On our show this weekend we are joined by our friend Dr. Wasim Deeb, an endocrinologist, in a discussion about low testosterone levels and hypogonadism in men. We will discuss some of the various products available on the market, the effects of too low or too high testosterone on fertility, and symptoms, effects, and treatments for low testosterone levels.

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Listen to August 3, 2013 episode

Female: This hour is brought to you by The Conversation on News Talk WOKV.

Jay Gray: Welcome to The Conversation on News Talk WOKV. Thanks for joining us! I am Jay Gray joined here by Dr. Ali Kasraeian 340-1045. Now before this show, we talked to Shannon Miller and she deals a lot with women’s health issues. Today, I think we’re going to deal with the men’s health issues. Talk a lot about low testosterone today.

Dr. Ali Kasraeian: Yes, welcome to The Conversation Jay. Thank you for joining us again as always. We’ve had actually a very interesting conversation about this topic already and we haven’t even started the show. Today, we’re going to talk about hypogonadism and low testosterone level, which over the past year or two has had a little bit more of an emergence in terms of how often I know in our clinic it comes up because of the amount of television advertising, direct to consumer advertising for testosterone supplementation and products. Essentially, medicine for low testosterone level are really hitting the market a lot. People come in and they ask us about low T and things of that nature.

Jay Gray: That’s funny that you’re mentioning that now because I have Facebook on one screen from WOKV, and I guess they go by what you look up. Since I’m a power lifter, first ad on the right side of the screen Natural Testosterone Lift. Literally, the first ad that pops up is about testosterone level increasing.

Dr. Ali Kasraeian: What do you think, from your perspective, I used to be fit and exercise was back in college. That’s been a long time ago, but when I was there the interesting thing was people would look for any type of shake, any type of supplement. I’m actually a diabetic. I’ve mentioned it a few times in the show and I wear an insulin pump. Before we get into it Dr. Wasim Deeb, my good friend and endocrinologist, is in the studio today to help talk about this as well. We’ll introduce him formally, but what I found was interesting is when it got close to competition time some of the people were competitive body builders would come and ask me whether I could give them a little bit of insulin because it’s an anabolic steroid. Of course I’d say no and run away. But it’s a very important part of those type of exercise based activities.

Jay Gray: It is! That’s the thing. It’s illegal in the United States. It actually is legal in a lot of other countries, but you get advertisements for it all the time. They can’t advertise for something legal, so it makes you wonder – does this stuff really work or is it actually just somebody out there trying to make a buck on something that, placebo? Maybe you think you’re getting extra testosterone and you really get nothing out of it? I get drug tested in my power-lifting league, so there’s no way I can use anything. Or you’re banned for three years. It’s almost a death sentence. If you can’t compete for three years, you’re done!

Dr. Ali Kasraeian: You’ll be old by then.

Jay Gray: Yeah, so I always wonder about those sites that say hey we’re going to give you natural testosterone. Look ripped like Hugh Jackman did in The Wolverine! He just took this pill for seven days and looked how jacked he got. It’s funny because a lot of these clients there that they talk about this, they will give you a 30-day supply. Say it’s a risk free week trial, but they give you 30 days. They still make you pay for the 30 days even though you signed up for the free trial. Unless you send it back and you have to pay the shipping back and all that stuff. I really think those are big scams out there. Curious what actually does work for people and what doesn’t.

Dr. Ali Kasraeian: So Dr. Deeb, what do you think?

Dr. Wasim Deeb: Just my own observation – five years ago, when we started to get, I was new in Jacksonville, get all patient list. If you look at my new consult, diabetes, diabetes, diabetes, thyroid, thyroid. Now, just look at last week and you see testosterone, testosterone, diabetes. It’s really amount like I would I say triple if not quadruple from the amount of reason for testosterone visit we got in the office.

Dr. Ali Kasraeian: I tell you the data supports that too. The Washington Post in late June had an article looking at this stuff. They quoted a study that looked at the amount of testosterone prescriptions out there between 2001-2011. They compared it and the rate has tripled in terms of that. The interesting thing going to what Jay was saying, about a quarter of those prescriptions a lot of times are placed without a testosterone level being checked. One thing that we’ll do today is hopefully educate everyone in terms of the signs and symptoms and everything that would prompt us as physicians to look for low testosterone as a source of a problem, but also for you to pay attention to. Then what the appropriate work up and management of a low testosterone level is.

Dr. Wasim Deeb: I just want to drop one more thing.

Dr. Ali Kasraeian: Sure.

Dr. Wasim Deeb: Actually this week, I have four patients who come to me with testosterone of 2,800, which is extremely elevated.

Jay Gray: Wow.

Dr. Wasim Deeb: Remember normal is 300+ to 800. All those people getting testosterone injection from everywhere without even level being checked, they feel really not tried at all. This is very common giving medicine or giving supplement without even checking the blood work.

Jay Gray: Do you see a guy come in that’s completely jacked and 300 pounds solid muscle saying I think I have low testosterone? Can you give me a prescription?

Dr. Ali Kasraeian: It’s a common tale.

Dr. Wasim Deeb: Yeah, actually they feel so bad though when they get so high because there’s really all these mood changes, aggressive behavior. Also muscles start to get wasted from too much testosterone sometime instead of the opposite way.

Dr. Ali Kasraeian: Interesting we’ll get into this a little bit. If your testosterone level is too high, you actually can have infertility issues which some people don’t understand that also. We’ll get into all that stuff today. Dr. Deeb, in terms of looking at these things, first if you’re expecting a low testosterone level, what are some of the symptoms people can expect?

Dr. Wasim Deeb: Number one is really the most common reason people check testosterone level has to do with sexual desire, libido and function. Any abnormal of this area always ask patients or doctor wise to check testosterone value. In addition to that could be infertility, could be osteoporosis, which is really men rarely have. But if a man has osteoporosis, it’s really important to check testosterone value because that’s one the reasons. There is gynecomastia or abnormal breast size, that’s another reason for checking testosterone, or mood swings a lot. Those are the symptoms in science criteria to really start thinking about testosterone.

Dr. Ali Kasraeian: Again, for those of you listening, you can kind of break this down into three things. As an urologist, we work very much hand in hand with our endocrinologist colleagues and our primary care physicians with testosterone issues because we see it a lot when people come in for erectile dysfunction. That’s one of the essentially three types of symptoms people experience. One is sexual dysfunction type of things. They notice erectile dysfunction. Their libido or their sexual desire is not quite as profound as it used to be. The other thing is people may notice energy issues, loss of energy, they’re sad. One study talked about a kind of downheartedness and fatigue. That’s a challenging one because you can have that if you’re stressed out, if you work too much, if your heart’s broken, if you have a low thyroid level. All of those things can come there, or if people are depressed. A lot of symptoms of hypogonadism or low testosterone level can make depression as well. People are not as interested in doing things. They might not have the physical ability to be engaged in more strenuous activities because their energy level is down. It’s really kind of a very interesting multi-disciplinary disease process that you have to look at multiple things, but you definitely look at testosterone level and that factor.

Dr. Wasim Deeb: Yes, I found a lot of low testosterone people who are really just depressed or no motivation to do anything, and you just screen and it is really abnormal. As you said the mood, sexual dysfunction, energy is the key. If you look at any fatigue national guideline to look up for men, it’s testosterone there, thyroid, Vitamin D, B12.

Dr. Ali Kasraeian: Yeah, I think that’s also interesting to look at. You can have kind of multi-factorial aspect of things. People who are diabetic have a hig