Why I Prescribe Testosterone Replacement Therapy

00:06:22
https://www.youtube.com/watch?v=-HCpJxMIwPU

概要

TLDRThis video explores testosterone therapy for men whose testosterone levels generally decline after age 35, leading some to use therapy to restore levels. The testosterone trials show therapy improves sexual function, walking distance, mood, anemia, and bone density. However, risks include increased coronary artery plaque and prostate-specific antigen levels, potentially leading to heart attacks and cancer. The Endocrine Society advises therapy only for men with consistent symptoms and low testosterone levels. Non-surgical options include weight loss and resistance exercise, reducing the need for supplements. For men needing therapy, a cautious approach with safety checks and regular screenings is crucial. A promising new molecule, 17 Alpha estradiol, is being researched for potential benefits. Clinicians must ensure accurate diagnosis and follow strict guidelines to avoid risks while maximizing benefits.

収穫

  • 🧪 Testosterone therapy can improve multiple health aspects but carries cardiovascular risks.
  • 📉 Testosterone naturally declines after 35, influencing libido and mood, among others.
  • 🩺 Accurate diagnosis of low testosterone levels is crucial for therapy consideration.
  • 🏋️ Weight loss and resistance exercise are safe methods to boost testosterone.
  • 🔍 Regular health screenings are vital during testosterone therapy for safety.
  • 🔥 Increased levels of non-calcified arterial plaque are a serious risk of the therapy.
  • 💪 Lifestyle changes, like diet and exercise, significantly impact testosterone levels.
  • 🌟 17 Alpha estradiol shows potential as a new treatment for muscle and lifespan enhancement.
  • ❌ Misuse of testosterone therapy in healthy men is discouraged.
  • 📊 Managing cholesterol, blood pressure, and sugar levels is crucial during therapy.

タイムライン

  • 00:00:00 - 00:06:22

    The video discusses testosterone therapy and its implications, focusing on how testosterone levels decline with age, leading many men to seek treatments to boost their levels. Testosterone acts as three different hormones and plays a crucial role in muscle building, sexual function, and bone density. Studies known as the testosterone trials showed that while testosterone therapy can improve symptoms in older men with low testosterone, it also poses risks like increased coronary artery plaque and higher prostate-specific antigen levels. The guidelines recommend ensuring low testosterone diagnosis through clinical symptoms and consistent testing before considering therapy, emphasizing lifestyle changes, weight loss, and exercise as safer alternatives. New exciting treatments like 17 Alpha estradiol, which could extend lifespan and improve muscle mass, are also introduced as future possibilities.

マインドマップ

ビデオQ&A

  • Why do testosterone levels decline with age?

    Testosterone levels generally decline from age 35 onwards due to natural aging processes.

  • What are the benefits of testosterone therapy according to the testosterone trials?

    Testosterone therapy improves sexual function, walking distance, mood, reduces depressive symptoms, anemia, and increases bone density.

  • What is the main risk associated with testosterone therapy?

    Testosterone therapy can increase non-calcified coronary artery plaque volume, raising heart attack risks.

  • When should a diagnosis of low testosterone be made?

    The diagnosis should only be made when there are consistent symptoms and unequivocally low testosterone blood levels.

  • How can lifestyle changes improve testosterone levels?

    Losing weight and engaging in resistance exercise can significantly increase testosterone levels.

  • What is the recommended treatment approach if testosterone therapy is necessary?

    The process involves safety checks like prostate cancer screening and managing heart disease risks before prescribing therapy.

  • What therapies are suggested as safer alternatives to testosterone therapy?

    Using GLP-1 for weight loss and resistance exercise are suggested safer alternatives.

  • Why should testosterone therapy not be used for healthy men with normal testosterone levels?

    Guidelines strongly recommend against its use due to unnecessary risks and side effects.

  • What molecule is being researched as a potential new therapy for men?

    17 Alpha estradiol is being studied as it may extend lifespan and improve muscle size.

  • What safety measures are taken during testosterone therapy?

    Patients are regularly screened for prostate cancer, and their blood pressure, sugar, and cholesterol levels are managed.

ビデオをもっと見る

AIを活用したYouTubeの無料動画要約に即アクセス！
字幕
en
オートスクロール:
  • 00:00:00
    there are specific circumstances when I
  • 00:00:02
    prescribe testosterone and given that
  • 00:00:03
    there's so much confusion about this
  • 00:00:05
    topic we'll have a deep dive into the
  • 00:00:07
    research we know that testosterone
  • 00:00:09
    levels generally decline from the age of
  • 00:00:11
    35 and onwards which has led many men to
  • 00:00:14
    want to measure their testosterone
  • 00:00:15
    levels and then use testosterone
  • 00:00:17
    therapies to bring their levels back up
  • 00:00:19
    because testosterone has many different
  • 00:00:21
    biological effects particularly because
  • 00:00:23
    it acts as three different hormones
  • 00:00:25
    testosterone itself stimulates protein
  • 00:00:27
    synthesis so it helps to build muscles
  • 00:00:30
    it's also converted into
  • 00:00:31
    dihydrotestosterone and estradiol and
  • 00:00:34
    it's estradiol that seem to cause the
  • 00:00:36
    benefits for our bones as well as
  • 00:00:38
    decreasing fat mass and for normal
  • 00:00:40
    sexual function but more about estradiol
  • 00:00:42
    later if men have low levels of
  • 00:00:44
    testosterone that's associated with low
  • 00:00:46
    libido depression low bone mineral
  • 00:00:48
    density anemia reduced muscle strength
  • 00:00:51
    and increased fat Mass so given that
  • 00:00:53
    testosterone levels generally decline
  • 00:00:55
    from the age of 35 and we lose the early
  • 00:00:57
    morning rise in testosterone many men
  • 00:00:59
    have elected to use testosterone
  • 00:01:01
    therapies to boost their levels but is
  • 00:01:04
    this a good idea do the benefits
  • 00:01:05
    outweigh the risks to explore this
  • 00:01:07
    concept a series of studies were done
  • 00:01:09
    called the testosterone trials which
  • 00:01:11
    only included older men with symptoms of
  • 00:01:13
    low testosterone and consistently low
  • 00:01:15
    blood testosterone levels and these
  • 00:01:18
    trials found overwhelming evidence that
  • 00:01:20
    testosterone therapy it does improve
  • 00:01:21
    sexual function walking distance mood
  • 00:01:24
    depressive symptoms anemia and bone
  • 00:01:27
    density so there are tangible benefits
  • 00:01:29
    but what about the risks and the biggest
  • 00:01:31
    risk is that we do see a greater
  • 00:01:33
    increase in non-calcified coronary
  • 00:01:35
    artery plaque volume these other blood
  • 00:01:37
    vessels around the heart so this study
  • 00:01:39
    it looked specifically at the blockages
  • 00:01:41
    in those blood vessels and they could
  • 00:01:43
    see over a one year period when
  • 00:01:45
    testosterone therapy was used those men
  • 00:01:47
    who were using that therapy they had
  • 00:01:49
    further blockages in their blood vessels
  • 00:01:51
    compared to Placebo which is very
  • 00:01:53
    concerning because this is non-calcified
  • 00:01:55
    plaque what that means is that it can
  • 00:01:57
    easily break away and cause heart
  • 00:01:59
    attacks there will was also a clear
  • 00:02:00
    increase in the prostate-specific
  • 00:02:02
    antigen in the blood so this is a common
  • 00:02:04
    marker for prostate cancer because of
  • 00:02:06
    these concerns the endocrine Society
  • 00:02:08
    they recommend that we should only make
  • 00:02:10
    a diagnosis of low testosterone in men
  • 00:02:12
    who have consistent symptoms and signs
  • 00:02:15
    and unequivocally low testosterone blood
  • 00:02:17
    levels so before I talk about the
  • 00:02:19
    process of prescribing testosterone to
  • 00:02:21
    men that have got low levels of blood
  • 00:02:23
    testosterone and have symptoms I want to
  • 00:02:25
    go through the lifestyle factors that
  • 00:02:27
    significantly increase testosterone and
  • 00:02:29
    are very safe we know that obese men who
  • 00:02:31
    manage to lose weight they have
  • 00:02:33
    significant increases in testosterone so
  • 00:02:35
    in addition to a healthy diet we've got
  • 00:02:37
    the game-changing weight loss
  • 00:02:38
    medications called glp-1 which is a
  • 00:02:41
    medication that I'm commonly prescribing
  • 00:02:43
    in the clinic we also know that
  • 00:02:44
    testosterone levels are greatly elevated
  • 00:02:46
    following resistance exercise so for
  • 00:02:49
    most men if they're a healthy weight and
  • 00:02:50
    they're doing resistance exercise they
  • 00:02:52
    don't need to worry about their
  • 00:02:53
    testosterone levels because their
  • 00:02:55
    testosterone levels will be at a healthy
  • 00:02:57
    range but if I see a male at the clinic
  • 00:02:59
    who is of a healthy weight and is doing
  • 00:03:01
    resistance exercise but still have signs
  • 00:03:03
    and symptoms of low testosterone and
  • 00:03:05
    they've got a low blood testosterone
  • 00:03:06
    level then we consider testosterone
  • 00:03:08
    therapy here's the approach based on the
  • 00:03:10
    clinical guidelines if there are signs
  • 00:03:12
    and symptoms of testosterone deficiency
  • 00:03:14
    we arrange an early morning blood
  • 00:03:16
    testosterone level if that initial
  • 00:03:18
    measurement is low we repeat it but we
  • 00:03:20
    also add on LH FSH and prolactin then I
  • 00:03:24
    get in contact with a local
  • 00:03:25
    endocrinologist because depending on how
  • 00:03:27
    low the levels of testosterone are they
  • 00:03:30
    may want to do pituitary Imaging so
  • 00:03:32
    that's a gland in the brain and if it's
  • 00:03:34
    decided that that patient would benefit
  • 00:03:35
    from testosterone therapy we need to do
  • 00:03:37
    some safety checks we need to make sure
  • 00:03:39
    that they don't have prostate cancer and
  • 00:03:42
    that we exclude polycythemia so
  • 00:03:44
    polycythemia is a high red blood cell
  • 00:03:46
    count once we've done all of that then I
  • 00:03:49
    prescribed the testosterone therapy and
  • 00:03:50
    I've seen firsthand how much it can
  • 00:03:52
    radically improve a patient's life and
  • 00:03:55
    we usually use a testosterone gel
  • 00:03:57
    because they typically result in normal
  • 00:03:58
    and relatively stable people blood
  • 00:04:00
    testosterone levels and most patients
  • 00:04:02
    prefer them to other preparations while
  • 00:04:04
    patients are on this therapy we need to
  • 00:04:06
    do everything that we can to minimize
  • 00:04:08
    the risks I regularly screen my patients
  • 00:04:10
    for prostate cancer and we do what we
  • 00:04:12
    can to protect them from heart disease
  • 00:04:14
    for example we control their blood
  • 00:04:16
    pressure we make sure that their blood
  • 00:04:18
    sugar levels are pristine and that their
  • 00:04:20
    cholesterol levels are at a healthy
  • 00:04:21
    range to clarify Statin medications
  • 00:04:24
    which are commonly used to lower
  • 00:04:25
    cholesterol levels they have no impact
  • 00:04:28
    on testosterone levels and the other
  • 00:04:30
    cholesterol lowering medications that
  • 00:04:31
    we've got available are pcsk9 Inhibitors
  • 00:04:34
    and acetamine by thinking about and
  • 00:04:36
    managing the risks of testosterone
  • 00:04:38
    therapy we can maximize the benefits to
  • 00:04:41
    summarize there has been a dramatic
  • 00:04:43
    increase in the inappropriate use of
  • 00:04:45
    testosterone therapy and healthy
  • 00:04:47
    middle-aged and older men it is
  • 00:04:49
    important for clinicians to understand
  • 00:04:50
    that the diagnosis of testosterone
  • 00:04:52
    deficiency should only be made on the
  • 00:04:55
    basis of clinical symptoms and signs
  • 00:04:57
    consistent with low testosterone levels
  • 00:04:59
    and consistently low blood testosterone
  • 00:05:02
    concentrations between 8 AM and 10 AM
  • 00:05:05
    for men that do not have a low
  • 00:05:07
    testosterone level the guidelines
  • 00:05:08
    strongly recommend against the use of
  • 00:05:11
    testosterone and this is in line with
  • 00:05:13
    the endocrine Society guidelines as well
  • 00:05:15
    for most men we've got safer ways to
  • 00:05:17
    boost testosterone levels we can use
  • 00:05:19
    medications such as glp-1 to make sure
  • 00:05:21
    that patients are at a healthy weight
  • 00:05:23
    and if we combine that with resistance
  • 00:05:26
    exercise most men do not need to worry
  • 00:05:28
    about their testosterone levels however
  • 00:05:30
    there are a select few men that do need
  • 00:05:32
    testosterone replacement therapy and
  • 00:05:34
    I've seen firsthand the significant
  • 00:05:36
    benefits that those men can get but
  • 00:05:38
    there's something bigger on the horizon
  • 00:05:40
    and that's a molecule called 17 Alpha
  • 00:05:42
    estradiol this is a so-called
  • 00:05:44
    non-feminizing estrogen and when it was
  • 00:05:47
    tested in male mice it extended their
  • 00:05:49
    lifespan by a whopping 19 plus those
  • 00:05:52
    mice had larger muscles so I'm very
  • 00:05:55
    excited for human studies to look into
  • 00:05:57
    17 Alpha estradiol because that might be
  • 00:05:59
    a therapy that most men should be on
  • 00:06:01
    time will tell just remember when you
  • 00:06:03
    are doing resistance exercise make sure
  • 00:06:05
    you're getting enough protein and I've
  • 00:06:07
    got a video about the protein research
  • 00:06:09
    here a massive thank you to do not
  • 00:06:11
    age.org for their ten thousand dollar
  • 00:06:13
    donation to my rapamycin study they are
  • 00:06:15
    a health research organization and to
  • 00:06:17
    benefit from their ingredients as well
  • 00:06:19
    as the 10 discount code check out the
  • 00:06:21
    pinned comment
タグ
  • testosterone therapy
  • male health
  • testosterone decline
  • endocrine society
  • non-surgical options
  • 17 Alpha estradiol
  • health risks
  • testosterone trials
  • weight loss
  • resistance exercise