Testosterone for Men With Dr. Abraham Morgentaler

hello dear ones i am so touched and excited to have with us dr abraham morgan taller and he's just an international authority on men's health dr morgan you're a pioneer you have changed the way men view testosterone in their life and i remember back to the time when testosterone was taboo i mean you know no one was allowed to use it and you by your work your research have really changed that now dr morgentaler is an assistant professor at harvard he's a big harvard man you got both your medical degree and your urology degree there right yeah and you're the founder of of men's health boston i refer to you all the time into your group because men really need to have this center where so much is known you bring together so many different aspects of men's health and you've written a book i remember when i first got your book testosterone for life oh my god i bought hundreds of copies and i gave it to men and it was groundbreaking and then you wrote about men's sexuality and uh god what was the name of that book it was men's well we started off it's great to see you and thank goodness for you you're a true pioneer as well and i'm just thrilled to be here with you and thank you thank you for all those kind words um so my last book was called it started off as being called one man fake it it came out in hardback and you know it's about stories from my practice around men and sexuality and how men often didn't fit the stereotypes that we attribute to them especially when they're behind closed doors and they tell what's true instead of you know how they what their persona is that they assume and um and the lead story was about a young man who faked his orgasms and i had never heard about that when he first started telling me about it uh i since know a lot more but i was just intrigued by it why would a man even do that and it really said something about the kinds of motivations and pressures that men feel that i think a lot of us men included just aren't aware of yes if there's enormous pressure men are in a rapidly changing i would say you know social norm now uh you know women certainly went through it in the the 60s and 70s and now men are really experiencing themselves in such a different light in a new way and there there's confusion uh dr morgan taller men are quite confused and thank goodness for that book i i'm rushing to buy it as soon as we're done with the summit and because i love men i love men and my brother partner you know it's just we're we're in the more we understand each other and the less suspicion there is really the greater love we can create so i'm really interested in you know i i would have always thought that testosterone was central to urology you know i mean testosterone men urology right but that's not so much the case and how did you actually get get interested in testosterone and start working with testosterone yeah you know i it's it's a um boy it's been some trip i have to tell you so i started out really working with testosterone with lizards when i was an undergraduate at harvard i was working in a lab and um you know nobody was talking about testosterone but the researchers animal people you know we knew about this and of course we've known about domestic animals you know what happens when you castrate them and remove their testicles and whether it's horses or cattle or or dogs or cats right like we we've observed these things um but testosterone in humans was something that really people didn't pay much attention to it so that was in the 1970s and it's actually kind of cool so these were american chameleons they're about four inches long and you know they're common in florida and the bahamas and if you've been there they're the guys that go up the trees and sometimes they get in your hotel room and um and when the male scene you put a male in a cage with a female and they've got this bright colored flap of skin that comes under their neck it's called a dewlap and the male sees the female and the dew lab comes out and the head bobs up and down very quickly and it's like the male's going yeah yeah yeah yeah the female if the female of her hormones are okay she'll actually do a very stately push-up and that kind of says that she's receptive the male comes closer the dewlap comes out yeah yeah yeah yeah and they end up mating and if you castrate the male if you remove the testicles then they have no testosterone that put the male in a cage with the female and they don't do anything they don't do anything the female will sometimes do a little push-up again like hey buddy i'm over here like like come on over we don't males don't care and so my experiment was actually to put tiny amounts of testosterone in the brains of these lizards and we had identified which were the sexual centers in their brain and i wasn't always successful but when i was these males without testicles would be put in the cage with the female and the dewlap would come out the head would bob up and down and they would mate again and it was unbelievable and so i did those studies in the 1970s and i recently wrote a 40-year perspective on testosterone my first paper was 1978 and what i got from that was that testosterone was a brain hormone and that it was necessary and sufficient for sexual behavior in the male lizard when i came out of my training in urology and started doing work with men in 1988 there was almost no testosterone used in this country and and what we thought about testosterone was it was dangerous for prostate cancer so we didn't have much to offer these guys who had sexual problems there was no viagra cialis yet and so because of my lizard experience i thought maybe men are like lizards and i just started testing some of these guys and was surprised at how often their levels were low it turns out we are like lizards prudence good lizards we're like we're like the good lizards thank you and so i started treating some of these guys and they did remarkably well but you know our fear was that it was going to cause prostate cancer and that really led me on what became the rest the the primary focus the rest of my career for the next 30 plus years wow so i would love to hear your story you know of going from because when i was in i did my urology rotation in my first year of residency and it was like testosterone is the fuel that feeds prostate cancer right really this was probably not this was 19 i think 83. you know nobody was speaking about it and it was dangerous so what is this story with testosterone and prostate cancer how it basically was man's enemy to really fairly heroic i would say yeah so by the time i came out the only men who are getting testosterone in this country and pretty much around the world were men young men who had lost their testicles to cancer or trauma or had pituitary tumors that had been resected like it was clear that young men needed testosterone in order to develop as men and to be sexually active to be muscular etc there was a problem with once they got to their middle you know 40s and above because then they started worrying about prostate cancer and that original story came from huggins in 1941 won the nobel prize 25 years later charles huggins university of chicago and in in the 1940s there was no treatment of any sort for any prostate cancer and what he did based on experiments in dogs was that he castrated these men with metastatic prostate cancer they didn't have psa then they had another test called acid phosphatase and when he when he removed the testicles acid phosphatase came down just like we would expect psa today come down and he also gave it to a few men and their acid phosphatase went up and so he concluded testosterone activates prostate cancer and ever since then everybody's been deathly afraid to give it and even today you know however many years later 80 years later every testosterone product has in the label that it's contraindicated in men with cancer and even in men with suspicion of prostate cancer so when i came out in 1988 i started doing some of this work and i saw how well some of these men did you know talk to them about the re you know what are the risks they would say doctor i would say well you know we worry about prostate cancer how can you check for it well we'll follow your psa and i'll examine you and some of them didn't feel like that was so great and at some point i decided i better start biopsying the prostates because once i saw testosterone really worked to help men for all the reasons that you know not just with sex drive but also mood and strength and vitality and sharpness of the mind like these guys felt like their lives were so much better and i realized that if i was going to do this i needed to really exclude the possibility of prostate cancer so i started doing prostate biopsies before i gave testosterone in the men even if they had a normal psa and a normal prostate exam so prostate biopsies weren't that much fun then um they're a little bit better now but still nobody likes it but a lot of these guys were really hungry to sort of have something done and have their lives improved and the belief back then was that high testosterone caused prostate cancer low testosterone was believed to be protective i was trained that if a man lost his testicles early in life he that man could never get prostate cancer and yet right away these men with low levels of testosterone we found them to have prostate cancer and i remember we presented when we had six out of 33 cases uh i had my fellow present this data at our national urology meeting the aua and this international figure came to the microphone he had a huge booming voice and he said this is garbage everybody knows high testosterone causes prostate cancer low testosterone is protective you guys stuck your needles places you never should have stuck them you found cancers you never should have found i'll bet you dollars to doughnuts you you can biopsy another 100 guys you won't find another cancer the gauntlet is thrown down thank you what are you going to say thank you for your comments we're just reporting what we found and then when we had 50 cases and the numbers were still about one in seven i submitted it to the journal of the american medical association and something happened to me then that's never happened before or since and i've published about 200 scientific articles now which is that the editor called me called me on the phone you know normally it's all from a distance emails and whatever back then it was by mail and um and he said listen our board just discussed your paper we find it very interesting but you know you only have 50 guys and it's but it's the opposite of what we've all been taught so i tell you what if you can collect more patients the numbers hold true we'll consider it again and when we had 11 cancers out of 77 men we it and it got published in jam in 1996. so here's what that meant it meant that at least part of the story of testosterone and prostate cancer could no longer be true we had high rates of prostate cancer higher than it should have been in men with low levels the old teaching was high testosterone was a problem low testosterone was protective half of that story was no longer true fast forward to 2004 testosterone is now sort of out a little bit more in the public there's now a testosterone gel that had come out in 2001 doctors were now getting detailed on the the fact that this was there the women's health initiative for women's and women and hormones you know had come out in 2002 so there was some interest in hormones and what are the risks in men so the new england journal of medicine was interested in the review article and we wrote that up we meaning my fellow and myself and at that point i was clear that low testosterone wasn't protective but i still believed because it was my training that high testosterone was dangerous in some way poorly defined but in some way it must be bad and we pulled together about 200 papers and this is on the risks of testosterone and we're focused mainly on prostate cancer and my fellow comes to me is a very confident guy he's now a prominent urologist in brazil and he looks nervous and he says chief we're about to write the article he says chief do you have the articles that show that testosterone is bad for prostate cancer i said hernani i thought you must have and it turned out that what we published was that we couldn't find a single article not one that showed any compelling evidence that high levels of testosterone were in any way or testosterone therapy were in any way related to risk of getting prostate cancer high grade cancer or stage with cancer progression with cancer we couldn't find anything and yet that was taught around the world it's unbelievable that's right that's really unbelievable yeah so it started a whole new i could have sunlight it started a whole new thing for us and then i started treating some men then who had prostate cancer with testosterone and i'm just trying to get out of the sunlight here illuminate like the beauty of a skylight is it lets the light in but sometimes it's not always what you want um and you know if i fast forward i can tell you today that we i've now treated many hundreds of men who have prostate cancer with testosterone i don't give them the testosterone to quiet their cancer although there may be some evidence that that may be useful but it's mainly because they have a need or they're deficient and symptomatic and and i don't i no longer believe that testosterone is dangerous for prostate cancer right and i think that's been so well written about in terms of your work and so widely publicized that i think are urologists starting to catch on to that fact that so it's better than it was so i think that most of the urology community has now accepted and the oncology community has accepted that if somebody has had prostate cancer that they were treated surgery or radiation they've had a good outcome without any evidence of recurrence that there's minimal maybe zero risk if they go on testosterone i think that's the part that's accepted most urologists will still have their patients wait two years after surgery and but you know it's it's funny we learn things in med we think we're so smart in medicine and really we're just following a lot of the stuff that we were we were taught and um you know the rules around testosterone and prostate cancer it wasn't it came before even our teachers and our teachers teachers it's just been this assumed knowledge this conventional wisdom that's been handed down without any kind of challenge or question questioning or when does it apply when does it not apply so you know i had a some years ago i had a 84 year old attorney come see me um and you know his sex drive was down and he wanted his sexuality to be better and i said listen you know it's uh you know at your age it's good chance your testosterone is low and i bet it might help you um so let's get a blood test so we got the blood test and sure enough it was low but he also had a high psa um yeah so it was like if i remember right it was six or that was eight and um you know i said to him listen i sir you're 84 i don't buy i don't do a lot of biopsies in manhood 84 but you're in great health and you know if you have an aggressive cancer we might want to know and treat you if it's not aggressive maybe we'll just leave it alone or maybe you don't even have anything if we do a biopsy he says i'd like to know so i biopsied him and he has low-grade prostate cancer we're called gleason 6. probably won't ever hurt him in his life and so i tell him that's what he's got and i'm ready to leave the room he just wants me to watch it and i say i think that's a good idea and then just as i'm leaving he says but what about the testosterone doctor now this was some years ago and we were going to follow him which we now call active surveillance it was new new days for that and um i said well i can't give you testosterone you've got untreated prostate cancer and he's he's a lawyer and he was still very sharp he said doctor if you give me testosterone will it make my psa go up could we follow it that way i said that's logical but i don't know because i've never treated anybody like you he said if the psa goes up with testosterone and we stop testosterone won't the psa come back down i say that's also logical but i don't know because i've never treated anybody like you wow he says doctor i'm 84 years old i've got to go sometime i can't make you feel that way but while i'm on this planet i'd like to live as well as i can and would you please treat me and i'll sign any consent form you want and i ended up treating him and i was nervous like the very next day as like what's going to happen to him because this really is where the rubber meets the road right like you can write all your conclusions from data whatever but here was a guy now living my patient in front of me with untreated prostate cancer and he wanted it to be treated with testosterone and i ended up publishing on him after two years his psa started in the eights it actually dropped into the sevens dropped into the sixes and stayed there for two years he was my patient on testosterone for a total of six years his psa never went anywhere we stopped when he was 90 because his wife brought him and he had dementia at that point so it was we let it go but he gave me then the courage to start treating men which for what is now pretty common for us to do which is active surveillance where we're just watching guys who have low risk cancers you know what year was that that that you saw your first uh patient like that you know for who had cancer i have to guess i'm saying i would guess it's about 10 years ago 10 years ago because i remember you mentioning that you had a study with men who had stage 4 prostate cancer that needed testosterone and who wanted testosterone and they were doing pretty pretty well i is that correct is that yeah so so we're actually writing up now so i've got a number of men with with metastatic disease um and men who have recurrences of their cancers after treatment which we call biochemical recurrence um and on the whole they've done really well now listens people with prostate cancer that has spread there's the natural history of that is that that continues right like it progresses on its own whether they get testosterone or not but the traditional treatment for those men has been to eliminate their testosterone completely we call that androgen deprivation and you know there's some increase in survival not amazing but some increase in survival but a lot of those men are just miserable they lose their strength they lose their personality they lose their motivation so i've had a couple of these guys um you know i had one guy who had surgery he was relatively young in his 60s and and he had surgery for prostate cancer they found lymph nodes so they left his prostate in place because what's the point and they radiated him and they started him on androgen deprivation these medicines like lupron and um and he was so miserable so he came in with his wife and um nice guy and he said doctor i'm so weak that i can't raise my hands up in the shower to wash my hair the wife tells me he's the most sociable person you've ever met we don't leave the house anymore he feels that he's not comfortable driving we had our favorite restaurants we don't do anything and he wanted he wanted to be on testosterone we ended up treating him first we stopped the androgen deprivation and everything comes back it's like his personality comes back starts driving they go to the restaurants they see his friends you know and the fear had been that their cancers would come back you know with a vengeance and so far we just haven't seen that that's that's wonderful and i have never seen men as miserable as those men who have had their testosterone completely removed it's it's it's really terrifying to think that any man would have to face that and so dr morgentaler you're you're just you're really a god and a um an example to man no no it's much more than that but listen how would you how would you you know who would you consider putting on testosterone therapy i mean what are some of the symptoms that men present with right so you know listen testosterone's a critical hormone for for men and for women as you know um and and most of us walk around and and in some ways it's the most natural treatment that exists because all we're giving to people is a chemical inside their body that they've always had they've always had it if somebody takes an antibiotic or an antihypertensive the body's never seen those molecules before i'm not saying that it's wrong to take them i'm just saying that if you want to take something or be natural testosterone is natural you couldn't find anything more natural and the goal of treatment is to get them back to where they were when they were i don't know 15 20 years younger and so we know what it does we know what it does in animals and we know what it does in humans at this point too um now but that doesn't mean that everybody needs to be on extra testosterone but you know the numbers of men who are do so men need to have some kind of symptom or some sign of deficiency and they need to have low levels now the trick is what's a low level and so people argue back and forth with this and um you know we have two two main blood tests that we look at in men one is called total testosterone or shorthand is just testosterone and that's what all of us trained on but much of the testosterone that's circulating in our system is attached to sex hormone binding globulin this big protein that holds onto it and holds on to it so tightly that as it goes past the cell that might need testosterone the testosterone can't release to go into that cell so the the form of testosterone that does go get through that lipid bilayer into the cell is the free testosterone it's called freaks it's unbound it's not attached to anything and so free testosterone can be measured and it turns out that large numbers of men may have variations and generous amounts of shbg that carrier molecules sex hormone binding globulin which if you have a lot of that carrier molecule will also make it look like you've got a lot of total testosterone but the part that's available to actually work me is unrelated to it so um so in my practice we use both total and free testosterone um but really most of the decisions are based on having a low level of free testosterone it gets even a little bit more complicated though because they're about three or four different assays different blood tests for free testosterone and several of them have different reference ranges so if i gave you know people i say what's the number it depends on what the test is that's being used but i can tell you that for most um the most common test now being used for free testosterone is called calculated free testosterone and the units are usually picograms per ml and if somebody man has symptoms and he has a level less than a hundred i think he's a candidate for treatment okay that's good i i have a lot of men who come in and say well you know his testosterone level might be 250 300 he's let's say 50 years old and he said well i went to the urologist you're all just said i have you know my my level is normal and yet i'm exhausted and i have foggy brains and i i'm no longer interested you know the symptoms you mentioned which are really pretty you know i can't get erections i'm not thinking about sex i you know i like to work out you know i can't lift my arms i'm not building myself so what would you do with that man who i mean what would you say to those urologists or to men who have been told that because it's so common that i hear all the time yeah it's awful we we hear that story about two or three times a week where somebody has absolutely low testosterone like it's it's no question and they've been told by their doctor well maybe it's a little low or it's borderline but you don't need it let's do something else and there is nothing else you know so viagra cialis thank goodness we have those medicines but all they help with is blood flow to the penis they don't help with sex drive they don't help with achieving an orgasm they don't help with sense of well-being they don't help with mood they don't help with muscle versus fat like it's not the same but there is a one of the biggest issues uh in our culture is that testosterone has had testosterone has a bad rap yeah well it used to i think you've changed that i mean i think still for the medical community for whatever reason they've decided that it's associated with abuse with improper prescriptions with um you know people cheat with it and bodybuild and all this stuff yeah there's a real reluctance especially on the medical side to treat so i i had a guy who saw the chief of endocrinology at one of our harvard teaching hospitals and he's in he was early 40s and married and his wife was upset with him because he just didn't have any sexual desire anymore and she's going listen honey were you young like like what's happening do you not love me you don't care for me you got to get this checked out he saw the chief of endocrinology and he had low levels of testosterone unequivocally low almost everybody would agree if your total is less than 300 you're low and he was like 220 or so and he tells me that the doctor confirmed that he had low testosterone but he didn't need treatment because in the olden days the queens used to have eunuchs men who had their testicles removed who would take care of the harem and often were it why considered wise advisors to the queens he says those eunuchs had it pretty good and your testosterone is better than theirs so you're fine goodbye and what this guy says to me he says that's ridiculous he says i don't care about any queens from olden days i care about the princess that sleeps next to me at night yeah yeah you know men want uh really it's it's new for me taking care of me maybe the last 10 years or 12 14 years you know men want harder longer stronger faster and you know we we need to support that because really that strength of their of their physicality and their soul and their their vision you know men are consciousness and so i think testosterone is actually a consciousness hormone maybe maybe good for the soul i mean what is it a soul hormone you know prince i think that what you just said is actually really important and act and very profound so we're in a very tough time for men in this country in in our current moment it's not true in other in other like europe for example but men are having a hard time figuring out what it is to be manly you know and if we can set aside you know sexual violence and sexual abuse and just call it criminal and we just talk about healthy normal male sexuality our fathers our brothers our husbands our sons it's a part of who we are and we can make fun you know what you said harder faster whatever we can i we can either um ridicule men for that being some of their priorities and their focus or we can recognize it and to some extent great extent honor it is something that is important for them and if we do that and we let the men be um big manly in in in the grandest sense of the word they're better partners when a man feels good about himself as a man just watch what he's able to give to his partner and to everybody around him it's when men feel small beaten that they're fighting about every last little crumb when they feel good about themselves and whole then they've got the freedom to be everything that they've always wanted to be yeah you know i was that i mean that is so beautiful the way you put that and i you know i you're a leader of men and and your words are important and you know dr morganton i remember i was going up to suzanne summers house once for an event it was a beautiful dinner and she has this little tram going up to her house and i was in this tram with three male doctors one was a plastic surgeon very well known then there was a great internist and i don't know there was another man and they started saying well i've been married 46 years and i said oh that's that's amazing uh you know here's to love and they said and i said how'd you do it i i had 27 years which was very good and they said well we've learned i mean i've learned never never never to say anything and it's like what do you mean well if my wife says something i say yes and it's like i said no no no come on we have another you know 30 seconds up here in the trend right that's not right that's not manny please don't do that you know if we do that to you and silence your voice we have silenced the lion's roar and then we don't like you guys you know then that's the dirty secret is that you know we control you with our power and then we end up sort of not liking you so it's so important for men to be your true self to be the vision of who they have for life and to help lead us you know we're really tired of you know always being the leader i mean we need our men so you're you're bringing that back dr morgan taller and you know really i'm i'm really so much a part of your fan club as a woman seeing what you're doing for men that's marvelous i love i love that story because i agree with you a hundred percent you know is that um but it's complicated right and a lot of what you and i are saying right now may not be politically correct but men need their strength yes and strength doesn't mean violence or aggression strength is is is contained within ourselves and it's and when we have true strength and we um earn respect we feel like we merit respect and we get it and you know in terms of male female relationships um you know i think a lot of the women want their men actually to be strong they may not want it it's not like it's not better than me or whatever is that we actually are you know i started off talking at the beginning of this with lizards right we are human we are we are animals we're a type of animal we share 98 of our dna with the great apes and throughout the animal kingdom there is male and female differences by that are biological and that play out in different roles and it's just so our brains are flooded with hormones early during a period of imprinting you know before we're born as male and female and it it has an impact on who we are and again it's not better one better the other and you know at work and and community there's no reason why everybody isn't equal and but we're different and men need things and they need to be they need to behave in ways and feel that that are different than the things that make men feel good about themselves are different than it is for women yeah thank goodness thank goodness you've spoken about aging is one of the the main reasons why testosterone is is low certainly as we age what about stress i remember one study that the army did with young men in combat and what happened to their testosterone levels i mean what are some other causes of low testosterone yeah so stress can certainly do it um you know one of the common things is impaired sleep so if you look at people who have impaired sleep for any reason you know night shift workers um people with sleep apnea anybody who goes in the hospital testosterone which is probably combination with stress too but testosterone levels drop so one of the rules is you never measure never bother getting a testosterone level on the hospital because it's always going to be be low we know that obesity lowers testosterone it's associated with diabetes you know we talk about general health issues with testosterone there's amazing data coming out of germany from this group that's had a registry now for about eight nine years and a lot of their patients are obese and had diabetes when they looked at that group at the end of i think it was six or seven years around 30 percent of them had stopped taking any diabetic medication at all they basically had cured their diabetes that paper just came out that's an amazing thing how else do you cure diabetes now the mechanism isn't the mechanism isn't voodoo the mechanism is they lost weight right but losing weight is a hard thing to do on your own you can do a diet it all comes back every one of these diets the end of 12 months average weight is back to baseline it's one of the hardest things humans do other than with bariatric surgery these guys had progressive decreases in their fat mass and their waist circumference and their weight and so i'm sure i'm certain that's the mechanism but how amazing to actually be able to have a remission if you will of diabetes type 2 diabetes amazing that's amazing yes so testosterone some men come to me and they say well you know i don't have any problems sexually although a lot of men do you know they start to lose their erections in the burger of their erections in their you know but they said i'm great in that area but my cardiologist says i have high high ldl and small dense particles you know of the ldl are also high and um you know he's basically putting me on lipitor what is the story with testosterone and cholesterol and cardiac disease and and and cardiologists don't really like testosterone for men it's really interesting yeah so the effects of testosterone on lipids looks like it's neutral looks like it's neutral uh cholesterol goes down but hdl goes down too um that part i think sort of balances out um the heart stuff was it's an interesting story and again like how society or medical communities work in the 60s and 70s there was a general belief never tested that testosterone must be bad for heart disease because men have to much more testosterone than women in the 80s they started looking at in these population-based studies and they found out no no no no that the men who get heart disease are the guys who have low levels of testosterone and so the data are now quite clear from observational trials that having low levels of testosterone just relative to the rest of your community you know like if you're in the lowest 20 or 25 percent puts you at higher risk of having atherosclerosis angina um um and mortality more cardiovascular mortality is increased in the men with the lowest testosterone levels by the way covid covid now yes italian study it happens in if you have a low testosterone you are at greater risk if you get infected of going to the icu and diet if you have a low testosterone and some of that may have to do with the immune properties of testosterone which are actually beneficial so the the heart stuff is now i think you know there have been a fair number of papers that have looked at it none of them prospectively all of them just observational but i think most of that is showing that if anything testosterone seems beneficial for the heart not worrisome oh that's wonderful and over the years i've followed you know lipids very closely in men and i always see i mean usually i see their hemoglobin a1c you know their chronic sugar response goes down and their friggin cholesterol goes down so i'm kind of surprised that you're saying that about lipids being neutral i think we should do a study because you know every man gets lipids every time so that would be interesting to look at so let's say we have the man he has low testosterone he has the symptoms how do you choose to treat him there's lots of different options yeah so you know my favorite is you know i think the concept is if you can get testosterone up well enough it doesn't matter how you give it to him like he'll have a response and so you know we have a couple of different choices we have pellets we have injections we have creams we have a nasal gel there's now a pill that's available um um we don't have too much experience with that yet mainly because of insurance is just learning how to how to deal with it the old pills caused liver trouble and so we'd never use them the new pills don't seem to be a problem with that my favorites that these days tend to be the pellets because it lasts for three months sometimes longer so it's you know it looks like a grain of rice we put it we numb up the skin and the buttock make a tiny little nick put these things in and they sit in the subcutaneous tissue in the fatty tissue and they just dissolve over the course of three to four months it's great levels go up they stay up they decline slowly injections been around forever they work but the levels go up the levels go down so it tends to be a lot of injections usually weekly for the guys the gels you know when they came out first it was like great you know it freed people up from getting injections but we find that a lot of people maybe as many as 20 don't absorb the gels that much um so there's a lot of getting blood tests adjusting it and then sometimes giving up but for some people that's the only way they want to do it and it's okay right right you know i think that that having being able to individualize uh treatment is is absolutely critical and i like the pellets too unfortunately you know the pellets i get are too big you know i like this little tiny green or rice i have to talk to you later about where you're getting them or if you're making them so listen i have young men who come in and i remember specifically a patient who was 32 who traveled the globe really once a month and he said prudence i have not thought about sex in a year nothing not a glimmer i never get an erection at night i never wake up in an erection and he had all the classic symptoms and extremely low testosterone it was 130 and 130 says something very very low so is it appropriate to put a young man like that who temporarily on on testosterone and what about testosterone in sperm counts you know for men who want to get pregnant yeah so that's an important consideration so when we give exogenous testosterone an outside source it fools the pituitary and the hypothalamus into thinking there's enough of this around and the hormones that then go down to the testicle luteinizing hormone lh and fsh follicle stimulating hormone basically gets suppressed and the end result is the testicles go to sleep so they start making testosterone they stop making sperm so anybody that goes on normal forms of testosterone needs to be asked are you playing have kids anytime soon would you like to and if they do then we have a couple of choices one is they can bank some sperm another and another is we can use other agents that will tell their body to make more testosterone on its own and which are okay for sperm there are two main ones one is called clomid or clomiphene citrate it's a pill it's been around forever it's used in women mainly but it's been around for men and the problem is that even though it reliably raises testosterone a lot of the guys don't actually feel much and that's because clomid works by blocking estrogen and amazingly most people aren't aware of this a lot of the beneficial effects of testosterone especially in the brain are by its conversion to estrogen so we actually need estrogen so we give clomid off into young guys interested in fertility it can help with sperm numbers sometimes but we rarely see a robust response to it the other one that works very well though is hcg human chorionic gonadotropin the problem is it's an injection that has to be given three times a week so the guys have to learn how to do it sometimes it's pricey but that will raise testosterone and it's fine for sperm and sometimes we use it in combination with testosterone just to preserve the testosterone is doing most of the work and hcg is just preserving some of the fertility right and you know my experience is that when men say they don't want a child and they're done with their children then change their mind and they've been on testosterone when i take them off of testosterone their sperm count comes back i've never actually had a man it's happened a few times over the years a number of times and they're they've all had their children so that was very encouraging to me you know it's not something and i do talk about banking sperm for men too yes oh abe we're coming to the end of our conversation but i really would like to know you know what makes you happy what brings you boy in life because you listen men are listening you're a role model and i want them to be happy i want them to be great and powerful and so what makes you happy you're you're sweet you're a sweetheart and it's actually great that you ask these types of questions too so listen i've been very fortunate in my life which is that i've had uh something that has engaged me intellectually for the last 40 years um you know on the the the the through line is around testosterone and you know is it really bad is it really good how do we do it and um you know at this point in my career having done what i've done you know i'm most proud really of the last few years we started the first international testosterone society it's called the androgen society and if any of your viewers are interested websites androgensociety.org and then as an offshoot of that we just started a new journal medical journal which is called androgens and we're trying to bring together the medical community from all over not just urologists or or integrative medicine but also endocrinologists public health uh basic science researchers so we've got that and you know at the end of the day for me it's like if i feel like i'm engaged in my own mind that makes me happy and if it's doing something that creates a platform for others to also learn and and help others with the knowledge that they get that's a great day it's a great day and you are a you know i think when when i see someone who's great that i want to emulate that i want their qualities i kind of come up next to them and they teach me how to do that so you're a teacher of men and i i really think that every man deserves your books they deserve your books we're going to put up our website so they'll see you i just want to tell listeners that you know dr morgenthau's my go-to man you know he's when someone has prostate cancer and they really want you know testosterone it's like i can't give it to you i'm not a urologist you know i so over the years you have been absolutely an angel to my patients and to men and thank you i thank you so much dr morgan taller oh thank you prudence it's marvelous you know the the thing we're working on now that really has me um excited is the men who have advanced prostate cancer and are looking to have a better life and are willing to take a certain amount of risk which i think is theoretical in order to have better quality of life and um so that that part's been a lot of fun for me too and still keeps me going thank you so much for doing this and it's been a pleasure to be with you thank you so much have a wonderful boston day thank you parents thank you for your generosity bye bye dr morgantown

Channel: Drprudencehall

Views: 5,753

Keywords: Abraham, morgentaler, hormones, wellness, medicine, alternative, wellbeing, men, men's, health, testosterone, harvard

Id: UqfAfYRB0Eg

Length: 49min 35sec (2975 seconds)

Published: Tue Jul 21 2020