Urologists answer your questions about testosterone replacement therapy | TRT

Hey guys welcome to my channel I'm Dr.  Rena Malik, urologist and pelvic surgeon,   and today we are going to be answering your  questions about testosterone replacement therapy.   I asked all of my instagram followers what  specific questions they had regarding testosterone   replacement and I brought along a colleague  today, Dr. Jonathan Clavell from Houston,   Texas who is a specialist in sexual medicine and a  urologist like me who's going to be answering some   of your questions about testosterone replacement  therapy. He has a great youtube channel called   Clavelluro which I'll link down below and you  can find him anywhere on social media with   @clavelleuro. He is awesome because he not only  does this in english but also in spanish so for   anyone who speaks spanish make sure you check him  out watch his videos because they are outstanding.   thanks so much dr clavel for joining us we're so  happy to have you well thank you dr malik for me   it is a pleasure to be here with you and i'm  honored to be part of your youtube channel oh   my gosh that's so sweet thank you so much well  it's an honor to have you on our channel too   so today we're talking about testosterone  replacement therapy and we all know that   testosterone is extremely beneficial but how can  men know when they need testosterone replacement   so the best way uh to see this and usually this is  usually what i tell guys uh whenever a guy shows   up into my office i usually tell them so think  about this way let's say like when you were 21   years old and dr malek you can probably remember  you're probably in college uh we felt invincible   you could be either studying all day working  all day then you can go you know go to the gym   play sports you could then go be partying all  night up until two o'clock in the morning and   probably at two o'clock in the morning you  probably even have the urge and the desire   to have sex you can even maintain an erection  and then you can go to sleep three hours later   you can do the exact same routine how are  you able to do that it's probably because   of testosterone so whenever i tell guys like what  happens when our testosterone starts decreasing   we start getting moody we start getting sluggish  you know we have low energy if we go to the gym   probably we're not going to get the same results  that we used to have before um sometimes a sex   drive can decrease i have so many guys who tell me  doc i'm just not interested in sex and sometimes   our erections can get a little bit weaker yeah  absolutely so those benefits with testosterone   are really far-reaching and all the areas you  talked about including when i see men a lot of   them tell me that they feel you know clear in the  brain a little bit of less decreased brain fog   of course they get the increased libido  they get better results in the gym and so   there's just all these really great benefits to  testosterone replacement therapy that is correct   and that's that is why it is so important that  you know once we start noticing these symptoms   that we go check get them checked out i mean the  testosterone levels vary so much like the normal   range is between 300 and about a thousand so  and everybody's different i have guys that   for example i have a patient who we call him andy  um and we call him andy 600 why because as soon as   he's below 600 he's knocking on our door he's like  hey doc i think i'm low i think i need a refill   and the same thing happens with guys who can be  at 350 and they still feel good so again it really   depends on how you feel if you start noticing  these symptoms i think it's time for a checkup   yes absolutely so my audience often wants to know  are there certain foods or activities that you can   do that can help boost your testosterone naturally  are there certain things that you recommend   so yes i mean most of the time in terms of  activities probably the most important thing so   there's multiple research studies that have shown  that better sleep can help increase and boost   testosterone if we exercise specifically weight  lifting and and basically just weight training   especially those bigger muscles like the back  the legs those can help boost testosterone and   probably something that's very difficult for  us here at least here in the united states   is reducing our stress levels when we are stressed  cortisol levels will rise and a cortisol has been   proven to be a competitor with testosterone  in our bodies and that can actually lower   our testosterone levels in terms of foods that  one is a little bit tricky because again there   are some studies that have shown that soy-based  products like tofu and edamame those can lower   testosterone then there's other studies that  show that completely opposite usually soy based   products can actually boost testosterone levels  so those can be a little bit tricky however the   most important thing is try to stay away from  processed foods high those high sugar those trans   fats those can actually lower your testosterone  levels and also alcohol consumption like chronic   alcohol consumption can actually affect those  glands that we have in our brain that stimulate   our testicles to produce testosterone and it  can also affect testicular size as well so   chronic alcohol consumption is usually one thing  that we want to avoid yeah i think a lot of people   are always looking for sort of a magic bullet  like one magical thing that's going to make   their testosterone better but there's really  nothing like that it's the whole package you   have to really invest in your sleep get some good  exercise avoid endocrine disrupting chemicals in   your environment and all those things together  can improve your testosterone but it's not like   you can just eat oysters and your testosterone is  going to automatically get better that is what i   tell my patients which most of the time they want  to get as natural as possible and one other thing   that can actually help i mean there are multiple  minerals and vitamins that can actually help   but again this are still like controversial most  of the time what i tell guys just try to keep that   diet as balanced as possible make sure that  you're eating healthy and that can actually   help you out what about vitamin d does it have a  role in boosting testosterone so with vitamin d   uh there are some studies that have suggested that  vitamin d can actually increase testosterone again   i mean vitamin d is healthy for our bodies so even  if it doesn't help i think it's good to ingesting   vitamin d you know go outside sun can actually  help with vitamin d as well so just try to   eat and keep the healthiest lifestyle possible and  i think that can actually help you keep your and   boost your testosterone levels i can't stress  it enough how important it is to actually get   outside and get true sunlight there's not a single  supplement out there that's going to replace this   the vitamin d that you can get from actual natural  sunlight our lives in these modern worlds are so   filled with all these fake led lights and they  really make it so that we can go our whole lives   without really going outdoors and so even if  it's 30 minutes a day taking a walk outside   to get that sunlight and of course protect  your skin use sunscreen when you go out   but it's really really important for so  many health benefits benefits in addition to   increasing your testosterone potentially well  definitely and and just because i'm married   to a dermatologist i have to add to that  please have sunscreen whenever you do that definitely and don't forget to reapply your  sunscreen either definitely definitely so a   lot of guys want to know if my testosterone is  low and i need testosterone is it safe for me to   take testosterone replacement so that is the one  million question that despite decades of research   some believe that testosterone therapy is still  unsafe uh when i counsel my patients i usually   try to explain to them like hey we're not trying  to add anything uh additionally to whatever your   body used to produce we're just trying to keep you  within that range that your body used to keep you   before us right we're not trying to add anything  additional we're just giving you something that   your body used to produce and it's not producing  anymore in terms of other things that we have   to keep you know because i know like whenever we  talk about testosterone therapy is it safe or not   one of the things that pop up is always prostate  cancer can this testosterone therapy cause   prostate cancer i want everybody listening to us  right now there's one thing i want you to remember   from this entire talk is testosterone therapy does  not cause prostate cancer i'm going to repeat that   again testosterone therapy does not cause prostate  cancer and also even if you had prostate cancer   before you had a prostatectomy so your prostate  got removed or you had radiation therapy and   now you're cured from your prostate cancer it is  probably safe for you to be able to get back on it   and in terms of testosterone cardiovascular risk  that's another thing that you know many patients   for example they show up to my office they tell  me but doc my cardiologist he's concerned about   me being on testosterone therapy usually what i  tell them is several years ago i was invited to   write an article about what are the controversies  between testosterone therapy and cardiovascular   risk and while i was doing my research i only  found two studies that showed that testosterone   therapy could lead to heart attacks or strokes  and when i started looking deeper into those   those two studies have been noted to be flawed  however i mean again this is a hot topic so   you can imagine like all the news outlets and  media where uh you know saying and putting out   that testosterone therapy could lead to heart  attacks or strokes however there's actually   been more than 20 studies that i was looking into  again this was like three or four years ago i'm   pretty sure there's even more research now and  there's multiple studies showing completely the   opposite that testosterone therapy can actually  decrease the risk of cardiovascular uh events so   again with testosterone therapy we keep our bones  healthier we keep our muscles healthier we have   more energy to exercise and those things will also  contribute to us having a healthier lifestyle and   therefore reducing that risk of cardiovascular  events so usually what i counsel my patients   is like hey yes there were two studies that  suggested that the testosterone therapy could   increase your risk of cardiovascular events  but most of the time it's actually pretty safe   yeah absolutely i mean our american urological  association guidelines basically say that it's   completely safe and is because the data is so poor  on this that it's really there's no conclusive   evidence that it causes any cardiovascular events  and also in regards to the prostate cancer thing   well we know that we're even giving it to men  when they've had prostate cancer in the past   after a certain period of time when we know  they're free of disease it's actually safe to   give those men testosterone too so it's not going  to cause a recurrence of prostate cancer in men   who don't have prostate cancer anymore the most  interesting part of it all is like there are some   some trials right now going on and there's some  research on patients even with metastatic prostate   cancer so they do interval um treatments with  testosterone and patients are doing fairly well so   it is actually surprise it's actually surprising  how much data we've been able to collect in the   past few years and how and now we have more  confidence to be prescribing these medications   to our patients you know a lot of guys who want  testosterone or feel like they need it or end up   needing it you know clinically need it they want  to know is it going to fix my erectile dysfunction   uh i love this one rina because how many men  show up to your office with the chief complaint   of erectile dysfunction they're already on  testosterone therapy and they're just disappointed   or even more so they're disappointed because  they've already gone to low t clinics with   their only complaint was erectile dysfunction they  were started on testosterone replacement therapy   and again they are not noticing those results  so why does this happen so usually whenever   i talk to my patient i usually i you let them  know it's like hey let's define some terms here   to everyone seeing this video there are multiple  types of erectile dysfunction there's psychogenic   there's vascular erectile dysfunction there's  neurogenic and there's also hormonal erectile   dysfunction so psychogenic is usually when you  are just not focused in the act it is the most   common type of erectile dysfunction in younger  men you are more focused on your penis than   your partner uh you're trying to pump yourself  up in the middle of sex instead of focusing on   your partner so that's i see that so often in  my office but that's a topic for another day   then we have the vascular erectile dysfunction  which again is the most common type of ed for   older men and that's when we start having problems  with either blood flow getting into our penis or   the blood flow is just not staying trapped inside  our penis and then we have the neurogenic one   which is the nerve related erectile dysfunction  most commonly happens after back injury   or you have brain injury also it can occur  after the prostate gets removed for cancer   the nerves are just not able to innervate those  blood vessels that bring blood flow into our penis   and then we have hormonal erectile dysfunction  which is when testosterone is low most of the   time however this is actually related to the sex  drive more directly than the actual blood flow   issue with the penis i have many men who come  into my office for eb and they flat out tell me   like doc i'm just not interested in sex so out of  all these types testosterone only helps with one   maybe two there are some you know we know that  testosterone can also help improve blood flow uh   throughout our body so there are some that you  know believe that it could it can contribute   to vascular erectile dysfunction but it's  certainly not the cure so whenever we talk   about erectile dysfunction it is so much more  complex than testosterone that is why it is   very important that you go see a urologist uh you  know a sexual health expert like dr malik myself   and there's multiple others across the nation so  that's the best way for for me to put it that way   how about you what do you think you said it  perfectly but i would say that be really careful   of these low t clinics i mean not all of them  are bad but a lot of them will give you like the   works and that'll include like shockwave and prp  and things are still considered investigational   and they will you know charge you an exorbitant  amount of money for things that are a lot cheaper   like intracavernosal injections or medications  that you can actually get a lot more affordably   when you go to a regular doctor and so there  is a little bit of concern you know just   like they're giving you testosterone saying  that your erections are going to get better   that they're doing all these things that you  may not be the right candidate for so just be   careful that is so true i mean i have so many men  who i i usually ask them it's like yeah doc i've   been going week every single week to this clinic  to get to my testosterone show i'm like how about   you give yourself testosterone shot and usually  they're surprised they're like can i do that   and i'm like yes you can i mean these are  you know cheap medications so you can get   in most in many pharmacies even if you don't  have insurance these medications tend to be   very affordable and you can do it yourself there's  it's no there's no rocket science to this you can   do it yourself at home yeah i have patients who  you know who do it twice a week because they you   know they they had some effects with once a week  and they do it twice a week and they do it at home   like it's totally totally reasonable so um what  about yeah what about what about side effects   with testosterone replacement what are  what should people be concerned about   so with with testosterone replacement therapy  i mean that sometimes i can actually increase   dht which is a you know an acronym for a very  long word that i'm not even going to mention   um it can increase fat in our sebastian's glands  sebaceous glands so we can actually have acne   there are some people that are very sensitive to  testosterone levels especially when there are in   the super physiological levels that means that we  are above the normal range and you can have acne   uh some there are some people can start noticing  some breast swelling or some breast tenderness   which we call gynecomastia uh the way the  reason that happens is because testosterone   gets converted to estrogen in our bodies that's  just a natural process that happens in our bodies   and there are some men that can you know start  experiencing that and there are medications that   we can give you to avoid you from having that side  effect there's also when you're in those higher   levels there could be an increased hematocrit  so basically the red blood cells inside our   veins and our arteries are gonna start to  increase and this can sometimes lead to headaches   and but that can easily be managed with a regular  blood draws or sometimes even just decreasing the   dosage or like you just mentioned before instead  of using a very high dose once or twice a week   we can probably do what we call micro dosing  so you can do a lower dose more frequently and   that way you stay within a normal range instead  of you you know being on a roller coaster and   another one that's very important if we give you  exogenous testosterone it can lead to testicular   atrophy so the at the testicles can actually start  getting smaller and hence sometimes that can lead   to infertility yeah that leads right into my next  question which is can you have kids while you're   on trt so when given most forms of testosterone  this can suppress our hpg axis and our ability   to produce our own testosterone so the way the way  this works is we have two glands in our brain that   one let's call it gland number one which is the  hypothalamus that will stimulate gland number two   uh to start producing the gonadotropins  which are two hormones that our bodies   uh that our you know brain sends to our testicles  to start producing testosterone and healthy sperm   when we give you testosterone your body kind  of like goes like on vacation they're like well   probably you don't need me anymore because i'm not  producing what i'm supposed to do so they just go   to europe they go on a vacation right and and  what i and usually what i tell them is like hey   you need your own production of testosterone to  start producing uh your to to start producing   healthy sperm however uh the most the other  thing that we need to understand is like for us   to maintain our own production of sperm there  are actually medications that we can give you   along with testosterone to help with that  one of those medications for example is hcg   remember that i said that there's two hormones  that our brains send to our testicles one is fsh   or follicular stimulating hormone which keeps  our it gets nutrients to the sperm to be healthy   and the other one's luteinizing hormone which  is lh and that's the one that actually helps   the testicles to start producing testosterone well  this medication hcg which by the way is considered   still considered off-label for the use in men  which is very important for us to understand   uh but hcg is an analog to lh to that luteinizing  hormone so they're basically the same thing so   with hcg what we're trying to do is trying to  overstimulate the testicles to start producing   its own testosterone um for example i am one  that for younger men who want to maintain their   fertility and they also want to uh you know boost  your testosterone levels hcg can actually be given   as monotherapy and and there's another medication  which is clamofien also considered off labor for   the use in men but that can also help stimulate  our testicles to start producing testosterone   yeah absolutely i definitely use some clomiphene  i i guess i haven't used hcg i thought it was   pretty expensive and difficult to get is  that accurate or am i inaccurate on that so   just until recently uh until two weeks ago it was  actually fairly easy to get usually we were able   to get it through compounding pharmacies and power  was one of the ones that was able to get this and   unfortunately a few weeks ago empower received  the cease and desist letter are basically saying   that they cannot produce this medication anymore  however there are still some other compounding   pharmacies that we can get it from but yeah this i  think is going to be a problem in the near future   because it can get expensive if you go to regular  pharmacies yeah yeah well good to know a lot   of people hear this terminology bio-identical  testosterone and i wanted to get your thoughts   on that so it's funny because even yesterday we  were texting about this about this bio-identical   testosterone i've talked to so many people about  this so bioidentical testosterone for everybody   who's reading this this is just a marketing  tool for many clinics to to guide you into uh   coming in to see them so that they can  give you this more natural testosterone   i have two disclaimers exactly so there i have two  disclaimers for everybody who's listening to us so   there's no testosterone used in testosterone  replacement therapy that is natural they are all   made in a laboratory and all testosterone used all  testosterone that we use is molecularly identical   to your body's naturally produced testosterone  was once it enters your bloodstream so i know   like this bioidentical testosterone again is a  term that you know for testosterone that is made   identical to the molecular structure  that the human testosterone produces   however all testosterone once it gets into your  bloodstream will be molecularly identical uh   to you know to your body's natural testosterone  you will be able to absorb it so most men that   come into my clinic then they tell me it's like  hey doc all right the are the testosterone that   you're going to prescribe is it bioidentical  i'm like all testosterone is bioidentical just   i mean there's no or there's no such thing as  bioidentical testosterone they're all made in   a lab and they're all most of them are actually  safe yes exactly 100 completely agree hard cosign   so um last question i have for you is what  if somebody wants to get off testosterone   replacement is there a specific age or cutoff  or can they get off testosterone replacement   so the quick answer to that is yes i mean can  you get off testosterone yes should you get off   testosterone probably not there's many people that  believe that testosterone is only a medication   given for erectile dysfunction so sometimes i  have guys who are in their late 70s late 80s   or for example they're widowed unfortunately  and they don't have a partner and they're just   not interested in seeking out a partner they're  like well doc i probably don't need testosterone   anymore but we have to remember testosterone  also helps with our energy it helps with our mood   it helps with our bone structure so usually for  for these guys who are older we don't want them   to start getting osteoporosis or osteopenia and  their bones start getting weaker and brittle so   usually what i tell them it's like hey try to keep  your testosterone as much as you can because again   it it helps you keep a healthier lifestyle and  one other thing usually what i tell my guys is   you know is there an age for you to stop i just  tell them there's two ways that you can age   you can age gracefully or you can age as a grumpy  old man you choose and most of the time they try   to age gracefully yeah absolutely i completely  agree i think especially the cognitive changes   and people really feel like their brain  is clearer and they feel like they can   be more active be more energetic they can go to  the gym and get muscle and like it just it really   changes their lives so i think they really um most  men that i see are very very happy and actually   don't really want to get off of it because unless  they've forgotten it's been so long ago since   they started that they forgot what it was like  before but in those beginning times where they   still remember how tired and foggy they were  they're pretty happy to be on it i i completely   agree and again i mean most of the time i mean  i've been surprised even guys in their 80s who   have bigger muscles than i do so it is possible  to age gracefully yeah absolutely well thanks   so much jonathan it was awesome to have you on i  will link all of his socials below make sure you   check out his youtube channel as always remember  to take care of yourself because you're worth it

Channel: Rena Malik, M.D.

Views: 1,005,363

Keywords: Rena Malik MD, urology, urologist, Rena Malik, testosterone therapy, testosterone replacement therapy, trt side effects, testosterone supplements, testosterone therapy for men, hormone replacement therapy for men, testosterone booster, testosterone therapy side effects, testosterone therapy results, testosterone therapy benefits, testosterone therapy reviews, testosterone replacement therapy results, testosterone replacement therapy benefits, trt, urologists review

Id: n-TFdxK6QjY

Length: 23min 28sec (1408 seconds)

Published: Tue Dec 07 2021