Dr. Scott Hopkins discusses the signs and treatments for low testosterone.
Testosterone is the male sex hormone. And it’s what makes us different as fathers, and sons,and brothers than our wives, and mothers and sisters. Testosterone affects every cell in the body, and is important in all of our secondary sexual characteristics. It’s why we as men grow beards, our body composition is different. Testosterone levels don’t always drop as we age, although they definitely can.
The symptoms of low testosterone are pretty varied. Often men will have decreased energy level. Often decreased libido, or sex drive. Sometimes, you’ll have a little bit of difficulty with erections. It’s also difficult to maintain lean muscle mass. There is an increased risk of osteoporosis,or thinning of the bones. We also can see an increased risk of what is called the metabolic syndrome, which is many of the diseases of modern America.
High blood pressure, type II diabetes, high cholesterol,obesity, and those diseases can increase the risk of heart disease, stroke, and other serious illness. Men can occasionally see low testosterone in their mid-to-late 30s, but more commonly we see low testosterone in the mid 40s to mid 50s.
The treatment options of low testosterone are to increase the testosterone levels. And there are a number of ways that we can do that. In young men, we often want to not treat with testosterone,but to trick the body into producing more testosterone. And there are a number of medications that can increase testosterone production by the testicle. In men who are a little bit older, and less concerned about fertility we can increase testosterone levels by testosterone replacement.
We can do that with topical testosterone, which are gels or patches that are applied to the skin. We can do that with injectable testosterone,which is injected into the muscle on a weekly basis. Or, we can do that with implantable, long-term testosterone which is injected into the fat in the arm,and will slowly dissolve over time bringing the testosterone level up. We hear a lot about low testosterone on ads, on the radio and in the newspaper, and not everyone should be on testosterone.
Men with normal testosterone should not be supplemented with testosterone because there are some risks associated with testosterone replacement therapy. There are some minor side effects such as acne,worsening male pattern baldness.There are other more serious problems such as an increase in the red blood cell volume, which can make the blood thick or sludgy,and increase the risk of heart attack or stroke. Young men who are put on testosterone are often rendered sterile, without the ability to conceive children. And that can be long-lasting and even permanent. There are other risks associated with testosterone treatment if it’s used inappropriately.
Blood in the Urine
Hematuria is blood in the urine and we see that in two different fashions, we see microscopic hematuria, which is blood in the urine that we only see under the microscope; or gross hematuria, which is blood that you can actually see yourself as you urinate. Blood in the urine has a number of causes,some of them are very serious and some of them are relatively minor. When we look at the most common cause of blood in the urine in men, is just an enlarged prostate which many of us get as we age.
Kidney stones can also cause blood in the urine and infections can cause blood in the urine. When we look at the more serious causes,we look at different types of cancers in the urinary tract. The most common is bladder cancer, but also kidney cancer and cancer in the ureter, which is the tube that transports urine from the kidney to the bladder. There’s also a significant number of people who just have a small amount of blood in their urine, which is not very worrisome.
Bladder cancer is an interesting cancer because it has a very well-known cause and that’s smoking. 70 to 80% of all bladder cancers are in smokers or former smokers. There are a number of other risk factors, the most common would be exposure to radiation therapy for other types of cancer,such as prostate cancer or rectal cancer.
When you combine smoking with radiation therapy that markedly increases the risks. There’s also an increase risk of bladder cancer in people who work with petrochemicals on a very regular basis. Although we see that much less often. So if a man or a woman sees blood in their urine,they always need to follow up with their physician. And typically they’ll need to be worked up by a urologist. Blood in urine can be very serious or less serious but we can’t tell just from the blood in the urine whether it’s serious or not. At Summit Urology Group we offer all urologic care for men, women, and children,in association with St. Mark’s and other great physicians.