Category Archives: Testosterone Replacement Therapy

You cant understand what you dont measure

Numbers are hard to come by, but Prins is one of about 3,950 Michigan youths between ages 13 and 17 who identified as transgender in 2020, according to the Williams Institute of UCLA.

Nationwide, there are more than 60 gender clinics treating transgender and nonbinary adolescents using gender-affirming care, nine of which are in Michigan.

Overall, nonbinary youths are believed to represent less than 1 percent of the more than 640,000 adolescents in Michigan. Nationally, their numbers are believed to be rising fast, as more come out, according to estimates from the Centers for Disease Control and Prevention.

Cataloging their population is tough, though, because the federal government has not allowed school districts to report data on nonbinary students, just males and females.

That may soon change as federal officials consider changing policies to allow but not require schools to collect the data.

The proposal comes from the federal Office of Civil Rights, which is considering collecting data on nonbinary students for its 2021-22 report in December, which identifies chronic absenteeism, sexual assault, school safety, harassment and bullying.

Such information could steer help to trans students who report high rates of bullying and harassment, according to Cody Venzke, senior counsel for the Center of Democracy and Technology, a nonprofit based in Washington D.C. that focuses on technology policy.

You cant understand what you dont measure, but with any sensitive data, there are risks to the students and families youre collecting data on, said Venzke, who proposes the policy change..

Someone could collect that data for a legitimate purpose but then later on it is used for a different purpose, such as a state agency identify trans students and reporting it to Child Protective Services, Venzke said, pointing out that some states have passed laws that consider transgender care as child abuse.

That is the No. 1 risk that schools face when they try to be a responsible steward of students data, he said.

Parents Defending Education, a Virginia-based group that opposes LGBTQ education in schools, objected to the proposal, stating it would empower schools to actively question and engage with children on gender and sexual identification issues that fall outside of the purview of public schools and are matters to be dealt with exclusively by parents.

Jennie Knight, vice president of the Grand Rapids LGBTQ Healthcare Consortium, said collecting data on transgender youths is important at a time when people are ringing alarm bells about more people coming out.

Knight said she has a 9-year-old son who just finished third grade and she does not want anyone at school talking to him about sex right now.

But I do think he should learn about all the different kinds of families there are, Knight said.

Being able to talk about gender at an age when children developmentally notice differences between themselves and others is not harmful, said Jennifer Schwartz, behavioral program manager at Corner Health Center in Ypsilanti, which offers health services and support for young people.

It helps them learn who they are as people later on, Schwartz said.

In the absence of schools, Michigan counties have begun expanding surveys to include information on LGBTQ people in health reports used to identify community needs.

In the last four years, at least 11 of 83 counties have collected such information, but the number of LGBTQ respondents is still very low, which makes it hard to accurately represent the community.

Accurately representing the community not only makes people feel safer coming out, but it also helps health departments tailor their services to meet those peoples needs, said Maris Brummel, an epidemiologist for the Kent County Health Department.

In 2020, for the first time, Kent County included demographics on its LGBTQ community in a county health report that lays out its residents health status, needs and issues.

Of the people surveyed, 4 percent identified as LGBTQ and about 1 percent of them are transgender. The report found 6 percent of the countys surveyed middle schoolers and 8 percent of its high schoolers identify as lesbian, gay or bisexual. The report excluded information on transgender youths.

One barrier is that many LGBTQ males and non-binary people dont feel comfortable responding to the survey, Brummel said.

Eaton County, for instance, is among the counties in Michigan that dont include LGBTQ residents in their community health reports because so few people responded that they identify as LGBTQ, said Milea Burgstahler, the countys quality improvement coordinator.

Less than six people identified as LGBTQ in the survey of Eaton County, which has a population of about 109,000. Burgstahler said, we couldnt analyze the data to represent a sample that is representative of the population.

Estimates vary nationwide, but the percentage of people nationwide identifying as lesbian, bisexual, nonbinary, transgender has steady increased since Gallup began polling in 2012. The firm now estimates 7 percent of the public identifies as something other than straight.

In Michigan, the U.S. Census Bureau estimated in 2019 there are about 24,000 same-sex households, about 1.1 percent of Michigan couples. Nationwide, the rate is 1.5 percent.

The national wave of legislation involving trans youths is exacerbating mental health risks plaguing them, said Erin Knott, the executive director of Equality Michigan, the states largest LGBTQ advocacy group.

We have seen in Michigan an uptick in harmful rhetoric aimed at our trans and nonbinary youth, Knott said.

She works with The Trevor Project, a national suicide prevention and crisis intervention nonprofit for LGBTQ young people. Last year, its hotline received 6,200 calls from Michigan kids, Knott said.

That year, a national survey by The Trevor Project found that 42 percent of the 35,000 LGBTQ youths who were surveyedand over half of them being trans and nonbinary youthsseriously considered suicide within the prior year.

Social media is elevating more transgender roles models, but how safe a person feels depends on where they live, said Leisha Taylor, a bisexual woman in Hillsdale. Taylor said historically, religious and conservative communities like Hillsdale have not welcomed gender diverse people.

The words they have used to describe us are abomination and abhorrent, Taylor said.

Taylor noted recent controversies in Hillsdale targeting the LGBTQ community as a reason why friends and family who identify as transgender have to hide it because they dont feel safe coming out.

In May, one member of the Hillsdale Community Library Board suggested forbidding the library from buying books for people under age 18 that discuss sexual identity and gender identity.

Gender diverse people can become confused about their identity when their communities are not welcoming or lack representation of transgender people, according to Jay Dunn, a 38-year-old man who transitioned in his late 30s.

Dunn grew up in Galesburg, a small city in Kalamazoo County, and came out to his parents as a lesbian at age 17.

It was tough growing up there, said Dunn, adding he was one of three openly gay students at his high school and they were frequently bullied.

While Dunn identified as a lesbian because he liked girls, he said his adolescence was a confusing time and something always felt off. It was not until a family friend came out as transgender that Dunn realized his authentic self.

Today, Dunn is receiving hormone therapy and had his breasts removed. He says it is the happiest he has ever been, noting that his wife now says your confidence is through the roof.

The only thing I regret is not being able to start transitioning sooner, Dunn said.

One of the most effective methods of treating gender-associated distress is providing adolescents access to gender-affirming care, according to endocrinologist Daniel Shumer who founded the states first pediatric gender clinic at Motts Childrens Hospital in 2015.

Gender-affirming care was first founded in Germany in 1918, began in the United States in the late 1940s and was made available to adolescents in 2007.

There are three forms of gender-affirming care: puberty blocking medicine, hormone therapy and gender-confirmation surgery, like breast removal or implants.

Puberty blocking medicine is a non-invasive, reversible process that desensitizes the brain gland that releases puberty hormones and allows kids time and space to explore their gender identity, according to Shumer.

Natural puberty would pick up where it left off if a patient chooses to stop taking puberty blockers.

Hormone replacement therapy produces more testosterone or estrogen depending on the sex features a person wants expressed. Both forms of treatment cost thousands of dollars a year without insurance.

Shumer said transgender and nonbinary adolescents experience gender dysphoria, unease that a person may have because of a mismatch between their biological sex and their gender identity.

Children generally feel this discomfort around age 10 when they are about to hit puberty and their bodies change in ways that make them uncomfortable, according to Shumer. At that time, transgender children who are out start asking their parents about getting gender-affirming care.

Shumer said a vast majority of the kids who are distressed about puberty and receive treatment grow into happy, healthy, successful, well-adjusted adults.

They really feel like the treatment theyre getting is making a huge difference and its potentially life-saving for a lot of these young people, Shumer said.

Shumer said he was exposed to a pediatric gender clinic during his medical training and saw how helpful providing high quality care to transgender and gender diverse young people can be.

There was quite clearly a need for these services in Michigan, Shumer said, noting that when the clinic opened, he was getting referrals from all over the state and the clinic became very busy quite quickly.

Over time, Shumer said the number of referrals increased to 100 new patients each year and more adolescents between the ages of 10 and 18 were seeking care.

Its clear that in Michigan and across the country, young people are thinking more critically about gender identity and exploring gender identity is a normal process of adolescence, he said.

Before Shumers clinic opened, families like Roz Keiths often traveled out of state seeking such care. Keith is the board president of Stand With Trans, a nonprofit support group for transgender kids and families with transgender members.

Keith said she was getting transferred all over the place because Michigan did not have resources for transgender youths when her son Hunter Keith came out as a transgender male in 2012.

Hunter Keith said it took a year for him to be seen by a specialist who was based in Boston, Massachusetts and had a very long waiting list.

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Trans teens: We need to be heard, counted. In Michigan, the backlash is harsh - Bridge Michigan

Curr Opin Urol. Author manuscript; available in PMC 2018 Nov 1.

Published in final edited form as:

PMCID: PMC5649360

NIHMSID: NIHMS910261

aBaylor College of Medicine, Houston, TX

aBaylor College of Medicine, Houston, TX

bScott Department of Urology, Baylor College of Medicine, Houston, TX

cCenter for Reproductive Medicine, Baylor College of Medicine, Houston, TX

bScott Department of Urology, Baylor College of Medicine, Houston, TX

aBaylor College of Medicine, Houston, TX

bScott Department of Urology, Baylor College of Medicine, Houston, TX

cCenter for Reproductive Medicine, Baylor College of Medicine, Houston, TX

Erectile dysfunction (ED) and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, co-administration with phosphodiesterase type 5 (PDE5) inhibitors, and libido.

Recent publications suggest that TTh improves mild ED, though may be less useful in men with more severe ED. In men unresponsive to PDE5 inhibitors and with mild ED, TTh can further improve erectile function. Testosterone therapy has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized.

The available literature supports a role for TTh in men with low testosterone levels, ED, and low libido, with symptomatic improvement in these men.

MeSH Keywords: Testosterone, Erectile Function, Phosphodiesterase 5 Inhibitors, Hypogonadal men

Multiple longitudinal studies have observed that as men age, they experience a decline in total serum testosterone beginning in the third decade of life [1, 2]. By age 70, 30% of men will have low testosterone levels [2]. The symptoms of low testosterone include decreased libido, erectile dysfunction (ED), decreased energy, depressive symptoms, and fatigue [3]. These symptoms can be frustrating to men, and can be at least partially reversed with testosterone therapy (TTh). In this review, we summarize the recent literature examining the relationship between low serum testosterone levels, ED, and decreased libido.

To identify articles for this review, the following search terms were used in Medline: testosterone, testosterone replacement therapy, erectile dysfunction, and libido. Relevant and recent articles were identified and presented in this review. Articles published within the last 18 months were prioritized in this review.

ED affects 1 in 5 men, with this frequency increasing with age and the prevalence of co-morbidities [4, 5]. The National Institute of Health (NIH) defines ED as the inability to achieve or maintain an erection that is satisfactory for sexual performance [6]. Subjective erectile function can be assessed using validated questionnaire metrics including the international index of erectile function (IIEF) with the erectile function domain (IIEF-EF) being the most specific for assessing ED. The IIEF-EF consists of 6 questions that inquire about frequency and hardness of erections, ability to penetrate during intercourse, ability to maintain an erection during intercourse, ability to maintain an erection to completion of intercourse, and confidence in a mans ability to get and maintain an erection [7]. The severity of ED is then classified as mild, mild to moderate, moderate, and severe dysfunction. The IIEF-EF is often used in studies to trend changes in erectile function, with a change of 2 IIEF-EF points being clinically significant for men with mild ED. The minimal clinically important differences (MCID) for moderate and severe ED are a change of 5 and 7 IIEF-EF points, respectively [8].

Erection requires a combination of vascular, neurologic, psychologic, and hormonal factors. Erections are initiated when nitric oxide and other neuroendocrine factors induce relaxation of the smooth muscles of the cavernous arteries and tissues resulting in increased penile blood inflow. As the corpus cavernosum fills with blood, the veins that drain the corpus cavernosum are compressed, resulting in maintained turgidity [9]. This initial release of nitric oxide is mediated in part by testosterone [10]. While evaluating neurologic, vascular, and psychologic factors can be difficult during a clinical visit, a hormonal etiology of ED can easily be assessed by measuring morning serum testosterone levels. The evaluation of testosterone levels in men with ED is recommended by the European Association of Urology guidelines and is indicated in select men with ED per American Urology Association guidelines [11, 12].

Numerous studies have examined the relationship between testosterone levels and erectile function. In cross-sectional studies, men with low testosterone (defined by the US Food and Drug Administration as levels less than 300 ng/dL) have a greater prevalence of ED when compared to men with normal testosterone levels [1315]. Studies have observed that men who have been placed on androgen deprivation therapy (ADT) for prostate cancer have a dramatic reduction in erectile function with a decrease in testosterone levels [1618]. Finally, numerous randomized controlled trials (RCTs) have demonstrated that erectile function improves when testosterone is given to men with low testosterone levels [1924].

In the past few years, several studies have shown that testosterone levels and erectile function are positively correlated. The recently published Testosterone Trials a set of RCTs of 790 men with late onset hypogonadism randomly assigned to either testosterone gel or placebo demonstrated that after 1 year of treatment that men who used testosterone gel had an IIEF-ED score 2.64 points [95% Confidence Interval (CI): 1.06 4.02] greater than men who had been assigned to the placebo arm [24]. It is important to note that men enrolled in this study on average had moderate ED, and so this improvement in erectile function was not considered clinically significant.

In early 2017, Corona et al. performed meta-analysis of 14 RCTs that studied the effect of TTh on erectile function in men with late onset hypogonadism, and compared pre- and post-IIEF scores [25]. Overall, when compared to placebo, TTh provided only a modest improvement in IIEF-EF, as the mean difference between groups was 2.31 points. The mean change in IIEF-EF, however, was greater when data were stratified by baseline testosterone level. In primary studies using a testosterone threshold <8 nM (231 ng/dL), IIEF-EF increased by 2.95 points, whereas in primary studies with testosterone threshold of <12 nM (346 ng/dL), only a 1.47 point increase in IIEF-EF was observed [25]. Given that a greater improvement in erectile function was observed in studies using a lower testosterone threshold, this supports the theory that once a threshold of normal testosterone level is achieved, higher testosterone levels do not further improve erectile function [26]. This definitive study by Corona et al. also suggests that TTh may be a useful monotherapy in men with mild ED.

Numerous studies have found that phosphodiesterase type 5 (PDE5) is upregulated in the penis by androgens [27, 28], and when animals are castrated, a decline in both penile nitric oxide and PDE5 levels are seen [2830]. These early studies support the possibility that men with low testosterone may have a relative deficiency of PDE5, resulting in lower efficacy of PDE5 inhibitors [31]. In a randomized controlled trial by Shabsigh et al., dual treatment with sildenafil and testosterone was more effective than monotherapy with sildenafil for men with testosterone levels <400 ng/dL who had previously failed a trial of PDE5 inhibitors. Men receiving both testosterone and PDE5 inhibitors had an improvement of 4.4 IIEF points from baseline to 4 weeks while those receiving monotherapy only saw an increase of 2.1 IIEF-EF points (p=0.029) [32].

While Buvat et al. observed a positive effect in hypogonadal PDE5 inhibitor non-responders, other RCTs have not observed such a positive effect. In a 2012 RCT, Spitzer et al. studied 140 men on sildenafil and then randomly assigned them to either receive testosterone or placebo gel. All men had a testosterone level <330 ng/dL or a free testosterone level <50 pg/mL. At 14 weeks, those on dual therapy had an IIEF-EF score 1.01 points higher than those receiving sildenafil plus placebo gel (p=0.36). This study demonstrates that the giving testosterone to men who respond to PDE5 inhibitors may not further improve erectile function after normalization of testosterone levels. However, there is growing evidence supporting the use of testosterone in men with low testosterone and mild ED, especially in those who were previously non-responsive to PDE5 inhibitors [33, 34].

These recent studies suggest that TTh may be most effective as monotherapy in improving erectile function in men with mild ED, but not in men with more severe ED. Early studies have shown that TTh can improve the response to PDE5 inhibitors in non-responders.

Libido, or sexual drive, is affected by a multitude of factors, including physiologic ones, such as a defect in the hypothalamic-pituitary access or depression, or environmental ones, such as marital discourse or anxiety [3, 35, 36]. Changes in libido can variably affect individuals, with a wide range of clinical presentations. Longitudinal studies have found that libido declines with increasing male age [35]. When assessing libido, many studies use the sexual desire (SD) domain of the IIEF (IIEF-SD), which asks men to two libido-related questions: Over the past 4 weeks, how often have you felt sexual desire? and Over the past 4 weeks, how would you rate your level of sexual desire? Like the IIEF-EF domain, the IIEF-SD questions can be used to diagnose mild, mild to moderate, moderate, and severe dysfunction [7]. Other studies have used their own scale, such as the Sexual Arousal, Interest and Drive scale (SAID) a validated patient reported outcomes measuring 5 scored items, including sexual thought, arousal, as well as interest and drive [37].

Several early studies have demonstrated that TTh improves libido [38, 39]. Recently, the Sexual Function sub-trial of the Testosterone Trials examined sexual desire. This placebo-controlled trial included 470 men aged 65 years or older with testosterone levels less than <275 ng/dL [24]. When assessing the impact of TTh on sexual symptoms, the authors used the Derogatis Interview for Sexual Function-Sexual Desire Domain, comprised of 25 scored items, and found that libido improved proportionately with increase in testosterone levels, with an effect size of 0.44 [95% Confidence Interval: 0.32 0.56] [40]. Interestingly however, these trials found no threshold below which libido was universally affected for all men in the study.

The results of the largest placebo-controlled multicenter trial assessing the effect of testosterone on sexual function in hypogonadal men (715 men, 18 years of age and older) were published in 2016. Brock et al. found that 60 mg of topical testosterone 2% gel applied daily resulted in a significant increase in testosterone levels as well as libido, as measured using the SAID scale after three months of treatment. The study examined a cohort of hypogonadal men with a mean age of 55. Though not placebo-controlled beyond the third month, the open label continuation of the trial for both placebo and active treatment groups showed continued improvement in sexual function at 9 months when on continuous TTh, with no new adverse events [23]. In the group initially treated with placebo, 60% of men achieved normal testosterone levels at the end of the open label study, compared to 66% of the participants on TTh for the duration of the trial. Interestingly, the group that had received placebo before the 3-month time point and later placed on the open-label TTh achieved the same libido improvements as the group that had been on TTh for the entire 9 months. This finding suggests that benefits of TTh on libido plateau after 3 months of therapy. However, the study lacked a true control arm during the open-label portion of the trial, limiting the ability to make this conclusion. Furthermore, a post hoc analysis of the trials outcomes after 3 months further revealed that a lower testosterone level at the start of treatment and higher plasma concentration achieved at the end of treatment were associated with a greater patient reported improvement in libido [41].

The Corona et al. meta-analysis also assessed the impact of TTh on libido in hypogonadal men, finding that for 1,269 men across 14 randomized, placebo-controlled trials, the IIEF-SD significantly improved (p=0.001) [25]. These findings suggest that TTh may be more effective in improving sexual desire than in improving erectile function in men with moderate or severe ED. Citing previous studies that had failed to show improvements in libido on therapy, Corona et al. highlighted that many of these studies did not specifically examine a population with low testosterone at baseline and that in eugonadal men, TTh may be less beneficial in improving libido.

While TTh can improve libido, it is not without its risks [42]. Due to the wide-spread use of testosterone-related products for seemingly age-related symptoms and the potential cardiovascular risk, the FDA has commissioned a large clinical trial to assess the safety of testosterone products [43]. A joint patient-physician decision should be made whether the potential improvement in erectile function, libido, and energy with TTh outweighs the potential side-effects in each individual patient.

Many studies have demonstrated that TTh significantly improves libido in men. Moving forward, large RCTs specifically studying older men for more than a year of treatment are needed to better determine at what testosterone thresholds men demonstrate improvements or decrements in sexual function and desire. Finally, current measures of evaluating libido are either very narrow in their scope or not validated. As such, future work should focus on more clearly defining the impact of TTh on libido.

In men with low testosterone, normalizing testosterone levels has multiple benefits, most notably improved libido and improved erectile function when used as monotherapy in men with mild ED. For the latter, TTh is especially promising in hypogonadal men with mild ED who are unresponsive to phosphodiesterase-5 inhibitors. Testosterone therapy may be ineffective in men with moderate and severe ED, as the etiology for these more severe pathologies often include advanced diabetes, radical pelvic surgery, or severe neurologic damage. In these cases, a hormonal factor is often not the primary cause of dysfunction, and thus while TTh should be considered, other treatments are likely to be more effective.

Key Points

Testosterone replacement monotherapy can improve erectile function in men with mild ED, but not moderate and severe ED.

In men with low testosterone who are unresponsive to PDE5 inhibitors, normalization of testosterone levels can improve the response to PDE5 inhibitors.

Testosterone therapy improves libido in men with low testosterone.

Funding

A.W.P. is a National Institutes of Health K12 Scholar supported by a Male Reproductive Health Research Career Development Physician-Scientist Award (HD073917-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Program (to Dolores J. Lamb).

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Testosterone Therapy Improves Erectile Function and Libido in ...

Its possible you dont have the energy, libido, or mood you used to. There can be several reasons, but one may have to do with dropping testosterone.

Testosterone is a hormone found in all humans. However, it plays a far more prominent role in men than women. It plays a role in sex drive, bone and muscle mass, fat storage, and red blood cell production. It may also affect a mans mood.

Testosterone typically peaks in a mans 20s or early 30s before it starts tapering off slowly over time. But everybodys baseline testosterone level is different. Some men are born with a lot of testosterone, while others are born with less. Normal testosterone can be anywhere from 280 to 1,100 nanograms per deciliter (ng/dL), which is a huge range.

So, somebody who has 1,100 ng/dL may feel it a lot more if levels get to 950 ng/dL than someone who starts with 500 ng/dL and sees it drop to 100 ng/dL. The difference may be more pronounced.

What might it feel like?

Low testosterone may create some of the following symptoms:

Youll only learn if you have low testosterone through blood tests, and youll only understand the rate its dropping with several tests used to track changes over time.

What can you do about it? There are a few things that may halt testosterone loss or at least slow it.

Diet and exercise can both play a role in testosterone levels. Weight training is associated with higher testosterone, and so is eating a nutrient-rich diet that is low in processed food. Fruits, vegetables, nuts, lean proteins, legumes, etc., is the way to go.

Managing weight may also help.

Testosterone replacement therapy, or TRT, is a procedure that can help, as well. It is still under study, but talk to your doctor if you believe low testosterone affects your quality of life.

Mat Lecompte is a health and wellness reporter for Bel Marra Health, which firstpublishedthis article.

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Low Testosterone and What You Can Do About It - The Epoch Times

When you are diagnosed with low testosterone, it is likely that you have a range of symptoms that you are keen to leave behind. These symptoms may include low energy, low sex drive, and even depression. Then, when you start testosterone therapy, you probably hope that these symptoms will quickly disappear. Its important to understand, however, that it can take some time for you to notice the benefits of the treatment.

Testosterone replacement therapy can take several months to fully resolve symptoms, but you might start to feel certain benefits much sooner. The following effects are some that you can expect to see within a few weeks of beginning therapy. As you read, however, it is also important to remember that every body is different. That means there is no exact time frame that applies to everyone. Ultimately, consult your doctor if you are concerned that TRT is taking too long.

Studies show that men who receive testosterone replacement start to notice their sex drive rising after just three weeks. This is often the first sign that the TRT is starting to work. Stick with it and you should soon see improvements in many other aspects of your life.

Its reasonable to expect your overall quality of life to start feeling better after three or four weeks. You should notice a reduction in depression after three to six weeks, although it might take several months to fully recover.

For men who have diabetes, or pre-diabetes, testosterone replacement therapy may bring dramatic and rapid improvements. After just a few days, your insulin sensitivity could measurably improve. However, full blood sugar control takes longer (often between three and twelve months). Continue taking your diabetes medications even if you feel better, and visit your doctor regularly to find out whether you need to adjust your dose.

Although the first testosterone therapy effects appear quickly, you need to keep up with the course of treatment for an extended period of time to reap the full benefits.

Your sex life should improve over time as you receive testosterone replacement therapy. Although most men notice increased interest in sex after just a few weeks, it could take as much as six months for your erections to improve firmness.

Taking TRT for several months can change the way your body looks. After three or four months, you should notice an increase in lean body mass. You might also notice that you have a little less fat. These changes occur because testosterone makes the body prioritize building muscle over putting down fat stores. If you regularly work out in the gym, you might notice your muscles getting stronger so you can lift heavier weights.

Perhaps the slowest-acting benefit of TRT is its effect on your bones. Studies show that men taking testosterone have measurably stronger bones after six months on the therapy. However, it can take three years or more for bones to fully strengthen on TRT.

Every man has a unique reaction to testosterone replacement therapy. The amount of time it takes to notice certain benefits depends on your current testosterone levels, the cause of your low testosterone, and other biological factors.

The most important thing to remember is that you need to be patient. Its normal to want to feel better as quickly as possible, but TRT takes time to work. Keep taking testosterone and stick to the dose recommended by your doctor.

If you have been on testosterone replacement therapy for several weeks or months and you are not noticing improvements, see your doctor for advice. Your doctor might need to change the dose or the method of delivery to ensure you get the full benefits of TRT.

Never stop your treatment without talking to a doctor first, even if you do not feel any effects. It is very important to always have medical supervision when stopping, starting, or changing your dose of hormone therapy.

The team of experts at Elite Healthcare Center can help you reap the benefits of testosterone replacement therapy. Schedule an appointment today to learn more about the benefits TRT can offer for you and how soon you can expect to start feeling them.

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How Long Does It Take to Feel the Benefits of Testosterone Replacement ...

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TRT Testosterone Replacement Therapy Clinic - Peter Uncaged MD

Have you or your partner ever noticed that you are having hot flushes, gaining weight, or an impaired sexual function?These are just a few of the symptoms of male menopause, a health condition that doesn't get much attention.

We all know that women have a fixed ovarian reserve which gradually decreases over time, leading to menopause. Men don't go through menopause, but they face a similar problem as their testosterone levels tend to drop dramatically. And it's called andropause, or just male menopause. As men age, they undergo a number of changes, from graying of hair to loss of muscle mass. The drop in testosterone levels is one of the most dramatic changes men go through.

"It's not often discussed since there isn't much research on the issue, owing to the fact that you don't die from a decrease in gonadal hormones, and the hormone withdrawal isn't as extreme as in women. When males experience this, there are typically other factors at play, in addition to the decline in hormones such as workplace stress, marriage stress, life management, and lifestyles," said Dr Anubha Singh, Gynecologist and IVF Expert from Shantah Fertility Centre, Vasant Vihar, New Delhi.

What is Andropause exactly?

The reduction in testosterone levels in males is referred to as male menopause.

"Anytime beyond the age of 40, when women's oestrogen levels begin to decline. Low testosterone is a term used by certain doctors to describe it. It is natural to see a decrease in the production of the male hormone testosterone as you become older, but it can also happen when you have diabetes. Late-onset hypogonadism, often known as age-related low testosterone, is a steady decrease in testosterone levels. It is a more gradual menopause than female menopause, in which ovulation stops and hormone production drops over a short period of time," explained Dr Anubha Singh.

What are a few of the signs and symptoms?

Fatigue, poor libido, and difficulties concentrating are just a few of the symptoms that might occur as a result of this reduction. Apart from these following are other signs and symptoms:

Diminished mental acuity (poor concentration, depressed mood) Loss of strength and energy

Gaining weight, losing muscle, and gaining fat

Depressed moods and/or a lack of zeal and enthusiasm Irritability

Muscle aches and pains (feeling stiffness)

Sweats or hot flushes

Hands and feet that are cold

Itching Sexual dysfunction Loss of height

What causes Andropause?

Testosterone is responsible for a variety of important functions in men. For example, it regulates libido, sperm production, and muscle mass. Dr Shobha Gupta, Medical Director and IVF Specialist from Mother's Lap IVF Centre, Pitampura, New Delhi explained "Testosterone is important for bone health and blood production. It is produced in the testes and adrenal glands. As men tend to grow old, testosterone levels tend to drop, along with the ability to produce sperm. This leads to a condition called andropause".

When do men experience Andropause?

Andropause can begin around the age of 40 but it can begin earlier and continues till 70.

There has been increasing discussions about andropause, but not all doctors and psychologists agree that there is male menopause because not all men experience it, and for those who do, they often do not express it. Their feelings are like freely as women.

Diagnosing and treatment

"If you feel the above mentioned symptom then that's your sign otherwise your doctor will likely do a blood test to measure your testosterone levels. If they are low, hormone replacement therapy (HRT) may be prescribed. You may be advised to change your lifestyle, such as get more exercise and eat a healthier diet," further explained Dr Shobha Gupta.

How can you help your body and mind cope with andropause?

Eat a good diet: A healthy diet, which includes a balance of vegetables, fruits, meats, fish and dairy products

Be active: Engage in regular exercise, including aerobic, muscular and flexibility exercises

Regular health check-ups: Get regular health check-ups including cardiovascular, prostate and testicular cancer

Hormones: Check hormone levels as you get older. Generally, between 40 and 55 several important hormones in a man's body begin to decline

Reduce stress: Exercise and relaxation help to reduce stress, as does talking to your partner, friends and family about your problems

Intimacy: Although sex is still important as you go through male menopause, you will start to view sex as a part of a loving relationship which includes friendship, intimacy and sharing

Sleep: Get plenty of sleep

Men cope differently with menopause, it depends a lot on their personality. Unlike menopause in women, Dr. Shobha Gupta believes "more research is needed on andropause, or male menopause, to fully understand it and determine what can be done to help men at this stage in their lives."

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Men have it too - The Hans India

Women undergoing the menopause and perimenopause should be encouraged to seek help with managing their symptoms, according to a group of prestigious medical charities who today set out a list of 11 new practice standards for menopause care.

The standards, drawn up by six key medical organisations including the British Menopause Society and Royal College of Obstetricians and Gynecologists, also suggest women who ask for help to manage symptoms should be offered holistic and individual advice on their treatment options.

This could include support to change their diets, quit smoking and reduce their alcohol consumption, alongside information on hormone replacement therapy (HRT) and other hormonal treatments.

The guidance comes in response to growing concern that millions of women are suffering menopausal symptoms without being diagnosed or seeking treatment. Even when women do visit a doctor to discuss their symptoms, around one third are not offered treatment such as HRT, according to the charity Menopause Support.

The other standards cover everything from diagnosis without the use of blood tests, to the use of testosterone to boost libido. Many of them are already in line with current guidelines from the National Institute for Clinical Excellence (NICE), although the British Menopause Society says its standards put more emphasis on tailoring treatment options for individuals, and allowing treatment to continue for as long as necessary.

They come as NICE is in the process of updating its guidance on caring for people experiencing menopause. In May it said it was considering including cognitive behavioural therapy to help manage menopausal symptoms, and said the new guidance will cover women, non-binary and trans people with menopause aged 40 and older.

Women aged 45 or over presenting with menopausal symptoms do not need a blood test to confirm diagnosis, according to the new standards. The diagnosis of menopause or perimenopause should be considered on the basis of a womans symptoms alone, unless there is uncertainty about the diagnosis, the standards suggest. That is in line with current NICE guidelines.

A dry or itchy vagina, or a sudden need to urinate, can be one symptom of menopause. About 50 per cent of menopausal women report experiencing genitourinary problems of this kind those suffering should be offered vaginal estrogen, the standards say.

Women having treatment for menopausal symptoms should ideally have a review three months after starting treatment and should continue to be reviewed at least annually after that, according to the standards. That review should include an assessment of symptom management and standard health check up, including weight and blood pressure checks.

Most menopause symptoms last for about seven years, and a fifth of women experience symptoms for up to 15 years. Women should be able to continue with HRT treatment for as long as they feel necessary, after weighing up the risks and benefits, according to the standards.

As women age the level of testosterone in their system can fall, causing a slump in sexual desire. Testosterone supplements can be issued for women with low libidos to redress this, if HRT alone has not proved effective, the standards say.

Early menopause can happen naturally if a womans ovaries stop making normal levels of certain hormones, particularly the hormone oestrogen. This is also known as primary ovarian insufficiency (POI). Women presenting to with a picture suggestive of POI should have a blood test to confirm the diagnosis, the standards say.

Women with POI are at increased risk of cardiovascular disease, osteoporosis and cognitive impairment. Taking hormone replacement until the natural age of the menopause can lower these risks, the standards stress.

Women who experience an earlier than usual menopause should be offered support in a similar way to women with POI, and should also be advised to take hormonal replacement until the natural age of the menopause, according to the standards.

If specialist input is required women should be referred to specialist menopause services, for example if HRT is not alleviating symptoms, where they have had an inconclusive diagnosis, or where a woman gas a complex medical background.

The rest is here:
New guidelines for menopause care say women should be offered personalised treatment including diet and HRT - iNews

Clarus Therapeutics (NASDAQ:CRXT Get Rating) and Biogen (NASDAQ:BIIB Get Rating) are both medical companies, but which is the superior investment? We will compare the two businesses based on the strength of their profitability, risk, institutional ownership, dividends, analyst recommendations, valuation and earnings.

Profitability

This table compares Clarus Therapeutics and Biogens net margins, return on equity and return on assets.

This table compares Clarus Therapeutics and Biogens top-line revenue, earnings per share and valuation.

Biogen has higher revenue and earnings than Clarus Therapeutics.

Risk and Volatility

Clarus Therapeutics has a beta of 2.84, meaning that its share price is 184% more volatile than the S&P 500. Comparatively, Biogen has a beta of 0.42, meaning that its share price is 58% less volatile than the S&P 500.

Analyst Ratings

This is a breakdown of current recommendations and price targets for Clarus Therapeutics and Biogen, as provided by MarketBeat.

Clarus Therapeutics currently has a consensus target price of $7.90, indicating a potential upside of 1,918.40%. Biogen has a consensus target price of $261.99, indicating a potential upside of 23.62%. Given Clarus Therapeutics stronger consensus rating and higher probable upside, research analysts plainly believe Clarus Therapeutics is more favorable than Biogen.

Institutional and Insider Ownership

19.5% of Clarus Therapeutics shares are held by institutional investors. Comparatively, 83.9% of Biogen shares are held by institutional investors. 5.3% of Clarus Therapeutics shares are held by company insiders. Comparatively, 0.5% of Biogen shares are held by company insiders. Strong institutional ownership is an indication that endowments, large money managers and hedge funds believe a stock will outperform the market over the long term.

Summary

Biogen beats Clarus Therapeutics on 8 of the 12 factors compared between the two stocks.

About Clarus Therapeutics (Get Rating)

Clarus Therapeutics Holdings, Inc., a pharmaceutical company, focuses on the development and commercialization of oral testosterone replacement therapy in the United States. It offers JATENZO, a soft gel oral formulation of testosterone undecanoate for treating hypogonadal men. The company has a licensing agreement with HavaH Therapeutics for product to treat androgen therapies for inflammatory breast disease and certain forms of breast cancer; and license agreement with The Royal Institution for the Advancement of Learning/McGill University to develop and commercialize McGill's proprietary technology designed to treat conditions associated with CoQ10 deficiencies in humans. Clarus Therapeutics Holdings, Inc. was founded in 2003 and is based in Northbrook, Illinois.

About Biogen (Get Rating)

Biogen Inc. discovers, develops, manufactures, and delivers therapies for treating neurological and neurodegenerative diseases. The company offers TECFIDERA, VUMERITY, AVONEX, PLEGRIDY, TYSABRI, and FAMPYRA for multiple sclerosis (MS); SPINRAZA for spinal muscular atrophy; and FUMADERM to treat plaque psoriasis. It also provides BENEPALI, an etanercept biosimilar referencing ENBREL; ADUHELM for the treatment of Alzheimer's disease; IMRALDI, an adalimumab biosimilar referencing HUMIRA; and FLIXABI, an infliximab biosimilar referencing REMICADE. In addition, the company offers RITUXAN for treating non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), rheumatoid arthritis, two forms of ANCA-associated vasculitis, and pemphigus vulgaris; RITUXAN HYCELA for non-Hodgkin's lymphoma and CLL; GAZYVA to treat CLL and follicular lymphoma; and OCREVUS for treating relapsing MS and primary progressive MS; and other anti-CD20 therapies. Further, it develops BIIB135, BIIB061, BIIB091, and BIIB107 for MS and neuroimmunology; Aducanumab, Lecanemab, BIIB076, and BIIB080 to treat Alzheimer's disease and dementia; BIIB067, BIIB078, BIIB105, BIIB100, and BIIB110 to treat neuromuscular disorders; BIIB124, BIIB094, BIIB118, BIIB101, and BIIB122 for treating Parkinson's disease and movement disorders; BIIB125 and BIIB104 for treating neuropsychiatry; Dapirolizumab pegol and BIIB059 to treat immunology related diseases; BIIB093 and BIIB131 to treat acute neurology; BIIB074 for neuropathic pain; and BYOOVIZ, BIIB800, and SB15 biosimilars, which are under various stages of development. The company has collaboration and license agreements with Acorda Therapeutics, Inc.; Alkermes Pharma Ireland Limited; Denali Therapeutics Inc.; Eisai Co., Ltd.; Genentech, Inc.; Neurimmune SubOne AG; Ionis Pharmaceuticals, Inc.; Samsung Bioepis Co., Ltd.; Sangamo Therapeutics, Inc.; and Sage Therapeutics, Inc. Biogen Inc. was founded in 1978 and is headquartered in Cambridge, Massachusetts.

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Head-To-Head Contrast: Biogen (NASDAQ:BIIB) and Clarus Therapeutics (NASDAQ:CRXT) - Defense World

DAVINA McCALL could not believe it when two US neuroscientists told her hormone replacement therapy might reduce the risk of dementia and she was not the only one.

In the presenters Channel 4 documentary Sex, Mind And The Menopause, Dr Lisa Mosconi and Dr Roberta Diaz Brinton from Arizona University said oestrogen could have huge potential in lowering womens chances of developing Alzheimers.

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Speaking exclusively to Sun Health, Dr Brinton revealed that women are twice as likely to get dementia because of the way their brain changes during menopause, when oestrogen levels drop and affect brain function.

She said: On average, women live four and a half years longer than men, but that doesnt account for a two-fold greater lifetime risk of developing Alzheimers disease.

Our research shows its not because women live longer than men. Its because they begin the disease earlier, in mid-life.

Due to oestrogen loss during menopause, the brain can suffer a 20 to 25 per cent drop in glucose metabolism, the process that provides the brain with fuel.

That drop can trigger a starvation response in the brain.

It can lead to a decline in white brain matter (which helps different parts of your brain communicate) and an increase in a sticky plaque, called amyloid beta deposition, which, according to Dr Brinton, is found in greater quantities in people with dementia.

In theory, prescribing oestrogen to women who are in perimenopause which starts several years before menopause could reduce their risk of these problems and dementia.

But HRT is not suitable if, for instance, you have had breast, ovarian or womb cancer.

Most read in Womens Health

And oestrogen treatment is no good post-menopause, either. Dr Brinton said: Using oestrogen as a treatment doesnt work, as the brain has already changed. Its needed when women have symptoms.

She adds there is no data on whether intervening before symptoms would work, and little research has been carried out on HRT and the brain in the UK.

That is not good enough, says Dr Louise Newson, who supports our Fabulous Menopause Matters campaign, especially when 600,000 British women have dementia and it is the leading cause of death in UK women.

The HRT shortages have also forced some women to take drastic action and buy the drugs they need on the black market.

Sam Youngz, 49, a wellness adviser from Telford, Shrops, said: My nan had dementia and my mum suffers. Ive been diagnosed with Ehlers-Danlos syndrome, a connective tissue disorder that affects the whole body including the brain. My risk is high.

Sam went through early menopause at 37 and was shocked by the revelations in Davinas show. She said: I was finally diagnosed as menopausal at 44, so the news is too late for me. I dont know if it would have helped, but I wish Id had the chance to try.

Fabulous Menopause Matters

An estimated one in five of the UKs population are currently experiencing it.

Yet the menopause is still whispered in hush tones like its something to be embarrassed about.

The stigma attached to the transition means women have been suffering in silence for centuries.

The Sun are determined to change that, launching the Fabulous Menopause Matters campaign to give the taboo a long-awaited kick, and get women the support they need.

The campaign has three aims:

The campaign has been backed by a host of influential figures including Baroness Karren Brady CBE, celebrities Lisa Snowdon, Jane Moore, Michelle Heaton, Zoe Hardman, Saira Khan, Trisha Goddard, as well as Dr Louise Newson, Carolyn Harris MP, Jess Phillips MP, Caroline Nokes MP and Rachel Maclean MP.

Exclusive research commissioned by Fabulous, which surveyed 2,000 British women aged 45-65 who are going through or have been through the menopause, found that 49% of women suffered feelings of depression, while 7% felt suicidal while going through the menopause.

50% of respondents said there is not enough support out there for menopausal women, which is simply not good enough. Its time to change that.

Dr Newson said research looking at both women who do and women who do not take HRT could be a game-changer.

She added: Is it because men have more testosterone in the brain that they are less likely to develop dementia?

We need answers. We know if women have their ovaries removed, their cognitive function declines faster than women who havent had them removed.

Women who go through early menopause are also more likely to experience dementia. But does giving these hormones back to women help reduce the risk?

Its logical to assume putting something back in the brain that helps it function would help. The logic is there. Nothing is proved.

After four years of low mood, brain fog and insomnia, Katie Taylor, 53, is reaping the benefits of HRT.

The Latte Lounge founder a website that supports women in mid-life lives in London with her husband and children, and at 47 was diagnosed as perimenopausal.

She began using oestrogen and progesterone patches and said: In a few weeks, all my symptoms disappeared. I had energy again.

She was sleeping better and her brain clarity returned. Katie added: I can see the difference HRT has made.

Dr Newson, who had brain fog before starting HRT, said: Many women think they have dementia. We know brain fog improves with HRT. If it helps reduce dementia risk too, then thats incredible.

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Im a GP heres the truth behind Davina McCalls claims about HRT and dementia... - The Sun

Looking for the best online hormone replacement therapy? If so, you have to make sure that you look carefully and patiently, as TRT can help you improve your life. Those who are experiencing issues with their manhood most of the time hide themselves because they fear judgements and conversations about it.

Just so you know, low testosterone levels affect not only the older generation but even the younger ones. There are certainties in life that may lower the testosterone level of even the younger generations.

There is no reason to feel ashamed if you experience this because it is a condition to be treated and not to neglect.

There are many clinics offering TRT, but just to set your expectations, not all of them are as good as the others. Spotting the best clinic to seek help from may not be easy, especially that you want to maintain your privacy and at the same time get the best result so you can go back to your old life, and make things better for you.

Low testosterone not only impacts your sex drive or erectile dysfunction, it also affects your mental, emotional and physical capabilities and abilities. If you have low testosterone, you are affecting not just yourself but everyone else around you.

Why would you make everyone suffer if there is a way you regulate your testosterone level?

Moving on, all the benefits of TRT cannot be achieved if in the first place, the clinic where you are at right now is not as reliable in terms of providing high quality treatment.

To help you spot on the best clinic to get this treatment from, here are some of the things you can do:

Ask around

Asking around may not be the easiest for you to do especially if you want to keep things just within yourself. But needless to say, if you have the courage to do so, might as well ask people around you, especially your family and friends.

Your family and friends are your most trusted source of information, and besides, if they know that you are struggling, for sure, they wont judge you.

This may not be the easiest to do, but if you want to get an assurance that the physician you will seek consultation from wont disappoint you, this is the best route you can take.

Read reviews online

Reading reviews online is another thing you can do if you want to spot the best TRT clinic out there. But since not all reviews online are legitimate, you have to be careful when choosing reviews to read and trust.

The reviews you must trust should be coming from either a trusted website or personality. Do not be deceived by reviews made only to market a specific clinic and not to help those who are in need of valid information about a good TRT to visit.

You may also want to join forums about TRT. Through this, you can get not only information about a specific clinic but also real life experiences of people who tried this.

Check the clinics history

Checking on the clinics history is also a good idea. Who are the doctors behind their clinics success and operations? How long have they been in the industry providing TRT service? The longer they are in the industry, the better. No clinic can last in this kind of industry unless they are providing or even exceeding what is expected from them.

Try their service

Lastly, try out their service. There is nothing more reliable than your own experience. Are you getting the result you are hoping for? Of course, you must not expect improvements after one injection, but needless to say, you must somehow feel positive changes as the treatment progresses.

Trying their service can be a bit costly especially if you made the wrong choice, so make sure that before you go through this option, you already completed your assignment and went through the ways provided above.

While with them, here are the signals that you actually made the right decision:

You can see improvements on yourself

Are you seeing and feeling improvements? Again, the result may not be abrupt, but small steps or improvements will surely go a long way. If after being with them for a long time you do not feel any positive changes, only side effects, then it is obviously time that you move out.

Sometimes, it pays to ask the clinic what you will get in case things didnt go well as planned. Some are not as comfortable asking this question, especially if they are being treated by popular, highly reputable professionals. But if you will think of it, things may happen unexpectedly, and to be on the safe side, it would be best if you know their action plans in case things didnt go as you agreed.

You can contact anyone, when necessary

If you can contact anyone from their clinic when needed or if you have questions, then you are in good hands. The availability of their office for questions and inquiries is a good indication that they are really after a satisfactory experience for their clients.

You do not feel betrayed when paying money

Do you feel happy every time you settle your payment with them? If yes, then obviously, you are in a good clinic. TRT is not as cheap, hence, paying without the feeling of regret is a clear sign that you are happy with whatever improvements you are seeing for yourself. If the other way is what you are feeling, then, it is time to move out and look for a different clinic to provide this service.

People, particularly your partner, is happy with the results

Is your partner happy with the result of your TRT? If so, then you are in good hands. Apart from yourself, it is your partner that can assess whether the treatment is doing well with you or not. If your partner is happy, then there is no reason to change clinics.

DISCLAIMER:

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How To Spot The Best Clinic For Your Hormone Replacement Therapy - My MMA News.com