Hormones (other than testosterone) that affect men’s sexual function

Estrogen, Prolactin, Human Chorionic Gonadotrin, Throid, Human Growth Hormone...and their function in men's sexuality...

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Harder, Straighter, Bigger. Step 4. Hormones. Testosterone.

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Hello this is Charles Runels and we're still talking about ways to help Peyronie's disease and erectile disfunction. Today we're talking about testosterone. Testosterone is associated with Peyronie's disease, we're not sure exactly why, but I have a theory about that. Peyronie's has an autoimmune component to it and for some reason men are less susceptible to autoimmune problems than women, so women have more rheumatoid arthritis, they have more lupus, they have more lichen sclerosus. All those things are caused by the immune system attacking itself. They have more multiple sclerosis and it's been shown that men who get MS, more likely to get it, as they approach andropause when their testosterone levels fall. Men are more likely to get Peyronie's disease if they have a low testosterone level. Likely that has to do with the protective effect of autoimmune, protecting from an over-active autoimmune system by having a normal testosterone level. There are other reasons for correcting your testosterone level and I'll get to those.

First I'd say that after treating many thousands of women and men over the years, I would say that the primary hormone that regulates sex drive and erectile function is testosterone. It's almost impossible to have a normal libido without it, for a man or a woman. It's difficult to have normal erectile function. Without it the penis actually starts to shrink, just like the muscles would shrink and atrophy without testosterone. Other benefits of it though would include the heart, which is also a muscle and so testosterone is needed to maintain the health of the heart. There was at one time this idea that perhaps testosterone was dangerous to the heart, but now we know that not to be true. It's the opposite is true, that if testosterone level is low, the heart suffers and can become weaker. Of course muscle mass is not just about looking pretty, it also has to do with functioning.

As people age, the number one reason for going in the nursing home is people becoming too weak to get to the restroom, and they start urinating on the floor. Muscle is not just about being attractive or looking fit, it has to do with functioning and as people get older, it becomes crucial to be able to move and there's like a bank system, whatever, as you age and the muscles become less forceful, whatever you had banked as a young person is drawn upon and if you didn't bank a lot of strength when you were young, there's less to draw upon and you're more likely to become feeble as you get older. Depression, we know that having a low testosterone level is associated with depression and correcting it help, but not only that, concentration and focus and just energy level. I've also seen some people who at one time were just absolute lawyers, people who were bouncers or special forces, military, or high intensity athletes. You know, snow board athletic acrobatic people.

Then they come to me with panic attacks and you think, how out of character that here's a man that a few years ago was in a situation where he was required to be very brave and now he gets panic just sitting around the house, and when you do blood work on those men, oftentimes their testosterone level is very, very low. Which can be traced back to oftentimes a head injury and pituitary function is not working and so they are completely out of character and become like a castrated animal basically. Going from very bold to very panicky and fearful because they lost their testosterone. Bone mass is also related to testosterone levels, and even more so than with muscle there's a deposit of calcium into the bone and inaudible 00:04:32 bone is not static like a board that supports your home, bone is constantly remodeling by osteo-blasts and osteoclast, adding and taking away calcium to the bone itself. As a young person there's more deposits and as people get older there becomes more withdrawal on a flow system. There's always coming and going of calcium into bone.

There becomes more going of calcium instead of coming as people get older. Testosterone helps hold onto the bone, it helps to bank bone, it helps keep bone strong. Weight. This is sort of tricky because weight, part of the reason that men have a lower percentage of body fat is because they have a higher testosterone level and yet, if you use testosterone as standalone to lose weight, it will not work because what will usually happen is people increase their, not only their sex drive, but they'll increase their appetite for food. If they don't counterbalance that with more exercise, they just gain weight. Although it's true that testosterone as a general rule decreases percentage of body fat, if it's not part of an overall health system that includes exercise and watching, being careful about how you eat, then it leads to weight gain. On the other hand, without testosterone, a man or woman can exercise ferociously and still have very much difficulty maintaining a normal body weight, and maintaining a lean body.

It's crucial. Those are some of the reasons why you would want to use testosterone. Why would you not want to use testosterone? One reason is some men worry about it effecting the prostate. Now we know after multiple, multiple studies, over and over again for the past 20 years, that having a higher testosterone level does not correlate with prostate cancer. After a man has had prostate cancer, there becomes this strategy to sometimes lower testosterone levels to help keep it from recurring, but most urologists these days will tell you that at some point after a man has become cancer free for a while, they will put him back on testosterone. So prostate cancer is not a side effect of testosterone replacement. My personal opinion is that even though the evidence is still not conclusive to some physicians, I think prostate cancer probably evolves out of chronic inflammation and chronic prostatitis. Prostate cancer correlates more with that, with a history of sexually transmitted diseases and chronic prostatitis than it does with testosterone levels. We know that chronic inflammation leads to cancer, and we know that infection leads to cancer to in other areas like the cervix.

Other things that make a man may not want to be on testosterone do include weight gain, but as I mentioned before, this is not a problem if the man's maintaining an active lifestyle. You can't undo a sedentary life and a very self-destructive diet by just using testosterone. Using testosterone along with an active lifestyle and a healthy diet will improve the results of those two things. Another side effect of testosterone can be acne, again this can be controlled in most people by just watching the levels of testosterone that are given, or just treating the acne itself, usually with Retin A or something like that. Hair loss is a, male pattern hair loss can happen in men and women who use testosterone. I don't have a solution for that. That's guaranteed. Although there are helps, inaudible 00:08:58 is one that can be used topically to block the conversion of testosterone to inaudible 00:09:03 or testosterone and can help with that. Lipids, some people have worried about testosterone causing problems with Lipid profiles, but we now know that in most people testosterone improves the cholesterol and Lipid levels and profiles.

There was a time when people worried about the liver. The liver problems that arose from body builders using testosterone came from using oral testosterone supplements. Not from parental or avoiding the gut, because when you take testosterone by mouth, it passes through liver before it gets distributed to the body and that strains the liver to convert it or to process it. That can lead to liver problems, but when you take it as an injection or a cream and you bypass the liver, then that's not a problem. Actually, it can help regenerate the liver. There are studies showing that when a man has, for example, cirrhosis of the liver, alcoholic cirrhosis, and if he stops drinking the testosterone can be used to help regenerate apatisites 00:10:13, or regrow the liver. Some things can't be regrown, but the liver is one of the organs that can actually regenerate itself. Those are the basic why's and why not's of testosterone. If a man is suffering with Peyronie's disease, I would highly recommend that he consider being, making sure his testosterone level is normal. We're getting to how to check it and how to replace it.

Same with erectile disfunction, and any of those other problems that we mentioned. Now, let's talk about how to replace testosterone. First to measure it is a little tricky because it varies during the day. It's usually higher in the morning and then there's a sine wave sort of response, but the highest level is usually in the morning. Some people make a big deal out of if you replace it, trying to somehow replicate that up and down that happens on a daily basis. There's really no evidence that's convincing to me that that's necessary. That's one of the arguments, for example, of using a testosterone cream is to apply it in the morning and it's higher in the morning. Before we get to how to replace it pharmaceutically, it's worth thinking how it might be replaced just naturally. Here are some of those strategies. One is just maintaining a healthy lifestyle. Those things your mother told you to do; sleep. Sleep is not just some thing that your body rests, it seems sort of a simplistic way of thinking about it.

What really is going on is that your brain somehow, which we don't fully understand, does things biochemically. For example, the pituitary gland, which is the master gland that tells the others what to do and how and when, the pituitary gland controls your adrenals, your testicles, your thyroid. It secretes over 200 hormones that we know about, over 200. We're not sure what all it's doing, but we do know that it creates a separate spectrum of hormones in deep sleep, as opposed to when walking around or awake during the daytime. Those deep sleep hormones have to do with regenerating, not just the brain, but the entire body. There's a spike in growth hormone for example. Sleep is one of the things that can help regenerate or elevate testosterone levels. Also, a high sugar diet has been show to lower testosterone levels and so a lower carbohydrate diet that's higher in protein is helpful. Occasional fasting, not extensive, but periodic fasting on very low calorie diet for one or two days every week to a month is something that will boost testosterone levels.

The old-school body builders like Vince Geronda 00:13:24 were big into periodic fasting, not as a way to lose weight, but as a way to gain strength. Empirically they figured out that it raises hormonal levels and helps anabolic repair. Those are some of the things that we know. Other things that are less talked about that we know is for example, there's evidence that the more a man ejaculates the lower his testosterone level will become. This thing that somehow it doesn't, there's really no downside to indiscriminate masturbation, is really false. Those are the natural things that can be done. Now, if that's not helpful for whatever reason, and it can happen at any age, things that might lower testosterone level even at a young age include head trauma, even trauma to the head that does not cause loss of consciousness can effect the pituitary gland. It's dangling from a little tiny stalk that with sheer forces can cause micro-infarction's and decrease circulation to the pituitary. Head trauma.

It could be from playing sports or a fall, or post-concussive syndrome from a nearby bomb in a war situation. It's a known phenomenon that's been talked about in the New England Journal. Other things that might lower testosterone in a young man include smoking pot, which will not only lower testosterone, but raise estradiol levels and taking narcotics. Narcotics like Oxycontin and Lortab 00:15:10, those morphine-like pain medicines basically put the pituitary gland to sleep. There's less luteinizing 00:15:18 hormone and folical stimulating hormone. Which are the hormones that tell the testicle to make testosterone. Pituitary goes to sleep and the man makes less testosterone when he's on narcotics. Assuming all these strategies have been tried and the man still has a low testosterone level, the pharmaceutical ways to raise it, actually before we get to that, let's talk about measuring testosterone. Testosterone is up and down as we mentioned before, but not only is it up and down, but it's bound so some of it is floating free in your bloodstream, and some of it is connected to a protein.

Sex binding globulin. If you measure a total level, it can be misleading because you're measuring not just the free part, which can actually activate your tissue and do the work, but the bound part. Picture it like a train and the proteins are like the box cars on the train that are carrying the testosterone around, but it's only the testosterone that jumps off the box car, jumps off the train and into the bloodstream that's doing any work. If you measure all the testosterone that's on and off the train, you can't really tell what you're doing. The way to get to that, the most accurate way to get to the actual free testosterone, which is the part that's jumped off the train, is to measure the total amount of it, that's on the train and off the train, or what's bound to the protein and what isn't, and also measure the sex binding globulin. Then you can calculate what part of it's free.

Then looking at that, my suggestion is that you put your testosterone levels in the upper 25% of normal for a 35 year old man. You don't need to be 18, but you don't need to let it just taper off down to nothing either. Okay. Once that's measured and it's determined that you need replacement and if you do the things that you know to do to try to bring them up normally, and that's not helpful, then some pharmaceutical options include Human Chorionic Gonadotropin 00:17:46, testosterone pellets, injections and a cream. Now, HCG, or Human Chorionic Gonadotropin, is a small amino acid peptide protein like luteinizing hormone, and so the body thinks it's luteinizing hormones, the testicles do, so when you use Human Chorionic Gonadotropin the testicles think the pituitary gland just told them to make more testosterone. For a young person who's close to normal, that is a good option. It's given sub-Q like an insulin injection twice a week, usually 2000 units twice a week. It's an odd hormone though in that if you go up on the dose, it can actually cause less response. It's better to start low and be patient.

You're fertilizing testicles, so you won't really know what the results of it are until you give it six to eight weeks, and then re-check your testosterone levels. The next thing that can be done are testosterone pellets. The downside to these are that whatever you put in, it's there for the next three months. There are those who've made a really nice business out of doing lots of pellets. My suggestion is that you do not use a pellet until you used injections to get an idea about what the ideal dose for you is, because if the pellets not enough, you're sucking wind. If it's too much, then you deal with side effects. Although pellets are a very elegant treatment, I think it's better to save that until after you've determined a proper dosage by using an injection of testosterone. Again, this is my opinion and there are many excellent physicians who have a different opinion and have amazing results. Medicine is still an art, and there are some parts of it that there's still some discussion about what the best strategy is.

I'm acknowledging that pellets are a wonderful option, whether it's something you start with or it becomes a second step, it's up to you and your physician. My preferred first step is injections using depo testosterone, most men should start with 200 milligrams IM every 14 days, or 100 milligrams IM every seven days. This is one where I do not prefer a compounded hormone because it seems that the quality variable varies. My preference is a name brand testosterone injected IM every two weeks. There is are also testosterone creams, the downside of the cream is you don't really know how you're absorbing it. People forget it, one day you do something and you're sweaty and you sweat it off. The next day you don't. There's just too much variability in my opinion. I'm not a big fan of testosterone creams. The problem with the cream is after being on it for six weeks, if you don't see anything changing, you don't really know what you have unless you do blood levels because you don't really know how much of it you've absorbed.

If you do injections, you know that you've absorbed what you injected and then you can make decisions based on that. Those are some of the ideas and strategies with testosterone. I highly recommend that every man know what their level is and that they do something to maintain healthy levels. On the other hand, testosterone is not the end-all, be-all, for example, a prolactin can decrease sex drive and make a man impotent even with amazing testosterone level. As can a low thyroid level or a very low growth hormone level. So it's not the magic cure, but it is a necessary ingredient and I highly recommend that you speak with your physician about it if you're having problems with erectile disfunction or Peyronie's.
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