

But the latest research, carried out at Monash University in Australia, suggests women may also benefit from a daily dose of testosterone gel.

Women are twice as likely as men to get Alzheimer's, although researchers are still unsure why.

However, falling testosterone levels are now being considered. 
Although testosterone is considered to be a male hormone, women produce small amounts in their ovaries. When they reach the menopause, testosterone production declines.

Some research suggests this causes a reduced libido in many women and that their sex drive may benefit from testosterone replacement therapy - such as gels or skin patches.

But the hormone has also been linked to brain function

A 2010 study at St Louis University in the U.S. found older men with depleted hormone levels were more likely to develop the brain-wasting disease. The Australian team behind the new research focused on whether women too might benefit.

Those in the trial, with an average age of 61, rubbed either a hormone gel or placebo gel on to the arms, shoulders or tummy every day for six months.

The women had their memory tested before and after the experiment, and the treatment group showed a significant improvement while there was no change in the placebo group. Blood tests also showed an increase in testosterone levels in the treatment group.

The results were presented at a recent conference but have yet to be published in a peer-reviewed journal.

Commenting on the trial, Dr Simon Ridley, head of research at Alzheimer's Research UK, welcomed the study but warned: 'We will need to wait for these findings to be peer-reviewed and published before we can evaluate what they could mean for people with dementia.'

Jess Smith from the Alzheimer's Society stressed that it's not certain that improved brain function scores actually translate into a reduced risk of dementia.
But she added: 'This small study indicates a possible future avenue for research into memory loss in women.'

New, first-in-class oral delivery of unmodified testosterone announced by TesoRx Pharma and CoreRx - it could change your life

TesoRx Pharma, LLC and CoreRx, Inc. today announced a manufacturing joint venture to produce TSX-002, a first-in-class oral testosterone drug targeting the $2.5Billion low testosterone market. TesoRx’s novel, proprietary formulation orally delivers therapeutic levels of unmodified testosterone in a safe and convenient manner. The company will be commencing its final Phase 3 Clinical Study in Q1 of 2014.

“This joint venture solidifies our ability to manufacture TSX-002 to the highest standards in an environment that can easily scale from our current level through Phase 3 and, ultimately, commercial release,” said Ramachandran “TR” Thirucote, Ph.D., CEO of TesoRx. “The CoreRx team has set itself apart with its service commitment and innovation, making them an obvious choice as TesoRx moves to the next phase of development.”

“This project represents a significant expansion in both the size and mission of CoreRx,” said Todd R. Daviau, President and CEO. “An oral therapy is long overdue in the treatment of male hormone deficiency and is the cornerstone of TesoRx’s current portfolio. We are happy to have been chosen as TesoRx’s development partner and are looking forward to this long-term manufacturing project with TesoRx.”

The acquisition of the Myerlake II site will add approximately 47,000 sq.ft. of additional manufacturing and office space. TesoRx plans to begin construction in the buildings across from CoreRx’s current 35,000 sq.ft. facility in the ICOT Center campus. It will house several additional suites dedicated to process development, clinical trial manufacturing and commercial manufacturing of hormone products.

Work on the expansion has already begun and should be completed by the middle of Q2 2014.
About TesoRx, Inc.

TesoRx is a privately held pharmaceutical company focused on the development of a first-in-class unmodified oral testosterone for androgen deficiency. The company is advancing its proprietary pro-liposomal formulation of testosterone (TSX-002), through Phase 2 clinical studies for low testosterone in adult males. TSX-002 has the potential to be the first unmodified testosterone for oral delivery to enter the international market. The US market for topical, transdermal and injectable testosterone formulations alone is currently estimated at US $2.5 Billion with prescriptions having grown 34% over the last 12 months.

About CoreRx, Inc.

CoreRx is a contract research organization providing customized pre-formulation services, formulation development, manufacturing, and analytical services to pharmaceutical, biotechnology, academic, and veterinary clients. The company is renowned for reliably expediting early development activities to speed potential drugs to clinical trials while applying stage-specific scientific knowledge and experience. CoreRx's unique corporate structure creates project teams that work intensively with each client, bringing an extension of its own organization into the CoreRx lab.

Keep on top of new developments at CoreRx and throughout the drug development industry by following and for more detailed information about the company, visit

Erectile dysfunction only one of many male ills caused by low testosterone

Courtesy of

Testosterone plays an important role in keeping your mind sharp and your body healthy—from the heart to muscles and bones to erectile dysfunction (ED). If you’re middle-aged, your body’s testosterone levels have already begun to decline.

Testosterone is a hormone that is produced primarily in the testicles. It is essential in the development of masculine characteristics, muscle strength, fat distribution and sex drive. Testosterone peaks during adolescence and as you get older, your testosterone level gradually declines — typically about 1 per cent a year.

Researchers have found low testosterone contributes to weight gain and obesity, elevated harmful blood fats, and insulin resistance – each of which is a risk factor for the development heart disease, type 2 diabetes and ED.

Heart health concerns with testosterone include elevated cholesterol and blood pressure, thus increasing the risk of heart attack and stroke. According to a UK-based study, having high testosterone isn’t what makes men susceptible to heart issues—it’s having too little.

Weight gain, diabetes and alcohol use can lead to fat forming around the mid-section — this contributes to the production of the female hormone oestrogen that counteracts the function of testosterone.

“Other men produce testosterone but may be resistant to it, just like diabetics are resistant to insulin,” says Dr Malcolm Carruthers, founder of The Centre for Men’s Health in London.

Low testosterone has also been linked to changes in sexual function. This may include reduced sexual desire, fewer spontaneous erections, and infertility. Many men blame their age or their relationship for problems with their sex lives, but it could be due to a hormonal imbalance.

Emotional changes have been linked to low testosterone as well. It can contribute to a decrease in motivation and self-confidence while increasing depression, trouble concentrating and forgetting things.

Low testosterone is partly due to the testicles not working properly, but a lot is related to the testes’ communication to the brain. Various underlying factors, including excessive levels of stress, medication side effects, thyroid disorders and excessive alcohol use can negatively affect the nervous system.

Raising your testosterone levels naturally

The most effective way to increase testosterone production is through one’s lifestyle. Decrease alcohol and sugar consumption while increasing vegetables, lean proteins, healthy fats and exercise.

Sex can also raise your testosterone level.

The testes produce testosterone by converting cholesterol in to testosterone. We get cholesterol from eggs, red meats, fish, avocados and nuts. Natural sources of saturated, monounsaturated, and polysaturated fats won’t make you fat and will help in the production of testosterone.

Un-natural fats found in packaged and fried foods have the opposite effect. Sugars, carbohydrates and man-made fats facilitate gaining weight around the waistline and contribute to the development of heart disease, diabetes and low testosterone levels.

A lack of sleep and excessive stress can lower testosterone levels throughout life. Stress triggers a hormone called cortisol that opposes testosterone. Cortisol also contributes to weight gain and the development of type 2 diabetes.

Exercise is an effective way to manage stress, balance hormones, increase muscle mass, and lower body fat levels. Lower body fat correlates to higher testosterone levels and lower risk of chronic-diseases.

By raising testosterone levels naturally, you’ll not only increase your body’s ability to gain lean, athletic muscle, but also improve your sex life. Testosterone is key to a healthier, more energetic life – both physically and mentally.

Dr Cory Couillard is an international health columnist that works in collaboration with the World Health Organization’s goals of disease prevention and global health care education. Views do not necessarily reflect endorsement.

Facebook: Dr Cory Couillard
Twitter: DrCoryCouillard

How seeing the doctor and using testosterone medically saved this marriage - and could save yours too

Courtesy of the

Author’s lack of a sex drive almost cost him his marriage, but he couldn’t let his wife go without doing everything he could to win her back.

By Pete Beisner / The Good Men Project

My wife and I are in a sexual time-out.  That is my polite way of saying that right now I would rather do the dishes than make love to her. This isn’t about my wife, as much as she sometimes wants to make it about her so that she can fix it. The most beautiful woman in the world could show up right now ready to fulfill my wildest sexual fantasy, and I would say, “Eh, there is some leftover pasta in the fridge. I am going to heat some up. Want some?”

Why am I telling you this? I believe that our ideas about marriage are distorted by how little we hear about the true inner workings of functioning marriages. Normally, you would only hear about something like this after the marriage has imploded. It is my hope that by talking about these things as what they are – a normal part of marriage – that we will not panic or despair when we encounter them.

This isn’t the first time that we have gone through something like this. However, it is the first time that we have been able to communicate about it clearly. And it is the first time that a dry spell has not left my wife feeling unattractive and deeply insecure.

It started not long after we fell in love with each other. There was a few heady weeks of pleasure, but quickly we sank into the routine that I had with my ex-wife: I avoided and she got frustrated and confused. The major difference between my current wife, Lynn, and my ex is that Lynn does not abide avoidance. She insisted that we talk about the issue.

I have to say that I didn’t see that one coming. I thought that she would be relieved that I was not going to impose on her by asking to have sexual needs met. But I was wrong. My wife loves sex and withers without it.

And so we talked about it for years. We tried marriage enrichment workshops and the exercises found in sex advice manuals.  When that didn’t work, I talked with a therapist. Lynn’s pet theory was that some of the sexually traumatic things that I had experienced when young had led me to cut off my sexuality.

I would like to say that I was fully cooperative with all of this. But in truth, I found it a bit annoying. I didn’t really see what all the fuss was about. The idea of sex didn’t particularly fill me with joy any more than exercise does. But like exercise, I was glad to have done it when I was through.

In retrospect, I can see where my responses must have been very painful to my wife. I didn’t just want to avoid sex; I also wanted to avoid being asked for sex. So if I thought that she was even moving that direction, I got anxious. And that anxiety came out as hostility or even shaming.

About six years into our marriage, my wife did something utterly unexpected. She told me simply and clearly that barring a major change in our relationship, she would never again initiate sex. It was too painful, she said, to keep putting herself out there and being rejected. It was breaking something deep inside of her to have something so core to who she is, her sexuality, routinely rejected with seemed to her to be a hint scorn. She had gained a lot of weight and felt worse than merely unattractive. She felt like she must be grotesque.

She had not made the decision lightly. She had considered the fact that in the three years since she had been keeping track, I had not once initiated sex. Given that, she assumed that we would now be entering a sexless marriage.  After a few months of consideration, and a period of mourning, she had decided that for now, she was willing to put aside her sexuality and live as a married celibate.

I expected her pledge to last a few weeks, and then things would go back to normal.  But I had clearly underestimated just how hurt she was and how determined she was not to make herself vulnerable to me again. There was not the slightest hint of sexuality between us. She was my friend and seemed happier and more relaxed than I had seen her in a long time.

Lynn said something that really stuck with me: “The person with the ‘no’ has all the power in the relationship.” She had taken back her own power by taking the question off the table. Her sexual needs were no longer any of my concern.

That was a wake-up call for me. I was not okay with a sexless marriage, not even in theory and not even when I didn’t particularly want sex. It sounded like a recipe for eventual divorce. And I love this woman more than life. There was no way I was going to let her go when I could do something to win her back.

As I mulled it over, I came face-to-face with what I had been asking of my wife. Without thinking about it, I had been asking her to stay in a vow of fidelity that was truly a vow of celibacy. She was in her sexual prime, and I was asking her to amputate a part of herself as casually as I might ask her to do the dishes.

I was requiring of my wife what religious organizations were asking gay people to do: Have all the feelings and desires of sexuality but never act on them. It was not acceptable when they asked for it and it was not acceptable for me to ask this from my wife.

I tried just being a good sport and going along with sex. It worked about as well as you would imagine it. That is when I decided that I was going to find an answer. I would either find a way of becoming a full partner in our marriage, or I would release my wife from her duties of fidelity.

My first step proved to be the most important one. I went back to our family doctor and demanded a testosterone blood test. On previous visits, when I had asked for one, they had told me that I obviously had plenty of testosterone. After all, I have enough hair on my body to pass for a Sasquatch, and I had classic male pattern baldness. This time, I insisted.

Later that week, we found out that my testosterone levels were those of a pre-adolescent boy. No wonder I was uninterested in sex. My body was still in grade school where girls are icky.

I won’t tell you that our life was all wine and roses after I started taking testosterone supplements. Lynn still had a lot of years of hurt to overcome. But it helped a lot that I suddenly turned into a horny teenage boy. I discovered the wonders of the female body and what the fuss about sex was really all about. As the months went by and our sex life became something that bonded us, that was fun and that fostered rather than destroyed intimacy, I watched my wife blossom. The weight peeled off of her, and she practically radiated happiness.

So why are we back in sexual time-out? A few months ago, my insurance company required that I switch to a generic form of testosterone. It didn’t occur to me to be on the look-out for changes in my sexuality. But as my levels slipped so did my interest in sex.

Last week, Lynn calmly told me that she was aware that I was no longer interested in sex. And I was beginning to exhibit the same subtle shaming behaviors that I had years before. She pointed them out to me, and for the first time I realized just how far I slid into scorn of sex when I had too little testosterone. I supported her decision not to bring her sexual needs to me until something changed. I didn’t want to hurt her anymore than she had already been.

I now have the correct dose of testosterone in a form that my body can absorb. I expect to be chasing Lynn around the kitchen by the end of next week. I look forward to watching her re-emerge from her shell and blossom again.

Lynn says she is sort of glad that this happened. It proves to her that my lack of desire had never been about her. She said, “I know now that there was nothing that I could have done to save our marriage if you hadn’t gotten testosterone treatment.”

I am somewhat grateful as well. It gives me mercy on people who are overtly prudish, and it makes me less scornful of men I know who cheat. I can see how someone in Lynn’s position, who knows that sex would obviously be an imposition on her spouse, could try to save her marriage by breaking her marital vows.

For the record, Lynn never cheated on me, although I would have forgiven her if she did. And, I am not in any way condoning cheating. I believe that spouses have the responsibility to do as my wife did for so many years: Keep talking about it and insisting that you work on it together as a couple.

I think I should also be clear in stating that of course no spouse has the right to demand sex from his or her partner. But marriage is a contract that covers sex, among other things. And if you cannot meet your obligations under the agreement, you need to at least be addressing it as a problem. You don’t get to just say “no” for months on end. You are obligated to at least say, “No, and I will do x to address this problem.”

I love Lynn, and I am truly sad about all the years of great sex that I missed out on. But I hope to make up for lost time now that the kids have left home and I have a good testosterone supplement.

Newsflash: Men don't always want sex

Courtesy of

BELIEVE it or not, not all men want sex on tap. Actually, some hardly want it at all. And apparently that's normal.

It's widely believed that men are always up for it. But a sex researcher reckons that men just can't say 'no'.

Andrew Smiler, author of Challenging Casanova: Beyond the stereotype of promiscuous young male sexuality , says men don't realise they can actually refuse sex.

"One of the things I've learned is that most, or even all, guys don't know how to refuse sex," he said.

"When I've asked specifically about refusing sex, the guys tell me that part of why it's hard to say 'no' is that they're concerned about how she'll respond, including concerns that she'll think he's either some type of wimp or gay," he said.

"Those comments have always come from heterosexual men and almost always about a relationship in the early stages."

Dr Smiler, former president of the Society for the Psychological Study of Men and Masculinity, recently wrote A Guy's Guide on When to Refuse Sex for the Good Men Project about when men should refuse sex with a new partner.

"Our cultural assumptions about male sexuality don't allow for the possibility that a guy would ever choose to say 'no'," he wrote.

"In fact, you may have a hard time imagining that a guy would ever turn down sex unless he was in the middle of a massive heart attack.

"Let me be clear about one thing. Guys are allowed to refuse sex by saying 'not now' or just 'no' and their partners need to respect that decision."

Dr Smiler said his empirical work on sex has been entirely with young heterosexual males.

He said guys are often uninterested in sex if they're tired, sick or too drunk to perform sexually.

"For older guys - typically aged 40 or over - other physical conditions start to come in to play including obesity, heart conditions, pulmonary issues, anything that impacts blood flow and a variety of other disorders," he said.

A recent survey for online pharmacy found 62 per cent of men turn down sex more frequently than their female partner, with a third admitting they had lost their sex drive, reports the Daily Mail.

They report that another poll reveals one in four men no longer has sexual intercourse at all - and the figure rises to 42 per cent for men over 55 - while a quarter said they had been affected by erectile dysfunction at some point in their lives.

Dr Malcolm Caruthers, founder of the Centre for Men's Health, told the Daily Mail that testosterone deficiency is becoming more common and happening younger.

"It used to be mostly men in their 50s, but it's now men in their 40s, or even 30s. Large studies done in America show that every decade there's a decrease in testosterone levels by as much as 10 per cent. I believe the same is happening in (the UK)."

Even rock star Robbie Williams has struggled to maintain a sizzling sex life.

The singer, who has been open about his low libido, said in a 2011 interview that he injects himself with testosterone twice a week to boost his sex drive.

The 39-year-old said a doctor told him that he had the "testosterone of a 100-year-old".

He's not alone. spoke to a couple of ordinary blokes about their sex-lives.

One man said his sex drive was higher than his wife's.

"Although this has changed over the years. Speaking to other blokes I know, I think women's sex drive peaks in their early 30s then drops off in their 40s - partly for biological reasons I guess and partly because of kids/exhaustion," he said.

"I think that because of television shows like Sex and the City and other cultural influences, women don't feel cool about admitting this."

The 43-year-old said he never refused his wife's advances.

"I used to, but again, like most men I think I now have a 'take it when it's available' kind of mentality.

"It's definitely OK (to refuse). In a mature relationship, partners understand that you may just not be in the mood or have stuff on your mind or whatever. It can still feel like a rejection, but not devastatingly, underminingly so."

The father-of-two said women need to know that their formula of "intimacy first, sex second" doesn't always work for men.

"Seems you always want a perfect meal and a kind of perfect emotional state of togetherness or something before you agree to hop in the sack with us," he said.

"For men it's often the other way around. We want the physical closeness and release of sex, and then relish the emotional closeness that follows.

"For men, sex brings us closer to you. We wish women would recognise this and be prepared to treat sex not as the ultimate expression of emotional closeness, but as a physical act which is a great way of helping achieve that closeness."

Another man who chatted to said his girlfriend had the higher sex drive, but that he never refused sex.

"Even if you're not in the mood for sex to begin with, it isn't exactly difficult to get in the mood. It's not as though sex is a chore," the 23-year-old said.

"I'd imagine it'd be OK to say no as long as I explained myself properly. Refusing sex without offering an explanation will only make your partner feel inadequate or insecure.

"Women need to know that men aren't always horny. So if your partner isn't keen to have sex at any given time, it doesn't necessarily mean he doesn't find you attractive - it could just mean he's not in the mood."

According to Sydney Men's Health clinic testosterone is responsible for the peak in sexual interest in men around the age of 20 and women in their mid-thirties.

"The ageing process in men and women reduces the available level of testosterone resulting in a natural decline in libido in the older years. However it has been found that an older man's libido may not necessarily be related to his level of testosterone," their website says.

"A common cause of low libido is not related to lack of production of testosterone but rather due to relationship problems, such as when a decision is required for a long-term commitment in a new relationship. Any medical condition as well as excessive alcohol intake may contribute to reduced libido."

Other reasons men aren't in the mood (according to an office poll) include exhaustion, energy levels, overtraining, sickness, stress, wanting a sleep-in and eating too much chocolate mouse for dessert.

Continue the conversation via Twitter @AndrewSmiler | @newscomauHQ

Hormone Levels Can Validate Presence of Pain and Affect Treatment

Serum levels of pituitary, adrenal, and gonadal hormones are the most objective biomarkers of severe uncontrolled pain, said Forest Tennant, MD, DrPH, of the Veract Intractable Pain Clinic, West Covina, California, in a presentation that focused on pain and hormones.

Hormones critical for pain control are cortisol, pregnenolone, dehydroepiandrosterone (DHEA), progesterone, testosterone, estrogen, and thyroid. The blood panel recommended as a pro le for pain management is adrenocorticotropin (ACTH), cortisol, pregnenolone, testosterone, DHEA, and progesterone. Dr. Tennant emphasized it is important to determine abnormal serum hormone levels for several reasons: to validate the presence of severe pain and need for enhanced treatment, determine if hormone replacement is needed, provide an objective measure of treatment success, and identify the complication potential of hormones, particularly cortisol and testosterone.

Patients who should be screened for hormone abnormalities are those who require daily opioids, complain their current regimen is not effective, or have central pain. Hormones suppressed by opioids include cortisol, testosterone, pregnenolone, estrogen, progesterone, and oxytocin; in addition, other hormones may also be affected. Long-acting opioids are more suppressive than short-acting, he said, due to their longer duration; some tolerance and homeostasis may develop over time.

Common manifestations of hypocortisolemia include low blood pressure, weakness, poor analgesic response, weight loss, cold, muscle wasting, brown pigmentation (in scars, under eyes, axillae, and creases), golden hue to skin or vitiligo, slow mentation, sitting still and staring straight ahead, and weak voice.Testosterone deficiency manifests with symptoms of fatigue, decreased libido and performance, depression, slow mentation, poor analgesic response, muscle weakness, and gynecomastia.

To spare or reduce opioids, serum hormone levels should first be normalized. If a patient is already taking an opioid, hormone levels should be determined prior to initiation of a long-acting opioid. In addition, an opioid should not be determined to be ineffective or causing hyperalgesia or allodynia until hormone serum levels are determined and normalized. Replacement hormone is needed when pain and/or opioids and other medications have reduced serum hormone levels. In patients with pain, the pituitary, adrenal, and gonadal glands are usually not irreparably damaged; therefore, sub-replacement is used in pain management.

Dr. Tennant said bio-identical, and not potent synthetics, should be used; for example, hydrocortisone in lieu of methylprednisolone, dexamethasone, or prednisone. The most common hormone replacements and their usual daily dosages are hydrocortisone (5 mg to 15 mg), pregnenolone (100 to 300 mg), testosterone (male, 10 mg to 100 mg; female, 2.5 mg to 25 mg), and DHEA (100 mg to 300 mg). Dosages should be increased daily over 6 to 8 weeks, with serum levels repeated every 1 to 4 weeks until hormone is in normal range. The patient can attempt tapering after pain is well-controlled.

With respect to hydrocortisone dosing, experts have various opinions, he said, which basically comprise two methods: higher morning dosage or split dosages throughout the day. For testosterone dosing, the injectable form should be avoided due to high serum levels and pituitary suppression. Topical compounds with concentrations ranging from 1% to 10% are popular; for example, 30 gm of 5% concentration provides 1 gm of base cream and 50 mg of active drug/day. Testosterone alternatives and enhancers include human chorionic gonadotropin (hCG), DHEA, and medroxyprogesterone.

Noting a “new vocabulary” is needed for neuroregeneration therapy, Dr. Tennant explained that neurosteroids, hormones that control neurogenesis and neuroprotection, are produced in the CNS and have a steroid ring structure not under control of the pituitaryadrenal-gonadal axis. This controls neurogenesis and neuroprotection. The pain-related functions of pregnenolone is neuroprotection; progesterone, neurogenesis; and DHEA, receptor regulation and nerve conduction.

Neuroregenerative hormones include hCG, progestins, pregnenolone, and oxytocin. The most promising research to date is with long-term use of hCG, he said. An open-label study in 26 patients with centralized pain who received hCG for 12 to 74 months resulted in pain free hours, permanent pain reduction, or less severe flares. Two patients were able to come off opioids. The hair loss and headaches reported by patients were relieved when the dose was lowered.