Understand the potential risks and consider alternatives before boosting your hormones indefinitely.

Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.

"Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs," says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. "Men should be much more mindful of the possible long-term complications."

MIND Depression Reduced self-confidence Difficulty concentrating Disturbed sleep

BODY Declining muscle and bone mass Increased body fat Fatigue Swollen or tender breasts Flushing or hot flashes

SEXUAL FUNCTION Lower sex drive Fewer spontaneous erections Difficulty sustaining erections

Images: Thinkstock

A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"

Just being tired isn't enough to get a testosterone prescription. "General fatigue and malaise is pretty far down my list," Dr. O'Leary says. "But if they have significant symptoms, they'll need to have a lab test. In most men the testosterone level is normal."

If a man's testosterone looks below the normal range, there is a good chance he could end up on hormone supplementsoften indefinitely. "There is a bit of a testosterone trap," Dr. Pallais says. "Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."

This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time.

A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.

The evidence for long-term risks is mixed. Some studies have found that men on testosterone have fewer cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. Other studies have found a higher cardiac risk. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on hormone treatments had noticeably more heart problems. "In older men, theoretical cardiac side effects become a little more immediate," Dr. Pallais says.

Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.

"Like any treatment, there is risk," Dr. O'Leary says. "I would not give it to a man who is being treated for active prostate cancer, but it's pretty safe under careful supervision for those who need it."

For the time being, the long-term risks of testosterone therapy are "known unknowns." It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises the risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says. "We need a large study with multiple thousands of people followed for many years to figure it out."

So, keep risks in mind when considering testosterone therapy. "I frequently discourage it, particularly if the man has borderline levels," Dr. Pallais says.

These steps can help you feel more energetic today without drugs or dietary supplements:

Pace yourself: Spread out activities throughout the day.

Take a walk: It gives you a lift when you feel pooped out.

Snack smart: Have a snack with fiber and some protein between meals.

A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.

Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.

If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?

If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.

Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.

After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.

Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

Ask your doctor to explain the various side effects for the differentformulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.

Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with these expectations in mind.

If erectile function has been a problem, testosterone therapy might not fix it. In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections.

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Is testosterone therapy safe? Take a breath before you ...

The most effective delivery method for Testosterone Replacement Therapy (or TRT) is Testosterone injections. Testosterone Replacement Therapy typically requires weekly Testosterone injections and ancillary medications, where necessary. These may include medications which allow the testes to continue its natural production of testosterone while on TRT, and an Aromatase Inhibitor, typically in pill form, to suppress the bodys conversion of Testosterone to Estrogen.

Every man has his own unique set of circumstances and must be treated as an individual. Therefore, EHormonesMD managed physicians perform physical examinations on every patient, in addition to using a combination of comprehensive, diagnostic lab work, feedback from the patient himself, as well as medical history and symptomology to determine the patients individual Testosterone Therapy regimen. However, it is important to note that not every adult male will be a candidate for Testosterone Replacement Therapy. This is why its very important that you speak with a doctor who specializes in treating Low Testosterone in adult men.

Ask yourself if you suffer from one or more of the following:

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Testosterone Replacement Therapy - Ehormones

Bryant Stamford, Special to the Courier-Journal Published 7:00 a.m. ET Sept. 7, 2017

A study suggests that exercise can reduce the risk of heart damage for middle-aged adults and seniors. According to the study, even those who are obese will benefit from physical activity. Wochit

Man working out(Photo: Minerva Studio, Getty Images/iStockphoto)

Testosterone (T) is a naturally occurring hormone in men, and most of it is produced in the testicles.

At puberty, T production escalates, bringing about masculinizing changes in muscle mass. also promotes sex drive, sperm and red blood cell production, bone massand determines how men store body fat.

It can impact quality of life issues as well, like mood, energy and motivation.

Beginning at about age 30, T production begins to decline on average by about 1 percent per year, plummeting late in life. This causes all sorts of problems, including lack of sex drive, inability to sleep, loss of muscle and bone mass, increased belly fat, the list goes on. Reversing these symptoms and improving the quality of life is the reason T replacement therapy (TRT) clinics supervised by physicians have sprung up around the country.

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Although it is considered a male hormone, women also produce a modest amount of T in the ovaries. After menopause, estrogen production declines, which alters the ratio of estrogen to T, explaining why women begin taking on some male characteristics, like storing more fat around the midsection, rather than on the hips, thighs and buttocks as occurs earlier in life.

Is TRT a good thing? It can bewhen managed responsibly. If you are older, and your T level is very low and falls below the normal range, it makes sense to address it with TRT because it can negatively impact health, increasing risks associated with diabetes, obesity and osteoporosis. Low T also may shorten life, but this is controversial because when TRT raises T levels it has not been shown to extend life.

More is not always better, and many TRT clinics are viewed with suspicion because they advertise that its possible to feel like you are 25 years old again, even though you are decades older. Perhaps this is possible, but at what price, and if you are taking huge doses of T, could you be damaging your health?

Research studies in 2013 and 2014 indicated that TRT increased the risk of heart disease in men 65 and older, and in younger men with a history of heart disease. However, subsequent studies refute these findingsand some show a deceased risk of heart disease. Another area of concern is an increased risk of prostate cancer, but this, too, is controversial. There does appear to be solid evidence that TRT can increase the risk of blood clots and stroke, plus sleep apnea, acne and breast enlargement.

All in all, some experts believe the benefits outweigh the risks, while others are more cautious because TRT hasnt been around long enough or impacted enough men to draw meaningful conclusions. Time will tell. In the meantime, like most things in life, moderation is the best approach.

Anabolic steroids (AS) are synthetic steroid hormones that resemble T. AS require a doctors prescription and were developed to promote muscle mass in postsurgical patients, particularly older patients. Unfortunately, AS use spilled over to strength athletes who wanted the advantages associated with increased muscle mass, and AS delivered as promised. This, in turn, inspired gross overdosing with AS as a means to producing freaky muscular proportions and super human strength.

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AS can cause a long list of negative side effects, the most serious being growth of tumors in the liver and acceleration of atherosclerosis (clogging of the arteries). AS suppress HDL (good cholesterol) production, which leads to a ratio of bad to good cholesterol that is out of whack, promoting clogged arteries and ultimately leading to a heart attack. Worse, because a doctors prescription is required, AS often are obtained illegally from foreign countries through the mail, with no sense of the quality of the product or the dangers involved.

When I was young, I was an enthusiastic weight lifter, working out hours every day. Some of my friends went the AS route and developed amazing physiques. Recently, I have endeavored to track them down to see how they are doing, and I was saddened to learn that too many have died prematurely, in their fifties and sixties, some even earlier. The most likely cause was a heart attack.

TRT has a place and can be beneficial if managed prudently. Just be careful of extreme approaches and promises that seem too good to be true. As for AS, there is no justifiable reason for athletes to be taking them. Ever!

Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.

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Is testosterone replacement therapy the right thing for aging males? - The Courier-Journal

Many things only occur in September. The school year gets into full swing as does football season. Gardens are nearing the end of their life spans . One of the most important events that happens every September is the Niobrara Health Fair Blood Draw. It will be held from 6 am to 9am Thursday September 14 and Friday September 15 at the Niobrara County Fairgrounds Auditorium meeting rooms. A team of skilled phlebotomists has been assembled to .expertly draw your blood and prepare it for shipment to Quest Diagnostics Labs in Denver for analyzing If you have limited funds for health care, this is the perfect way to gather a large amount of information about your body and health for a minimal investment. Most doctors readily accept the results of this blood testing and it is a bargain compared to the same tests done at a hospital lab.

A list of the screenings available and the associated prices follows:

The most basic and popular test is the HealthScreen/TSH/Direct LDL Measurement (previously known as the Chemistry Panel) which will give information on cholesterol levels, triglycerides, liver function, kidney function, thyroid function, and shows the presence of a gout indicator. This test is $35. A twelve hour fast is recommended.

A complete blood count (CBC) is available for $17.00 and will give information about the presence of infection, anemia, and early signs of leukemia.

The PSA or Prostate Specific Antigen Test is available for $27.00 and is used to detect possible prostate cancer. It is recommended for men over the age of 50.

The Hemoglobin A1C test priced at $27.00 is available for diabetics to check their average blood sugar levels and help determine if their medication is working properly. It is also recommended for anyone with a family history of diabetes.

Vitamin D screening is available for $42.00 It has been recently determined that low levels of vitamin D may be the cause of many aches and pains. Vitamin D deficiency may also be related to other health issues.

The Cardio CRP test is $32.00 and screens for high levels of a protein that indicates inflammation in the body, especially in arteries. Arterial inflammation may cause cholesterol deposits to break away and clog an artery leading to a heart attack or stroke.

The Cardio IQ+HealthScreen test is also available for $92. This test is generally only recommended for those people with known cholesterol issues and provides a much more detailed cholesterol analysis. It also includes a basic blood chemistry test to check kidney, thyroid, liver and bone functions. A twelve hour fast is recommended. This test is not done if the regular chemistry test for $35 is chosen.

A Gluten Intolerance/Celiac Screen test is available for $42. This test will indicate the presence of celiac disease and help individuals determine if they should avoid foods containing gluten.

Vitamin B12 and Folate testing is also available for $42. This test will determine if you have abnormal levels of vitamin B12 or of folate, another B vitamin.

Female and Male Testosterone testing is priced at $42. This test will indicate abnormal levels of this hormone. It is a great way to determine if you many need testosterone replacement therapy.

An InSure FIT Colon Screening Kit is also available for $25.00. This is a take home kit that checks for colorectal cancer.

Dont pass up this economical opportunity to get more information about your health. Be sure to attend the Niobrara Health Fair Blood Draw on Thursday September 15 or Friday September 16 from 6 am to 9 am at the Niobrara County Fairgrounds Auditorium. If you participated in the past, you should have received, or will be receivingsoon, a post card reminder in the mail. For additional information or questions, please contact Randi Ross at 307 334-0107 or 307 216-0073

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Health Fair blood draw - Lusk Herald

In June of 2014, the U.S. Judicial Panel on Multidistrict Litigation (JPML) consolidated all federally filed testosterone-replacement therapy (TRT) lawsuits into one court in the Northern District of Illinois. District Judge Matthew Kelley decided early on that trials would be scheduled based on the type of TRT product used. Since AbbVies product AndroGel leads the market in testosterone-replacement products, the first bellwether trials each involve AndroGel.

In the second case to be tried, a Chicago jury determined that manufacturer AbbVie should pay $150 million to an Oregon man who suffered a heart attack after taking the drug.

The plaintiff first started taking AndroGel in 2008, and used it through 2012. He suffered a heart attack that year, at 49 years old. He claimed that AbbVie failed to warn of the risks associated with their drug, which he claims include blood clots, heart attacks, and strokes. He also claimed that the company misled consumers when they aggressively advertised the drug as a solution for age-related low-T.

The jury came back with a split verdict. They awarded the plaintiff $150 in punitive damages, stating that AbbVie was liable for false marketing and fraudulent misrepresentation. At the same time, however, they concluded that the plaintiffs heart attack was not caused by AbbVies negligence, and did not award him any compensatory damages.

AbbVie blamed the plaintiffs heart attack on other risk factors, including high blood pressure and cholesterol, obesity, and smoking. The company is expected to appeal the verdict.

This is only the second of seven planned bellwether trials to go to a jury. (An earlier trial ended in a mistrial, and is expected to begin again in September.) The consolidated litigation includes about 4,000 lawsuits, with all plaintiffs claiming that the manufacturers failed to warn of cardiovascular and blood-clot-related risks.

Even if the verdict doesnt stand, it sends a powerful message to AbbVie, and shows that juries will likely react unfavorably to AbbVies aggressive million-dollar advertising campaign. The company marketed the drug as an effective treatment for low-T, which it described as a condition with the same symptoms of normal male aging, like fatigue, muscle loss, and drop in libido.

The FDA, however, approved testosterone replacement only for medically diagnosed low testosterone, or hypogonadism. Studies have shown that many of the men who were convinced to take the drug never had a single testosterone test to diagnose any medical condition.

In 2014, for example, researchers reported that 40.2 percent of U.S. men did not have a testosterone test in the 180 days before beginning therapy, and 50 percent had only one test (doctors usually conduct at least two to get an average reading).

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Jury Punishes AbbVie for False Advertising in First MDL Verdict - Legal Examiner