Testosterone is the hormone that puts hair on a man's chest and is the force behind his sex drive.
It’s the hormone that builds a man physically – building muscles, strengthening bones and deepening the voice.
It’s normal for men to experience a gradual decline in testosterone after age 30, but the symptoms of low testosterone can mirror those of other conditions, which is why it’s important for men to stay on top of their overall health.
Whether to test your testosterone levels is a conversation you should have with your doctor, and Dr. Norm Shively, board certified urologist for Yakima Urology Associates, is here to tell you why.
Selected Podcast
Low Testosterone in Men
Featured Speaker:
Dr. Norm Shively, Yakima Urology Associates
Dr. Norm Shively is a board certified urologist for Yakima Urology Associates. Dr. Shively received a bachelor’s degree at Whittier College, a medical degree at Oregon Health Science and continued his education with a surgical/urology internship at the University of New Mexico. Dr. Shively completed a medical mission in South Africa before completing his urology residency in 1988. He is active in several professional organizations and previously served three years as Chief of Surgery. Transcription:
Low Testosterone in Men
Melanie Cole (Host): Testosterone is the hormone that puts hair on a man’s chest and is the force behind his sex drive. It’s the hormone that builds a man physically, building his muscles, strengthening bones, and deepening the voice. It’s normal for men to experience a gradual decline in testosterone after age 30, but the symptoms of low testosterone can mirror those of other conditions and may be quite alarming. My guest today is Dr. Norm Shively. He is a board-certified urologist for Yakima Urology Associates. Welcome to the show, Dr. Shively. Tell us a little bit about what is low testosterone and things that we hear in the media about low T and what symptoms should men be on the lookout for.
Dr. Norm Shively (Guest): Well, thank you. Yeah, low testosterone is getting a lot of press these days and we’re certainly seeing a lot of it in the office, people having questions about it. When we decide to treat low testosterone, really, it’s based on a couple of things. You alluded to a fact that with low testosterone there may be the loss of energy, loss of sex drive or libido, maybe some loss of muscle mass, gaining weight, these sorts of things. Those are sort of signs and symptoms, but also, we base treatment on documenting a low serum testosterone, which is a blood test.
Melanie: When would a man or his wife or his spouse send him in to the doctor? Because really, we women are who send our men to the doctor in the first place. Is this something you think that the women would notice first or that the men would notice and try and ignore for a while?
Dr. Shively: I would have to say I think men are worried about it. At least, when they come to see me, it’s not that they were sent in by their wife. It’s usually that they’re complaining of some things that are kind of parts of the normal aging process where they may be run down, feeling tired, and just not as strong as they used to be. Part of that is just normal parts of life. They often come in with the complaints that they’re just not strong enough and they can’t do the things they want to do. Another part of it is testosterone has quite an effect on the mind. These fellows may be a little bit depressed, may lack gumption to get up and go. They may have some kind of self-esteem or self-confidence issues. Testosterone is an amazing compound in the body and affects so many things that there are often psychological issues that will bring them in. And with all the press testosterone is getting now, we’re a society who like the quick fix. It’s like, “Oh, gee, I’m tired. I’m run down. I must have low testosterone.” We’re seeing advertising now. We’ve got these great preparations now for replacing testosterone. That’s generated by the industry. Guys are just more aware it and kind of wondering now, “Could this be low testosterone for me in why I’m so tired?”
Melanie: Tell us about the mainstream treatments. When you do actually test someone, blood test and you diagnose them with low testosterone and they’ve had all these symptoms, what are some of the treatments? And then we will start with some of those media things and maybe some natural treatments.
Dr. Shively: Well, let me back up by just saying that there’s not a pill. We don’t like to give testosterone or testosterone supplement orally because they can have some very serious liver consequences. Basically, we want to give it parenterally, which means any way but oral. There’s some transdermal preparations. There is a patch that can be worn. There are several lotions or creams that are applied usually over the shoulders or upper body. There’s even a little patch that you stick inside your gums and put a couple of little patches a day there to secrete testosterone. Those are absorbed by the bloodstream across the oral mucosa. But basically, it has to be done parenterally. Those preparations are really pretty expensive, and insurance reimbursement is kind of iffy on those. The insurance companies really don’t like to pay for this, so they’re expensive treatments. Probably the cheapest is actually getting a shot, and we have a preparation that lasts several weeks to about every three weeks. A fellow may come in and get a shot, or sometimes we teach them how to give it to themselves or their spouse give it at home.
Melanie: How often and how long does it last? Is this something that now if they have low testosterone that they’re going to have to keep a watch on for the rest of their life, or is it something that will just build itself back up once you start this therapy?
Dr. Shively: Well, that is an excellent question because it really is sort of a trap. Because once you’re on testosterone therapy, your body’s production of testosterone—that is, the testicular production of testosterone—is stopped. You’re committed to use testosterone really forever. Even if you stop it, your testosterone production will start again, but it may not reach the same level. It really is a commitment. It’s not just like, “Okay, we’ll use it for six months, boost things up, cure the problem, and that’s it.” Because once you stop it, there will be zero testosterone in your bloodstream because it’s not being produced and it takes a while for that to build up, so the symptoms will return. As good as it sounds to get started on testosterone and get the beneficial effects with increased energy and libido and drive and all that, it can be really a lifelong proposition. I think men need to know that, and I tell them that right from the get go. That’s one of the little bit controversial parts of supplementing testosterone. It’s really not just a quick fix.
Melanie: Are there other risks that might include prostate issues or BPH? Do men have to be aware of some of these before they consider starting this?
Dr. Shively: Well, I like to have a thorough discussion with the patient and discuss these things with them. The ones that I find the most satisfying to treat are guys who are profoundly hypogonadic. They have some syndrome or some cause where they come in and their testosterone is way, way down. They’re having the signs and symptoms. They have hot flashes. They have this profound fatigue, depression, all sorts of things. Then you can document the low testosterone, then it’s a no brainer. Let’s give you the stuff. But for the fellows who are just tired, it’s a little bit tougher because there are some issues supplementing testosterone. One is -- they’ll get back at me. I’ve had a few fellows or their spouse come in and say, “You know, this testosterone is not working so good because he’s now aggressive and he’s just kind of hyper.” I’ve had some wives actually ask me not to give it. You mentioned prostatic enlargement. Prostate is an organ that’s dependent on testosterone for its growth and can be stimulated to grow and cause some urinary obstructive symptoms, like a little bit more difficult to urinate. And prostate cancer is associated with testosterone. Now, supplementing testosterone and the presence of testosterone in the body does not cause prostate cancer. But the prostate itself, including prostate cancer cells, are stimulated by testosterone. So if a fellow has some occult prostate cancer, we give testosterone, those cancer cells are going to be stimulated to grow. Part of starting it is screening for prostate cancer with a PSA, and of course, feeling the prostate on digital rectal exam.
Melanie: In just the last few minutes, Dr. Shively, if you would, give us some natural treatments, maybe some behavioral or lifestyle modifications, things you might like men to do to increase their levels of testosterone naturally and why they should come to Yakima Memorial Family of Services for their care.
Dr. Shively: Well, I’m not sure that we can necessarily raise testosterone levels except one thing that seems to interfere with testosterone metabolism and availability is obesity. Certainly, weight loss, getting rid of excess fat stores, which tends to absorb or break down or make less available testosterone in the body is one of it. Certainly exercise, low-fat diet, weight loss are things that fellows have to do. Exercise program. Of course, they should feel better anyway. A lot of these signs and symptoms that we wish testosterone will take care really are kind of a lifestyle thing. A healthy lifestyle with good diet, exercise, weight loss, those are probably going to have more benefits and less cost associated than getting a shot, getting a preparation to supplement testosterone.
Melanie: Thank you so much. For more information on Yakima Memorial Family of Services, you can go to yakimamemorial.org. That’s yakimamemorial.org. You’re listening to Healthy Yakima. I’m Melanie Cole. Thanks so much for listening.
Low Testosterone in Men
Melanie Cole (Host): Testosterone is the hormone that puts hair on a man’s chest and is the force behind his sex drive. It’s the hormone that builds a man physically, building his muscles, strengthening bones, and deepening the voice. It’s normal for men to experience a gradual decline in testosterone after age 30, but the symptoms of low testosterone can mirror those of other conditions and may be quite alarming. My guest today is Dr. Norm Shively. He is a board-certified urologist for Yakima Urology Associates. Welcome to the show, Dr. Shively. Tell us a little bit about what is low testosterone and things that we hear in the media about low T and what symptoms should men be on the lookout for.
Dr. Norm Shively (Guest): Well, thank you. Yeah, low testosterone is getting a lot of press these days and we’re certainly seeing a lot of it in the office, people having questions about it. When we decide to treat low testosterone, really, it’s based on a couple of things. You alluded to a fact that with low testosterone there may be the loss of energy, loss of sex drive or libido, maybe some loss of muscle mass, gaining weight, these sorts of things. Those are sort of signs and symptoms, but also, we base treatment on documenting a low serum testosterone, which is a blood test.
Melanie: When would a man or his wife or his spouse send him in to the doctor? Because really, we women are who send our men to the doctor in the first place. Is this something you think that the women would notice first or that the men would notice and try and ignore for a while?
Dr. Shively: I would have to say I think men are worried about it. At least, when they come to see me, it’s not that they were sent in by their wife. It’s usually that they’re complaining of some things that are kind of parts of the normal aging process where they may be run down, feeling tired, and just not as strong as they used to be. Part of that is just normal parts of life. They often come in with the complaints that they’re just not strong enough and they can’t do the things they want to do. Another part of it is testosterone has quite an effect on the mind. These fellows may be a little bit depressed, may lack gumption to get up and go. They may have some kind of self-esteem or self-confidence issues. Testosterone is an amazing compound in the body and affects so many things that there are often psychological issues that will bring them in. And with all the press testosterone is getting now, we’re a society who like the quick fix. It’s like, “Oh, gee, I’m tired. I’m run down. I must have low testosterone.” We’re seeing advertising now. We’ve got these great preparations now for replacing testosterone. That’s generated by the industry. Guys are just more aware it and kind of wondering now, “Could this be low testosterone for me in why I’m so tired?”
Melanie: Tell us about the mainstream treatments. When you do actually test someone, blood test and you diagnose them with low testosterone and they’ve had all these symptoms, what are some of the treatments? And then we will start with some of those media things and maybe some natural treatments.
Dr. Shively: Well, let me back up by just saying that there’s not a pill. We don’t like to give testosterone or testosterone supplement orally because they can have some very serious liver consequences. Basically, we want to give it parenterally, which means any way but oral. There’s some transdermal preparations. There is a patch that can be worn. There are several lotions or creams that are applied usually over the shoulders or upper body. There’s even a little patch that you stick inside your gums and put a couple of little patches a day there to secrete testosterone. Those are absorbed by the bloodstream across the oral mucosa. But basically, it has to be done parenterally. Those preparations are really pretty expensive, and insurance reimbursement is kind of iffy on those. The insurance companies really don’t like to pay for this, so they’re expensive treatments. Probably the cheapest is actually getting a shot, and we have a preparation that lasts several weeks to about every three weeks. A fellow may come in and get a shot, or sometimes we teach them how to give it to themselves or their spouse give it at home.
Melanie: How often and how long does it last? Is this something that now if they have low testosterone that they’re going to have to keep a watch on for the rest of their life, or is it something that will just build itself back up once you start this therapy?
Dr. Shively: Well, that is an excellent question because it really is sort of a trap. Because once you’re on testosterone therapy, your body’s production of testosterone—that is, the testicular production of testosterone—is stopped. You’re committed to use testosterone really forever. Even if you stop it, your testosterone production will start again, but it may not reach the same level. It really is a commitment. It’s not just like, “Okay, we’ll use it for six months, boost things up, cure the problem, and that’s it.” Because once you stop it, there will be zero testosterone in your bloodstream because it’s not being produced and it takes a while for that to build up, so the symptoms will return. As good as it sounds to get started on testosterone and get the beneficial effects with increased energy and libido and drive and all that, it can be really a lifelong proposition. I think men need to know that, and I tell them that right from the get go. That’s one of the little bit controversial parts of supplementing testosterone. It’s really not just a quick fix.
Melanie: Are there other risks that might include prostate issues or BPH? Do men have to be aware of some of these before they consider starting this?
Dr. Shively: Well, I like to have a thorough discussion with the patient and discuss these things with them. The ones that I find the most satisfying to treat are guys who are profoundly hypogonadic. They have some syndrome or some cause where they come in and their testosterone is way, way down. They’re having the signs and symptoms. They have hot flashes. They have this profound fatigue, depression, all sorts of things. Then you can document the low testosterone, then it’s a no brainer. Let’s give you the stuff. But for the fellows who are just tired, it’s a little bit tougher because there are some issues supplementing testosterone. One is -- they’ll get back at me. I’ve had a few fellows or their spouse come in and say, “You know, this testosterone is not working so good because he’s now aggressive and he’s just kind of hyper.” I’ve had some wives actually ask me not to give it. You mentioned prostatic enlargement. Prostate is an organ that’s dependent on testosterone for its growth and can be stimulated to grow and cause some urinary obstructive symptoms, like a little bit more difficult to urinate. And prostate cancer is associated with testosterone. Now, supplementing testosterone and the presence of testosterone in the body does not cause prostate cancer. But the prostate itself, including prostate cancer cells, are stimulated by testosterone. So if a fellow has some occult prostate cancer, we give testosterone, those cancer cells are going to be stimulated to grow. Part of starting it is screening for prostate cancer with a PSA, and of course, feeling the prostate on digital rectal exam.
Melanie: In just the last few minutes, Dr. Shively, if you would, give us some natural treatments, maybe some behavioral or lifestyle modifications, things you might like men to do to increase their levels of testosterone naturally and why they should come to Yakima Memorial Family of Services for their care.
Dr. Shively: Well, I’m not sure that we can necessarily raise testosterone levels except one thing that seems to interfere with testosterone metabolism and availability is obesity. Certainly, weight loss, getting rid of excess fat stores, which tends to absorb or break down or make less available testosterone in the body is one of it. Certainly exercise, low-fat diet, weight loss are things that fellows have to do. Exercise program. Of course, they should feel better anyway. A lot of these signs and symptoms that we wish testosterone will take care really are kind of a lifestyle thing. A healthy lifestyle with good diet, exercise, weight loss, those are probably going to have more benefits and less cost associated than getting a shot, getting a preparation to supplement testosterone.
Melanie: Thank you so much. For more information on Yakima Memorial Family of Services, you can go to yakimamemorial.org. That’s yakimamemorial.org. You’re listening to Healthy Yakima. I’m Melanie Cole. Thanks so much for listening.