When your spouse, partner, father, or other important adult male in your life won’t go to see a doctor, what can a concerned woman do? If you find yourself in this situation, you are not alone. According to the US Department of Health and Human Services’ Agency for Healthcare Research and Quality, men are 24 percent less likely than women to have visited a doctor within the past year, and they are 22 percent more likely to have neglected having their cholesterol levels checked.

The Agency also finds that men are 28 percent more likely than women to be hospitalized for congestive heart failure, 32 percent more likely to be hospitalized for long-term complications associated with diabetes, and more than twice as likely to require amputation of a leg or foot due to diabetic complications. Failure to get immunized for pneumonia contributes to the fact that men are 24 percent more likely than women to be hospitalized for pneumonia.

Why Men Don’t Go to Doctors

According to a study presented at the American Sociological Association in San Francisco in summer 2009, men who strongly value old-school ideas about masculinity, such as men should be strong and silent and not complain about pain, are only half as likely as other men to visit a doctor for an annual physical or seek other types of preventive health care.

In a similar vein, a 2007 study conducted for the American Academy of Family Physicians (AAFP) of more than 1,100 men found that 92 percent said they wait at least several days to see if they feel better before they seek care from a health professional. Nearly 30 percent push the envelope and say they wait “as long as possible” before considering a doctor visit. At the time, AAFP President Rick Kellerman, MD, remarked that “One of the biggest obstacles to improving the health of men is men themselves. They don’t make their health a priority.”

Tips on How to Get A Man to a Doctor

• Offer encouragement. In the AAFP study, 69 percent of the men said they had a spouse or significant other in their lives, and of those men, nearly 80 percent said the other individual had an influence in their decisions to go to a doctor. If you are trying to encourage your spouse or partner to go a doctor, he may consider it to be nagging. The secret may be in the delivery: gentle suggestions work for some men, while others respond to a more direct approach. Only you know how much so-called “nagging” may be helpful—or turn him off completely.
• Express concern. Offer to listen to his reasons why he doesn’t want to go to a doctor. Talking about it may give him a different perspective.
• Express understanding. Men frequently comment (not always to their partners, however) that getting a physical exam and undergoing tests can be embarrassing or uncomfortable. A physical for prostate or urinary tract problems, for example, involves a digital rectal exam and examination of the scrotum, which may make some men feel uncomfortable, just like some women dread or avoid gynecological examinations for the same reason. If discomfort is an issue, perhaps you can work together to find a healthcare provider with whom your partner or spouse feels comfortable.
• Send him e-mails. These should be brief but relevant communications about the health issue(s) that concern him. For example, if he has been experiencing problems with urination or erectile dysfunction, you might send an e-mail containing a “Prostate Health” checklist from a men’s health website.
• Go to screenings together. For basic preventive care, you can offer to go with him to screenings. Hospitals, clinics, community health fairs, senior centers, and other venues often offer preventive screenings for cholesterol, blood pressure, blood glucose, PSA, and bone density. These events are typically low-key, nonthreatening affairs.
• Help him find a healthcare provider. Among the reasons some men give for not going to a doctor are “I don’t have time” and “I don’t know of a good doctor in my area.” You can reduce or eliminate these excuses by gathering information about doctors and specialists in your area, getting recommendations from friends and other trusted healthcare providers, and investigating the potential candidates on the internet.
• Go to health lectures. Healthcare providers frequently give presentations to the public at hospitals, community centers, or other venues. Cities that have teaching hospitals often have such programs on a regular basis. Attend these programs together or encourage your spouse or partner to go. They are an excellent way to learn more about a specific doctor and/or medical condition and may be the trigger that gets a man to go to a doctor or seek medical help.

You have a better chance of convincing the man in your life to go to a doctor if you and he understand why he is reluctant to go, educate yourselves about the available medical care in your area, and then work together to make it happen.

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Sources:

American Family Physicians

Health and Human Services’ Agency for Healthcare Research and Quality

No wonder it is so vital to men’s health and the propagation of the species!

The Prostate’s Purpose:

1. Gland

The primary job of the prostate is to produce and secrete some of the alkaline seminal fluids during ejaculation (about 30-35% of the semen ejaculate). Being alkaline, the prostate fluid, which is milky whitish in color, helps the sperm survive in the acidic vaginal environment. The prostate is considered to be a gland since glands secrete something.

2. Mix Master

The prostate mixes its fluids with those from the seminal vesicles to transport the sperm made in the testicles. Together these fluids surge through the prostate into the urethra during ejaculation. The urethra doubles as the semen tube during ejaculation and as the urine tube from the bladder, both fluids exiting the tip of the penis. The section of the urethra that runs through the prostate gland is called the prostatic urethra and is about 3cm (1½”) long.

Prostate-specific antigen (PSA) is a fluid produced in the prostate, playing a key role in enabling the sperm to swim into the uterus by keeping the semen in liquid form. It counteracts the clotting enzyme in the seminal vesicle fluid, which essentially glues the semen to the woman’s cervix, next to the uterus entrance inside the vagina. PSA dissolves this glue with its own enzyme so that the sperm can dash into the uterus and impregnate an egg if it is there.

It is this same PSA that is tested during the PSA blood test, a very controversial test because of the many factors that can cause the results to vary widely.

3. Muscle

The prostate is also a muscle that pumps the semen out through the penis with enough force to enter into the vagina to help the sperm succeed in reaching the cervix and ensuring procreation of the species.

4. AH!

An added bonus for males, the pumping action of the prostate sure feels good, making sex desirable and thus helping procreation.

5. G

The prostate is the male G-spot. Prostate stimulation can produce an exceptionally strong sexual response and intense orgasm in men that are receptive to this sexual technique. The ability to control ejaculation at the prostate can also lead to prolonged orgasms and “injaculations” where no semen is expelled. This is done in advanced Taoist and Tantric sexual practices to contain the sexual energy internally.

6. Filter

The prostate also filters and removes toxins for protection of the sperm, which enhances the chance of impregnation and ensures that men seed with the optimum quality of sperm. This is perhaps the prostate’s most important function and, at the same time, can be one of the main reasons there is a growing epidemic of prostate disease and cancer as men deal with more and more toxins in food and the environment.

7. Erections

The prostate erection nerves are responsible for erections. These nerves trigger the penis to swell and harden with extra blood flow into it, producing an erection.

If these nerves, which attach to the sides of the prostate, get damaged then erectile difficulties are guaranteed. That is why many medical prostate procedures (surgery or radiation) have an unwanted side effect of erectile difficulties or impotence.

8. Secretions

Prostatic secretions also play a valuable role by protecting the urethra from urinary tract infections, which seem to be much more rare in men than women.

9. Valves

The prostate, which surrounds the upper part of the urethra tube just below the bladder (the prostatic urethra), controls the flow of urine. It prevents urine from leaving the bladder, except when released by urination. It also prevents urine from damaging ejaculate during orgasm.

It does this with two small prostatic muscles called sphincters. They act as gatekeepers with shut-off valves to control and regulate the dual-purpose urethra tube. These gatekeepers ensure the right fluids flow at the right time – urination or ejaculation. Not a bad design!

One sphincter is located where the bladder and the upper part of the prostate meet (the internal upper sphincter). When functioning properly, it prevents urination until it’s time to go and stops seminal fluid from shooting backwards into the bladder during ejaculation. When damaged, semen is forced back into the bladder and eventually exits with normal urination. This is known as retrograde ejaculation and is another possible side effect of prostate surgery – no chance of seeding a woman then!

The second, external lower sphincter is at the base of the prostate and is subject to our control. It prevents dribbling after peeing and is how we voluntarily can delay urination when inconvenient to go. Incontinence occurs when control of either sphincter is damaged and urine leaks or flows uncontrollably, thus forcing many men with prostate problems to wear adult diapers.

It’s easy enough to voluntarily control the lower sphincter and to stop urine or semen from exiting if you have enough Kegel muscle control, the ability to squeeze the flow shut. Either one of these sphincter muscles will block the urine until the urge to pee happens and the timing is right to release and let the urine flow.

An enlarged prostate or BPH can squeeze the prostatic urethra tube and the upper or lower sphincter, making urination difficult with a host of unpleasant, uncontrollable symptoms. BPH surgeries that remove part of the prostate can easily have side effects of incontinence or retrograde ejaculation.

10. Hormones

The prostate gland contains a crucial enzyme, 5-alpha-reductase. This enzyme converts the hormone testosterone in the body to DHT (dihydrotestosterone), which is at least ten times more powerful than simple testosterone. This potent hormone DHT has several purposes including male sexual drive and function. Over time, a build-up of toxins in the prostate may affect the production of this enzyme, which is then responsible for the declining sex drive in men as they age.

DHT and testosterone have mistakenly been targeted as guilty hormones in prostate problems rather than the excessive rise in modern male estrogen levels, leading often to medical interventions with serious side effects including lack of libido. Estrogen levels rise because of the prevalence of estrogens in factory foods, commercial meats and dairy, and estrogen-mimicking chemicals present in body-care and household products. It’s even found in municipal water and some plastic food packaging.

With such a complex gland having so many functions, prostate disease can wreak havoc on a man’s health. Men would be wise to do all they can to enhance the health of their prostate – an unhealthy prostate can have an enormous impact on sexual function and simple daily urination.

The prostate is a powerhouse: a remarkable gland with huge repercussions on a man’s quality of life!

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Ronald M Bazar, a Harvard MBA, is a health enthusiast and author of the new comprehensive book on the prostate called ”Healthy Prostate: The Extensive Guide To Prevent and Heal Prostate Problems Including Prostate Cancer, BPH Enlarged Prostate and Prostatitis“, which is available on Amazon, iTunes, Kindle and more outlets.

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A new penis enlargement technique reported in the Journal of Sexual Medicine involves injecting a substance called hyaluronic acid into the penis. According to the study’s authors, the men who participated in the study got a bigger penis and were pleased with the results.

If you are not familiar with hyaluronic acid, it is a substance produced naturally by the body, but it can also be made in a laboratory. You may know it better as the filler that can be injected into the face to temporarily reduce wrinkles by “filling in” soft tissue. Doctors also use hyaluronic acid injections for some patients who have arthritis of the knee.

The quest for a bigger penis drives some men to purchase unusual herbal remedies from late night commercials or to attach weights to the end of their penis in an attempt to stretch it. Men have even resorted to undergoing surgery that involves implanting cadaver tissue around the shaft to give the penis more girth.

Compared with these penis enlargement attempts, the use of hyaluronic acid injections may sound tame. In the study, which was conducted at Korea University in Seoul, 50 men with “subjective small penises” agreed to let the tissue surrounding the penis be injected with 20.5 cc of hyaluronic acid.

The men reportedly were pleased with the results: on average, they experienced a 4-cm (about 1.5 inches) increase in penile circumference (girth), and the bigger penis was maintained for 18 months.

What is the average penis size? According to a study published in Psychology of Men and Masculinity, the erect penis size of most men (68%) is between 4.6 and 6 inches long. The remaining 32% of men have an erect penis that is either longer than 6.1 inches (16%) or shorter than 4.5 inches (16%).

The use of hyaluronic acid injections to make the penis bigger did not cause any serious side effects, and the study’s authors concluded that the wrinkle reducer was “a very effective and safe technique for penile augmentation.”

Sources:

Kwak T et al. The effects of penile girth enhancement using injectable hyaluronic acid gel, a filler. Journal of Sexual Medicine 2010 Mar 11

Does penis size really matter? http://www.everydayhealth.com/mens-health/penis-size.aspx

A research team at Thomas Jefferson University’s Kimmel Cancer Center used prostate cancer cells and showed that curcumin suppressed two substances (p300 and CPB) known to work against hormone therapy. In addition, they investigated the use of curcumin in mice and noted prostate cancer tumor growth and mass were significantly reduced in mice dosed with the spice.

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A new study is the first “to have proved the relationship between green tea consumption and incident risk of functional disability.” In other words, drinking green tea daily can improve your chances of enjoying a healthy, independent retirement and being less likely to develop problems when performing everyday activities.

In the study, which was published in the American Journal of Clinical Nutrition, a team of Japanese researchers followed 13,988 Japanese adults age 65 and older for a three-year period. The team evaluated how much green tea the older adults consumed daily and compared it with the level of functional disability they experienced.

Problems with everyday activities such as dressing, shopping, and doing housework were noted in 7% of study participants who drank at least five cups of green tea daily, compared with nearly 13% among adults who drank less than one cup of green tea per day.

The “secret” of green tea is believed to be the presence of catchins, a type of phytonutrient and potent antioxidant capable of fighting and destroying molecules that damage cells and contribute to disability, aging, and disease.

Previous research has indicated that one of the most important catechins is EGCG (epigallocatechin gallate). One example of the importance of EGCG has been seen in studies involving green tea and prostate cancer, where EGCG has been shown to slow the growth of prostate cancer as well as reduce the levels of PSA and two biomarkers for prostate cancer, hepatocyte growth factor and vascular endothelial growth factor.

The benefits of green tea extend ever further, as a growing number of studies show EGCG and green tea to be associated with weight loss, reducing heart disease risk, protecting gum health, and offering anticancer potential beyond prostate cancer.

Now in this latest study, the lead researcher, Yasutake Tomata, of Tohoku University Graduate School of Medicine, has noted that “green tea consumption is significantly associated with a lower risk of incident functional disability, even after adjustment for possible confounding factors.”

At this point, the study’s authors are encouraging more studies to confirm any protective benefits of green tea against functional disability in older adults. However, given what we already know about the health advantages of green tea, it seems a wise choice to make green tea a part of your daily diet to enhance your health now and for your retirement years.

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Source: Tomata Y et al. Green tea consumption and the risk of incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study. Am J Clin Nutr 2012 Mar; doi: 10.3945/ajcn.111.023200

Questions on Erectile Dysfunction and Urinary Incontinence After Prostate Cancer Treatment

Your doctor has just given you the diagnosis: prostate cancer. Now is the time to learn as much as you can about your treatment options and then, with guidance from your physicians, make a decision that’s best for you. Generally there is no right answer for the best prostate cancer treatment because good data from well-run trials are lacking. That’s one reason why it is so important to consult with several experts (e.g., medical oncologist, radiation oncologist, urologist) when making your decision.

When making your treatment decision, determine what is important to you regarding post-treatment priorities, as now is also the time to plan your recovery. Two major areas of concern for many men who undergo prostate cancer treatment are erectile dysfunction and urinary incontinence. Therefore, the following questions may help you make your decision and to understand the possible and probable effect of choosing a particular treatment on erectile dysfunction and incontinence.

• How soon can erectile dysfunction occur after radical prostatectomy? [1]
• How soon can erectile dysfunction occur after hormone therapy begins? [2]
• How soon can erectile dysfunction occur after chemotherapy begins?
• How soon can erectile dysfunction occur after radiation therapy begins? [3]
• What options are available for treating erectile dysfunction?
• How common is urinary incontinence after radical prostatectomy?
• How common is urinary incontinence associated with hormone therapy?
• How common is urinary incontinence associated with radiation therapy?[4]
• How common is urinary incontinence associated with chemotherapy?
• What are the different types of urinary incontinence?
• What treatment options are available to resolve urinary incontinence?
• What tests does a physician do to determine the type of urinary incontinence?
• What dietary changes can I made to improve urinary incontinence?
• What are Kegel exercises and what type of urinary incontinence can they treat?[5]
• What is a penile clamp and what type of urinary incontinence does it treat?
• What are collagen injections and what type of urinary incontinence do they treat?[6]
• What is an artificial urinary sphincter and what type of urinary incontinence does it treat?[7]
• What is a male sling and what type of urinary incontinence does it treat?
• What complementary/alternative therapies can I use to treat erectile dysfunction?

[1] Erectile dysfunction can begin immediately after undergoing radical prostatectomy, whether nerve-sparing technique was used or not. If the nerve-sparing technique was used, recovery from ED may occur within the first year after surgery. Recovery is less likely but still possible after a non-nerve-sparing technique. Source: WebMD: http://www.webmd.com/sexual-conditions/erectile-dysfunction-prostate-cancer

[2] Erectile dysfunction may occur about two to four weeks after the start of hormone therapy and is usually accompanied by a decreased libido. Source: WebMD: http://www.webmd.com/sexual-conditions/erectile-dysfunction-prostate-cancer

[3] Erectile dysfunction usually begins about six months after radiation treatment. Source: WebMD: http://www.webmd.com/sexual-conditions/erectile-dysfunction-prostate-cancer

[4] Urinary incontinence occurs in less than 1% of men who undergo brachytherapy. However, among men who have had a TURP, the risk of incontinence is 25%, and up to 40% if they have had more than one TURP. Source: 100Q&A about Prostate Cancer .

[5] A study that compared Kegal exercises with no treatment for 300 men who had urinary incontinence after radical retropubic prostatectomy found that 94.6% of patients achieved continence after 6 months compared with 65% of patients in the control group. Filocamo MT et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol 2005 Nov; 48(5): 734-38

[6] Collagen injections were found to work best in men who have had a radical prostatectomy but not suitable for patients who have had radiation or cryotherapy because these latter treatments cause damage to the urethra. Westney OL et al. Transurethral collagen injections for male intrinsic sphincter deficiency: University of Texas Houston experience. J Urol 2005 Sep; 174(3): 994-97

[7] A recent (December 2009) study names the artificial urinary sphincter as the “gold standard” for treatment of urinary incontinence after radical prostatectomy. Rodriguez EF, Arano BP. Urinary incontinence after radical prostatectomy. Urinary artificial sphincter. Arch Esp Urol 2009 Dec; 62(10): 838-44

Risk of Lower Urinary Tract Symptoms, Incontinence Growing: What You Can Do

Picture 2.3 billion people. That’s the number of adults who will experience at least one lower urinary tract symptom (LUTS) by 2018, according to a study from the University of North Carolina (UNC). In addition, urinary incontinence is also expected to increase, which means together there will be a staggering number of individuals who can expect to have symptoms of incontinence ranging from urinary frequency to dribbling to getting up multiple times during the night to urinate (nocturia), and failing to reach the toilet in time, among other problems.

The researchers reached their conclusions after using data from two main sources: a telephone survey of more than 19,000 men and women in five countries, and the worldwide and regional population estimates from the US Census Bureau International Data Base, along with definitions from the International Continence Society. Lead author Dr. Debra E. Irwin from the Department of Epidemiology at UNC pointed out that “It is well known that people do not always seek medical attention for urinary problems, so basing our figures on studies using self-reported symptoms is an effective way of measuring worldwide prevalence.”

Some of the findings of the research team include:

• LUTS will affect 45% of men worldwide (most cases are associated with benign prostatic hyperplasia [BPH])
• Between 2008 and 2018, the number of people experiencing at least one LUTS will increase by 30% in Africa, 20.5% in South America, 20% in Asia, 16% in North America, and 2.5% in Europe
• Overactive bladder (OAB) will increase worldwide by 20% between 2008 and 2018
• Urinary incontinence will increase worldwide by 22% between 2008 and 2018

These findings led Dr. Irwin to comment “We believe that our study underlines the clear and urgent need to improve the awareness, prevention, diagnosis and management of these conditions.” So what can you do now to help prevent LUTS and urinary incontinence?

Tips to Prevent LUTS and Urinary Incontinence

A key to preventing LUTS and urinary incontinence is to follow certain lifestyle habits and behaviors that support and promote prostate and urinary tract health. The following tips may help prevent you from becoming one of the statistics revealed in the new study.

• Follow The Prostate Diet: The Prostate Diet is designed to support and promote prostate and urinary tract health. Key to The Prostate Diet is a focus on maximizing fruit and vegetable intake, choosing healthy fats (omega-3s and monounsaturated), selecting plant protein over animal protein, drinking green tea (early in the day to avoid nighttime urination), avoiding foods and additives that can be harmful to your prostate and urinary tract (including but not limited to meat, calcium supplements, and foods high in sugar), choosing whole natural foods, and drinking pure water.
• Avoid drinking fluids late in the day: Staying hydrated is important, but avoid drinking fluids 2 to 3 hours before going to bed to prevent getting up during the night.
• Limit or avoid alcohol: If you do drink, limit your intake to one to two drinks daily, because alcohol can irritate the bladder and increase urinary frequency.
• Maintain a healthy weight: Carrying around excess weight places unnecessary pressure on the bladder, which can exacerbate urinary incontinence and LUTS. If you are having trouble losing weight, seek professional advice.
• Don’t smoke: Smoking is a risk factor for urinary incontinence. If you smoke, quit.
• Manage stress: Stress can have a significant negative impact on urinary tract function, weaken your immune system, and contribute to urinary incontinence. Incorporate stress-reducing activities or practices into your lifestyle.
• Reduce caffeine: If coffee, tea, colas, energy drinks, and chocolate are on your menu, it’s time to check your caffeine intake. Caffeine can promote urinary frequency, so it’s best to limit or avoid products that contain caffeine.
• Avoid foods that irritate the bladder: Carbonated beverages, citrus fruits and juices, milk and cheese, tomatoes and tomato products, and spicy foods can make urinary incontinence and overactive bladder worse.
• Don’t hold it: When you feel the urge to urinate, don’t hold it. Retaining urine can irritate your urinary tract and possibly cause a urinary tract infection.
• Avoid constipation: The Prostate Diet consists of many high-fiber foods, which is the best diet to follow to avoid constipation. Also drink plenty of water to facilitate movement through the intestinal tract.
• Practice Kegel exercises: If you practice Kegel exercises regularly (preferably daily), you can maximize and help maintain bladder control. Kegel exercises can be done just about anywhere and only take a few minutes per day.
• Maintain good hygiene: To reduce the risk of infection, keep your penis and surrounding area clean.
• Control diabetes: Uncontrolled diabetes can contribute to overactive bladder.
• Check your medications: Some prescription and over-the-counter (OTC) medications can cause urinary incontinence or urinary symptoms. These include alpha-blockers, antidepressants, antihistamines, calcium-blockers, diuretics, narcotics, sedatives, and OTC allergy, cold, and diet medications.

Supplements for Urinary Tract Health

Natural supplements can help prevent and fight lower urinary tract symptoms, such as urinary retention, urinary urgency, painful urination, and other symptoms associated with BPH, and urinary incontinence as well.

• Beta-sitosterol is a phytosterol (cholesterol-like substance derived from plants) that helps relieve symptoms of BPH.
• Cranberry contains a special kind of phytonutrients called A-type proanthocyanidins (PACs), which help prevent the development of urinary tract infections. This quality may make cranberry helpful in managing LUTS.
• Diindolylmethane (DIM) is a phytonutrient that is released in the body when gastric acid from the digestive process acts on indole-3-carbinol, the precursor to DIM. Among older men who have BPH, taking DIM may improve reduce nighttime urination.
• Green tea contains potent antioxidants known as catechins, which appear to contribute to its ability to reduce levels of dihydrotestosterone (DHT), a hormone that increases a man’s risk of developing LUTS and BPH.
• Omega-3 fatty acids suppress inflammation in the urinary tract, which can help manage urinary incontinence and overactive bladder.
• Pollen extracts have demonstrated an ability to reduce symptoms of BPH. In one study, more than 75% of men with BPH who took a pollen extract reported significant improvement in their symptoms.
• Probiotics are beneficial bacteria that can restore the bacterial balance in the urinary tract, which in turn supports urinary continence.
• Pygeum is an herbal extract derived from the Prunus africana tree, and valued for its ability to relieve LUTS associated with BPH.
• Quercetin, a phytonutrient found in red grapes, red wine, onions, and other foods, has potent anti-inflammatory and antioxidant properties, which make it helpful in managing LUTS.
• Saw palmetto has a long history of use in the management of prostate and urinary tract problems. Recent scientific studies show saw palmetto inhibited the enzyme (5- alpha-reductase) that is associated with BPH and LUTS.
• Stinging nettle has anti-inflammatory and diuretic properties that have made it a choice for management of urinary tract and prostate problems. In one study of 620 men who had BPH, 81% of the participants who took stinging nettle had improved symptoms compared with 16% of men who took a placebo.
• Uva ursi has antibacterial properties that make it helpful in managing urinary tract infections, suggesting uva ursi may be helpful in treating urinary incontinence.
• Vitamin D, at low levels, is associated with a greater risk of having an enlarged prostate and the urinary tract symptoms that accompany it.
• Vitamin E and the anti-inflammatory abilities of one of its forms, gamma-tocopherol, may have a role in BPH. In addition, research indicates that men with BPH may have lower levels of another form of vitamin E, alpha-tocopherol, than men without BPH.
• Zinc is a mineral found in large concentrations in the prostate gland. Research shows zinc has antiproliferative effects in BPH cells and may also have an important role in regulating cell growth and cell suicide in BPH cells.

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Source: Irwin et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary. Br J Urol Intl 2011 Oct; 108: 1132. doi:10.1111/j.1464-410X.2010.09993,10498.x

What is Testosterone Replacement Therapy?

Testosterone replacement therapy is the use of testosterone supplements to restore testosterone levels to a normal range in men who have a deficiency of the hormone. This therapeutic approach can be used to treat erectile dysfunction that is associated with a testosterone deficiency, and to treat symptoms of andropause (male menopause). Testosterone replacement therapy should not be used unless a man has a verified deficiency of testosterone.

To get the most accurate reading of your testosterone levels, a saliva test is recommended. A blood (serum) test does not measure all the hormone that is carried by red blood cells, and thus doctors could prescribe a dose that is too high.

Bio-identical testosterone gel or cream is the best way to get the hormone into your system. The term “bio-identical” means that the hormone is biochemically the same as the hormone the body produces naturally. Synthetic hormones are drugs and are foreign to the body, so the body essentially does not treat them like hormones. Because synthetic hormones are not true hormones, they do not provide the same benefits as the real thing.

A testosterone cream or gel allows the hormone to be absorbed through the skin and into the blood without having to pass through the liver, as an oral dose would have to do. Oral testosterone goes through the liver and 90 percent becomes bound to protein, severely limiting its effectiveness. Transdermal testosterone is at least 10 times more efficient than oral dosing. A compounding pharmacy can make up a testosterone cream that will provide you with the right dose to bring you back into balance.

Can Testosterone Replacement Therapy Cause Cancer?

One of the pressing questions men ask when faced with the possibility of starting testosterone hormone therapy is, “Can testosterone replacement therapy cause cancer?” Up until recently, this question would likely have been answered by most doctors with a resounding “yes.”

However, a great deal of research has been done to determine whether the “yes” response to the question about testosterone therapy and prostate cancer is accurate, and based on accumulating evidence, it appears the answer is “no.” One compelling reason for the “no” response can be attributed to the comprehensive investigative work done by Abraham Morganthaler, MD, FACS, author of Testosterone for Life, who evaluated the original work by urologist Charles Higgins in the 1940s, research that led to the misconception that taking testosterone can cause prostate cancer.

Morganthaler discovered that this idea arose out of one case study involving one patient. In other words, the fear that testosterone therapy can cause prostate cancer was based on nothing. In fact, in recent years there have been many studies that dispel the myth that testosterone replacement therapy causes prostate cancer or has a significant negative impact on the prostate. For example:

• A Beth Israel Deaconess Medical Center review of 72 studies (Rhoden 2004) found “no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer.”
• A report by The Prostate Cancer Center Hamburg-Eppendorf in Germany. (Isbarn 2009) stated “the available research strongly suggested that testosterone therapy neither increases the risk of prostate cancer in normal men nor causes a recurrence of the cancer in men who have been treated successfully for prostate cancer.”
• In a study of 57 men who received testosterone supplementation for an average of 36 months after prostatectomy surgery, although mean testosterone levels rose in all the men before testosterone therapy, there was no increase in PSA values after testosterone therapy started. So, testosterone replacement therapy caused hormone levels to rise, PSA values to remain the same, and symptoms to be relieved. Baylor College of Medicine study (Khera 2009)
• A study conducted within the ongoing Osteoporotic Fractures in Men cohort looked at the association between testosterone, estradiol, estrone, and sex hormone-binding globulin and prostate cancer. Only estrone was strongly related to an increased risk of prostate cancer. University of California, San Francisco (Daniels 2010)
• In a landmark study reported in 2006, men who had low testosterone levels were given testosterone injections or placebo every two weeks for six months. Before and throughout the study, the investigators took measurements of testosterone and DHT from both blood samples and the prostate itself. The researchers found that although blood concentrations of testosterone and DHT rose substantially in men who were given hormone replacement therapy, the concentration of testosterone and DHT did not change at all in the prostate gland. In addition, testosterone therapy had no effect on biochemical markers of prostate cell growth. Therefore, the authors noted that while testosterone replacement therapy normalized blood levels of testosterone, treatment did not affect prostate tissue or prostate cell functions. According to Morganthaler, “it is as if once the prostate has been exposed to enough testosterone, any additional testosterone is treated as excess and does not accumulate in the prostate.” To state it another way, he said “we say the prostate has been saturated with regard to testosterone.” (Marks 2006; Morganthaler 2008)

According to a Johns Hopkins Prostate Disorders Special Report, “Testosterone-Replacement Therapy: Does It Increase Prostate Cancer Risk?” the jury is still out on whether testosterone replacement therapy is safe when men take it for a prolonged time. Morganthaler would take that a step further, as he has noted that “The relationship of testosterone to prostate cancer has undergone a significant reevaluation, and all recent evidence has reinforced the position that testosterone therapy is safe for the prostate.”

In addition, if you already have prostate cancer, the concern has been that taking testosterone could make the cancer progress faster, or that the hormone could promote tumor growth. These worries are the reasons why some doctors will not prescribe testosterone therapy for men who have a history of prostate cancer.

Morganthaler explains why this is not a concern by referring to the study by Marks and the point about how “once the prostate has been exposed to enough testosterone, any additional testosterone is treated as excess and does not accumulate in the prostate.”

Basically, when men have very low testosterone levels, prostate growth is hypersensitive to any change in the concentration of testosterone. Therefore, while severely reducing testosterone levels (as is done in men with prostate cancer who undergo hormone ablation therapy) will cause prostate cancer to shrink, giving testosterone can cause prostate cancer to regrow. “However,” Morganthaler notes, “once we get above the point where the prostate is saturated with testosterone, adding more testosterone will have little, if any, further impact on prostate cancer growth. Experimental studies suggest the concentration at which this saturation occurs is quite low.”

Testosterone Replacement Therapy and the Women’s Health Initiative

Another reason why many doctors are reluctant to prescribe testosterone replacement therapy is related to the Women’s Health Initiative (WHI) results. For years, postmenopausal women were prescribed hormone replacement therapy to relieve symptoms brought on by the dramatic decline in estrogen associated with menopause. Women were also told that hormone therapy would help prevent osteoporosis and reduce their risk of heart disease.

But when the WHI results were announced, it was learned that hormone-replacement therapy raised the risks of cardiovascular disease, breast cancer, stroke, and blood clots. Sure, it relieved menopausal symptoms—but at what cost. Today, hormone-replacement therapy is prescribed only for postmenopausal women who are experiencing distressing symptoms, and then usually, for only a very short time.

Experts do not want to make the same mistake with testosterone replacement therapy. So far it appears testosterone replacement therapy is useful and safe for some men who have a testosterone deficiency and who have been treated for prostate cancer.

However, if you are considering testosterone replacement therapy:

• You should be monitored closely for any rise in PSA levels and/or return of prostate cancer
• Avoid synthetic testosterone. Instead, ask your healthcare provider about bio-identical testosterone therapy. This form of the hormone mimics the activity of the testosterone naturally produced by the body.
• Your physician needs to balance testosterone with estradiol, because the proper ratio of testosterone to estradiol is necessary for prostate (and overall) health

Another fear associated with taking testosterone is that when a man first takes the hormone, the prostate reacts very quickly and begins to grow. This increase in size usually stops after the first few months of treatment, so the prostate gland typically ends up being no larger than it was before the hormone level began to drop. Bottom line: the increase in prostate size resulting from testosterone therapy is not usually sufficient to cause any of the urinary symptoms associated with benign prostatic hyperplasia or to worry about the development of prostate cancer as numerous well-run studies have shown, and as Morganthaler explained above, testosterone does not increase the risk of prostate cancer.

Additional references

Marks LS et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 2006 Nov 15; 296(19): 2351-61

Morganthaler A. Destroying the myth about testosterone replacement therapy and prostate cancer. Life Extension 2008 December.

Natural Remedies for Andropause, Male Menopause

Although declining levels of testosterone and other androgen levels is a natural part of aging and the hallmark of andropause, there are a number of lifestyle options men can choose that can help alleviate or treat the symptoms of male menopause. These andropause natural treatment suggestions are also part of the foundations of The Prostate Diet and the 6 Pillars of Prostate Health.

• Eat more fruits and vegetables: A poor diet can contribute to andropause. Fruits and vegetables are rich sources of antioxidants, polyphenols, vitamins, minerals, and fiber, all of which are essential for a healthy diet.
• Choose healthy fats: Healthy fats, such as monounsaturated fats and omega-3 fatty acids, help support a healthy heart and blood circulation.
• Select plant protein over animal protein: Plant protein sources, such as beans, legumes, and selected grains, are important components of a healthy diet and can also assist in preventing symptoms of male menopause, including loss of strength and lean body mass.
• Consume green tea: Green tea contains substances called catechins that possess potent antioxidant properties and therefore assist in preventing illness while supporting general wellness.
• Eat omega-3 rich foods: The omega-3 fatty acids fight inflammation, a process that destroys the body’s natural antioxidants and weakens the immune system, and may also help with depression.
• Avoid foods and additives that are harmful to health: Some foods, supplements, additives and nutrients are especially harmful to overall health, including but not limited to meat, calcium, and foods high in sugar.  Read more
• Consider supplements for andropause. Some natural supplements can help raise testosterone levels or reduce estrogen levels. Consult a knowledgeable healthcare provider before using any of these supplements. Read more
• Hydrate often: Drinking pure water is a basic component of a healthy diet.
• Achieve and maintain a healthy weight. Being overweight and carrying too much body fat has an effect on hormone levels, as fat cells generate estrogen, which can throw off a man’s sensitive balance of estrogen and testosterone.
• Exercise regularly. Lack of exercise contributes to andropause, and so the antidote is maintaining a regular exercise program, which also helps control and maintain a healthy body weight. Read more about exercise and health
• Manage stress. Andropause has a psychological component, namely depression and mood swings. Practicing stress management techniques can help alleviate and even prevent these symptoms.
• Experiment with natural therapies. Natural treatments such as acupuncture, biofeedback, homeopathy, hormone restoration, and stress management techniques may relieve some symptoms of male menopause.
• Lead a hormone friendly lifestyle. Smoking, use of some medications, and alcohol consumption all can contribute to male menopause symptoms.
• Maintain hormone balance. Hormone balancing plays a major role in prevention and management of andropause symptoms.  Consult your healthcare professional to have your hormone levels measured and, if it is appropriate, discuss the possibility of male hormone replacement. Read more about hormone balance
• Maintain a healthy sex life. Changes in sexual function and sexual desire may occur with andropause. However, maintaining open communication with your sex partner and getting help for sexual problems from a trusted healthcare professional can alleviate the stress and anxiety that may accompany those changes so you can maintain a healthy sex life.
• Avoid exposure to toxins. Exposure to chemicals and other environmental toxins can have a negative effect on overall health and sexual health.

See also

What is Testosterone?

10 Signs of Testosterone Deficiency

Factors that Decrease Testosterone

Natural Ways to Increase Testosterone

Supplements that Increase Testosterone

What is Estrogen (Estradiol)?

Causes of Estrogen Dominance in Men

Factors That Can Reduce and Inhibit Estrogen

Environmental Sources of Estrogen

References

Makinen J et al. Increased carotid atherosclerosis in andropausal middle-aged men. J Am Coll Cardiol 2005 May 17; 45(10): 1603-8

Marks LS, Mazer NA, Mostaghel E, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 2006;296:2351-61.

Morganthaler A. Destroying the myth about testosterone replacement and prostate cancer. Life Extension 2008 December:

Testosterone Replacement Therapy for Male Menopause/Andropause

Andropause treatment is usually reserved for men who are experiencing life-changing symptoms, and the treatment is testosterone replacement therapy (also referred to as male hormone replacement therapy, low t therapy, hormone replacement therapy for men, and testosterone replacement). Two questions men often ask are, Can testosterone therapy cause cancer? And, Is hormone replacement therapy safe?

When it comes to hormones, prostate cancer depends on estrogen rather than testosterone, and the fear that taking testosterone will increase a man’s risk of developing prostate cancer has been put to rest.  However, it took decades to dispel this myth, which was based originally on a single patient in a study from the 1940s. Among the studies that led to banishment of the testosterone myth was a 2006 report that showed that raising testosterone levels in the blood did not raise levels inside the prostate, and thus the prostate was not exposed to excess testosterone. According to Abraham Morgentaler, MD, FACS, author of Testosterone for Life, there is now “good evidence that testosterone therapy is quite safe for the prostate. There is even now a growing concern that low testosterone is a risk for prostate cancer rather than high testosterone.”

Before starting use of testosterone for male menopause, men should undergo a complete general exam, including a digital rectal examination, PSA test, lipid panel, liver function tests, blood test to determine testosterone levels, and cardiac function tests as well as, in some circumstances, a prostate biopsy. All of these tests should be repeated every 3 to 6 months while men are being treated, because male hormone replacement therapy side effects can be significant and include an increased tendency to form blood clots, thrombophlebitis (swelling of the veins due to blood clots), and liver toxicity, as well as breast enlargement, urinary tract blockage, sleep apnea, and a rise in PSA levels.

The testosterone used in andropause replacement therapy is available in several forms, including

• Oral. Some oral forms are associated with a high risk of liver toxicity, although newer forms bypass the liver and are less toxic.
• Injectable. Two forms of injectable testosterone are available: testosterone cypionate and testosterone enanthate, and they must be given every 2 to 3 weeks in order to maintain desired hormone levels. Use of injectable testosterone may result in excess hormone being converted to estrogen, which is not desirable.
• Implants. Subcutaneous pellets called Testopel are implanted just under the skin in the buttocks every 3 to 4 months. The procedure can be performed in a doctor’s office and takes 5 minutes. Because testosterone implants provide a constant level of the hormone in the blood, it is a preferred form of testosterone replacement therapy.
• Gels. Topical testosterone gels (Androgel, Axilron, Fortesta, Testim) can be applied daily to the thigh, shoulders, or underarms. Testosterone gels cause minimal side effects and, like implants, are a preferred form of hormone replacement for men.
• Transdermal patches. Use of a transdermal patch for testosterone (Androderm) is highly effective in restoring testosterone levels. Testosterone patches must be applied daily to either the arm, back, or upper buttocks, where they provide continuous 24-hour release of the hormone. The most common side effect is skin irritation.

The goal of male hormone replacement therapy is to have men achieve and maintain a testosterone level that is appropriate for their age and stage of health and without significant side effects. (In fact, testosterone is often considered one of the anti aging hormones.) To make sure this goal is reached and sustained, men need to have their blood tested routinely and their testosterone treatment altered as needed.

Although testosterone replacement therapy as male menopause treatment may relieve symptoms of andropause in some men, those who have declining levels of other hormones may not get the relief they want since low testosterone may not be their only problem. Male hormone therapy using testosterone replacement is not appropriate for all men who have andropause. Men who have breast cancer or prostate cancer should not take testosterone, and those who any of the following conditions should discuss the benefits and risks with their doctor before starting therapy: liver disease, heart disease, BPH, kidney disease, diabetes, or swelling of the face, hands, feet, or lower legs. Possible risk factors associated with testosterone replacement therapy include infertility, excessive red blood count, water retention, tender breasts, worsening of existing breast cancer in men, liver damage (oral testosterone only), and worsening of prostate symptoms (rare).

See also

What is Testosterone?

10 Signs of Testosterone Deficiency

Factors that Decrease Testosterone

Natural Ways to Increase Testosterone

Supplements that Increase Testosterone

What is Estrogen (Estradiol)?

Causes of Estrogen Dominance in Men

Factors That Can Reduce and Inhibit Estrogen

Environmental Sources of Estrogen