LOWT Taking Control of Your Health: A G u i d e f o r Men with Low Testosterone DVD Inside with John Ratzenberger
Contents Introduction 3 What is Testosterone? 4 What Causes Low Testosterone? 5 Symptoms of Low Testosterone 7 How Do I Know if I Have Low Testosterone? 9 Testosterone Replacement Therapy (TRT) 10 Overall Health: What You Can Do 15 Conclusion 21 Resources 22 Copyright 2010 Conrad & Associates, LLC All Rights Reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval system, without the written permission of the publisher, except when permitted by law. Manufactured in the United States of America taking control of your Health: A Guide for Men with Low Testosterone 1
Introduction Millions of men may be feeling less energetic, and experiencing a lower sex drive than they d like, because of a little-known medical condition called hypogonadism (hî-põ-gõ-na-dizm). This condition is also called low testosterone, because of below-normal levels of the hormone, testosterone. Although there is a natural decrease in blood testosterone levels with increasing age, symptoms of hypogonadism are not a natural part of aging! Hypogonadism occurs when testosterone levels fall below what s considered normal, and is linked with specific symptoms that may interfere with a man s life. Low testosterone is a treatable medical condition affecting millions of men. This guide will teach you the basics of testosterone and how to raise your levels if they are too low. Low testosterone can make you feel tired, uninterested in sex, and weak. It can also make you more likely to have certain health problems, such as weakened bones or a depressed mood. But many other conditions may cause the same symptoms. A doctor can help determine if these symptoms are due to hypogonadism or some other condition. This is very important because, if your testosterone levels are normal, adding more of the hormone will not help, and it may not be safe. Fortunately, there are several ways to raise testosterone, which may relieve the symptoms of low testosterone. In this booklet, you ll learn the basics about testosterone, why it can be too low, and what you can do about it. Learning about low testosterone is the first step to restoring your health if you have hypogonadism. 2 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 3
What is Testosterone? What Causes Low Testosterone? In men, testosterone is a hormone made primarily in the testicles. During puberty, testosterone promotes the growth of facial and body hair and the maturation of male genitals. Testosterone is needed throughout a man s life because it supports many aspects of health, including: Sex drive and sexual function Muscle mass and strength Mood Energy levels Bone strength Testosterone levels are controlled in two main ways: by the testicles and by the brain. Sometimes testosterone levels fall because the testicles themselves are impaired or damaged by such things as: Physical injury Surgery Radiation Genetic and developmental disorders Infection (including mumps in teenagers and adults) HIV/AIDS Certain medications Testosterone levels peak around age 20. After that, testosterone levels begin to decline by about 1 percent a year. Men vary a lot in how much testosterone they produce. Levels as low as 300 and as high as 1,000 are both generally considered normal. Levels below 300 may be considered below normal. Some men may begin to feel symptoms of hypogonadism at these levels. Other times, the problem is in the brain. Low testosterone can result if the hormone control switch in the brain is damaged by: Tumors Surgery Radiation Injury Genetic problems Nutritional deficiencies Excess iron in the bloodstream Certain medications 4 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 5
Symptoms of Low Testosterone Also, you may be more likely to have low testosterone if you have any of these conditions: Obesity Diabetes High blood pressure High cholesterol HIV/AIDS Asthma or chronic obstructive pulmonary disease (COPD) Low testosterone is a medical condition that can cause the following symptoms: Tiredness or loss of energy Low interest in sex Loss of vitality Problems getting or maintaining an erection Depressed mood Decreased sense of well-being Muscle weakness Reduced bone density Low blood iron levels Small or soft testicles Many of these symptoms can also be produced by other physical or mental problems. This is one reason low testosterone is often overlooked by both patients and doctors: they think the symptoms are due to some other cause or are just part of the normal aging process. 6 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 7
How Do I Know if I Have Low Testosterone? If you are experiencing any of the symptoms listed previously, your physician may check your testosterone levels. Checking testosterone levels is easy. Testosterone circulates in the blood, so it can be checked with a simple blood test. The most common test measures the total amount of testosterone in a unit of blood. But sometimes a different test is used. One test measures only the amount of testosterone in your blood that is active. This is called free testosterone. Testosterone circulates in the blood. So it can be checked with a simple blood test. A diagnosis of hypogonadism is made only if your testosterone levels are low and you have bothersome symptoms related to low testosterone. Since testosterone levels go up and down normally throughout the day, tests may need to be repeated several times to get an accurate picture. Tests are usually done early in the morning, since this is when testosterone levels are highest. But having a below-normal level of testosterone by itself may not be a problem. Some men feel fine even with quite low levels. A diagnosis of hypogonadism is made if your testosterone levels are low and you have bothersome symptoms related to low testosterone. That s why your doctor will ask you about symptoms you may be feeling, such as tiredness or lack of interest in sex. He or she will also check for conditions such as diabetes or depression because these can cause some of the same symptoms as low testosterone. 8 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 9
Testosterone Replacement Therapy (TRT) If you have been diagnosed with hypogonadism, you have several options for replacing testosterone. This is called Testosterone Replacement Therapy, or TRT. All TRT options require a prescription. In the United States, TRT can be administered in the following ways: Gel Testosterone gels are applied daily to the skin of the shoulders, upper arms, or abdomen. The testosterone in the gel is absorbed into the body through the skin. Gels provide continuous delivery of testosterone throughout the day. If used correctly, testosterone levels can return to normal and stay there. But although gels are a popular treatment, it s important to make sure the gel doesn t transfer to others by touching the area where the medication was rubbed on the skin. Patients should ensure that women and children avoid any contact with unwashed or unclothed application areas. Early puberty has been seen in children who were accidentally exposed to testosterone gels. If a child or woman makes contact with a gel application area, they should thoroughly wash with soap and water right away. Patients must strictly follow the recommended instructions for use. Injection Testosterone can be given as a shot (usually in the buttocks) every 7-21 days, generally in your doctor s office. With these shots, testosterone levels reach their highest point 1 2 days after dosing, and slowly fall over the next several weeks. The doctor will carefully monitor testosterone levels, as injections may cause them to rise above normal range. This could mean the patient has a higher risk of side effects like the possibility of increased red blood cells, causing a thickening of the blood. Pellets Pellets are placed several inches under the skin near the hip, during a surgical procedure by a doctor. After several pellets are inserted, normal testosterone levels last from three to six months. The pellets can be replaced by a doctor. Swelling and pain at the insertion site may be a common side effect of this therapy. Patches Patches also allow testosterone to be absorbed by the skin. Patches are applied daily to the back, abdomen, thighs, and upper arms. Patches are applied to a different site each day to lessen the risk of skin irritation, with a minimum of a week between applications to any given spot. 10 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 11
Buccal Tablet In the mouth, a tablet is placed next to the gum, where testosterone is absorbed over a 12-hour period. Normal testosterone levels are reached within the12-hour dosing period. This treatment may cause gum or mouth irritation, and a bitter or unusual taste. Each treatment option has advantages and disadvantages. Ask your doctor which option might be best for you, and how to use it properly. Warnings & Precautions You should not use TRT if: you are a man with known or suspected prostate cancer, or if you have breast cancer you are a woman who is breastfeeding, pregnant, or may become pregnant (TRT is not indicated for use by women) Patients treated with testosterone may have a higher risk of prostate cancer. Your doctor will likely monitor for prostate cancer before and during treatment. No matter how it is delivered, TRT may produce side effects, including: Acne or oily skin Fluid retention Stimulation of prostate tissue, which may cause some difficulties with urination Breast enlargement Worsening of sleep apnea (a sleep disorder that results in frequent night-time awakenings and daytime sleepiness) TRT may also cause serious health problems, such as: Low or no sperm count More red blood cells, with thickening of the blood that can increase the risk of heart attack and stroke If you are using TRT, regular follow-up appointments with your doctor are vital. It s also very important that TRT not be used by men with normal levels of testosterone. Patients with an enlarged prostate (a condition called benign prostatic hyperplasia, or BPH) who are treated with testosterone may have a higher risk that symptoms could get worse. 12 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 13
Overall Health: What You Can Do Exercise regularly It is well-known that physical activity is important for your overall health. It can help control your blood pressure, improve your cholesterol levels, help maintain normal blood sugar levels, boost oxygen to your brain and body, and improve your mood. Generally, you can improve your overall health by taking a few basic steps: > Exercise regularly > Eat a healthy diet > Try to maintain your ideal body weight > Quit smoking > If you have diabetes, maintain good blood sugar control If you are not now in shape, talk with your doctor before starting to exercise regularly. He or she may recommend starting slowly: just 5 or 10 minutes of walking twice a week, for example. Then you can gradually build up to at least 30 minutes every day. 14 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 15
Eat a healthy diet You don t have to deprive yourself of good-tasting food to improve your health and boost your energy. Old-fashioned, home-cooked meals made with real ingredients are often fine. Slow food is usually better for you than fast food! Talk with your doctor about the right diet for you. Here are some tips for healthy eating from the American Heart Association: Balance how much you eat with your physical activity to maintain a healthy body weight Eat a diet rich in vegetables and fruits Choose whole-grain, high-fiber foods Eat fish at least twice a week Limit your intake of saturated fat Use fat-free (skim), 1% fat, and reduced-fat dairy products Avoid drinks and foods with added sugars Choose and prepare foods with little or no salt If you drink alcoholic beverages, do so in moderation 16 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 17
Maintain your ideal body weight Obesity has been shown to be associated with low testosterone levels. For overall health, it is important to maintain your ideal body weight. Quit smoking Nearly everyone knows that smoking is bad for your health. Quitting can increase blood oxygen levels, raise your energy level, and lower your risk of heart disease or stroke. Less well-known, however, is that smoking is also bad for a man s sexual health. If you have diabetes, maintain good blood sugar control People with diabetes are more likely to have low testosterone than men who do not have diabetes. So, if you have diabetes, you should get tested for low testosterone and work hard to maintain normal blood sugar levels with careful monitoring and medications. Normal testosterone levels are part of being fit and healthy. If you have symptoms of low T, get your T level checked and take steps to raise it if necessary. 18 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 19
Conclusion Many men do not know that low testosterone levels can produce troubling symptoms. By reading this booklet, you ve joined the group of men who know to watch this aspect of their health. You ve seen that the hormone testosterone is important throughout life. A simple blood test can show if you have low testosterone, and a visit with your doctor can confirm whether or not you have hypogonadism. If so, you can choose from several options to deliver testosterone to your blood. Doing so may relieve your bothersome symptoms and may help restore your energy, positive mood and sexuality. Remember, each treatment option has advantages and disadvantages. Talk with your doctor about which option might be best for you, and how to use it properly. 20 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 21
Resources Sponsor American Urological Association www.auanet.org American Urological Association Foundation www.urologyhealth.org Abbott Laboratories Inc. Abbott is a global, broad-based health care company devoted to the discovery, development, manufacture and marketing of pharmaceuticals and medical products, including nutritionals, devices and diagnostics. The company employs approximately 83,000 people and markets its products in more than130 countries. American Association of Clinical Endocrinologists www.aace.com American Geriatrics Society www.americangeriatrics.org AGS Foundation for Health in Aging www.healthinaging.org Is it Low T? Specific information on low testosterone and testosterone replacement therapy www.isitlowt.com 22 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 23
Partner Partner American Urological Association Founded in 1902 and headquartered near Baltimore, MD, the American Urological Association is the pre-eminent professional organization for urologists, with more than 14,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of educational and research programs for its members, including UrologyHealth.org, an awardwinning online patient education resource. The AUA also supports the American Urological Association Foundation, Inc. (founded in 1987 as the American Foundation for Urologic Disease). The Foundation s mission is to raise funds to advance medical research in urologic diseases, educate the public about cures and treatments, and advocate on behalf of affected patients. The Foundation pursues this mission through patient education materials, fundraising events and patient education conferences. For information about prostate health and urologic diseases, please visit www.urologyhealth.org or www.auafoundation.org. AUA Foundation The AUA Foundation is the world s leading non-profit urologic health foundation and the official foundation of the American Urological Association. Our mission is to promote health, provide hope and promise a future free of urologic disease, including cancer. American Geriatrics Society Founded in 1942, the American Geriatrics Society is a nationwide, not-for-profit association of geriatrics healthcare professionals dedicated to improving the health, independence, and quality of life of all older people. The Society supports this mission through activities in clinical practice, professional and public education, research, and public policy. With an active membership of over 6,700 healthcare professionals, the Society has become a pivotal force in shaping attitudes, policies, and practices in geriatric medicine. For more information, please visit www.americangeriatrics.org. AGS Foundation for Health in Aging In 1999, the American Geriatrics Society reached beyond its traditional role as a professional medical society and launched the AGS Foundation for Health in Aging (FHA). The FHA aims to build a bridge between geriatrics healthcare professionals and the public, and advocate on behalf of older adults and their special needs: wellness and preventive care, self-responsibility and independence, connections to family and community. The FHA champions initiatives in public education, clinical research, and public policy that advance the principles and practice of geriatrics medicine; educate policymakers and the public on the healthcare needs and concerns of older adults; support aging research that reduces disability and frailty, and improves quality of life and health outcomes; encourage older adults to be effective advocates for their own health care; and help family members and caregivers take better care of their older loved ones and themselves. For more information, please visit www.healthinaging.org. 24 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 25
Credits Taking Control of Your Health: A Guide for Men with Low Testosterone has been made possible through the expertise, time and effort of many individuals, including the Sponsor and Partners. Sponsor Abbott Laboratories Inc. Partners American Urological Association AUA Foundation American Geriatrics Society AGS Foundation for Health in Aging Contributors to the Video For the AGS/AGS Foundation: Tomas L. Griebling, M.D., M.P.H., F.A.C.S., F.G.S.A. John P. Wolf 33 Masonic Distinguished Professor of Urology Vice-Chair, Department of Urology Faculty Associate, The Landon Center on Aging The University of Kansas Immediate Past President Special thanks to: John Ratzenberger Harry Fisch, M.D. Clinical Professor of Urology and Reproductive Medicine Department of Urology Director, the Male Reproductive Center New York-Presbyterian Hospital/Weill Cornell Medical Center New York City Darius A. Paduch, M.D., Ph.D. Assistant Professor of Urology and Reproductive Medicine Department of Urology New York-Presbyterian Hospital/Weill Cornell Medical Center Staff Scientist, Population Council New York City Ira D. Sharlip, M.D. Clinical Professor of Urology Male Reproductive Health Center University of California at San Francisco Immediate Past President International Society for Sexual Medicine Chairman, Public Media Committee, AUA Project Manager Carol Brandenburg Executive Producer Conrad Productions Guidebook Author Stephen R. Braun Medical Writer Amherst, MA Guidebook Design Cinda Debbink Design Partners www.dgdesignpartners.com 26 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 27
DISCLAIMER: This guidebook and DVD program are intended for informational purposes only, with the understanding that no one should rely upon this information as the basis for medical decisions. Anyone requiring medical or other health care should consult a medical or health care professional. Any actions based on the information provided are entirely the responsibility of the user and of any medical or other health care professionals who are involved in such actions. The sponsor (Abbott Laboratories Inc.), the producers (Conrad Productions and Alan Weiss Productions), the guidebook author (Stephen Braun), the DVD writer (Deborah Gobble) and the partners (American Urological Association, AUA Foundation, American Geriatrics Society and the AGS Foundation for Health in Aging) have made reasonable efforts to include timely and accurate information in this guidebook and DVD. Accordingly, the sponsor, producers, writers and partners make no representations or warranties, express or implied, regarding the accuracy or completeness of the information provided herein and specifically disclaim any liability, express or implied, in connection therewith. 28 taking control of your Health: A Guide for Men with Low Testosterone taking control of your Health: A Guide for Men with Low Testosterone 29
LOWT Taking Control of Your Health: A G u i d e f o r Men with Low Testosterone Some men feel less energetic, and have a lower sex drive than they d like, because of a medical condition called hypogonadism. This condition is also called low testosterone, because of below-normal levels of the hormone, testosterone. Hypogonadism is not a natural part of aging. It occurs when low testosterone levels cause some specific signs and symptoms that interfere with your life. Low testosterone can make you feel tired, uninterested in sex, and less energetic. DVD Inside But testosterone levels can be safely brought back to normal when used as directed under the care of a physician. This may relieve the bothersome symptoms of low testosterone. In this booklet you will learn: with John Ratzenberger The basics about testosterone Why testosterone levels can drop below normal Ways to restore testosterone Tips for improving your overall health