Articles on androgen replacement therapy

How Safe Is Testosterone Replacement ?

Dr. Anish Kumar Gupta, Andrologist
Testosterone Therapy – Know the Side Effects before the Benefits.It is important to first and foremost understand that Testosterone is not a recreational or a performance enhancement drug, and is strictly something to be prescribed by someone who knows why it is being done. Als,o supplementation is of no use, it is eventually replacement, which should be the key to understand its effects and some effects.Understand the potential risks and consider alternatives before boosting your hormones indefinitely.There is a notion that Testosterone is a performance enhancer, which promise that treating “low T” this way can make men feel more alert, energetic, mentally sharp, and sexually functional. But, beware, Men should be much more mindful of the possible long-term complications.The Low - T BoomJust being tired isn’t enough to get a testosterone prescription. If a man’s testosterone looks below the normal range, there is a good chance he could end up on hormone supplements—often indefinitely. On treatment, the body stops making testosterone. And it may or may not recover to a complete extent.This wouldn’t matter so much if we were sure that long-term hormone therapy is safe, but there are small risks that could add up to harm over time. That should be a bigger concern.What are the Risks?A relatively small number of men experience immediate side effects such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also like to watch out for high red blood cell counts, which could increase the risk of clotting.The evidence for long-term risks is mixed. Cancer prostate and cardiovascular risksneed to be assessed and monitored if symptoms complex deterioration occurs.Testosterone supplementation can affect your Fertility. While testosterone supplementation increases testosterone levels, and reduces some ofthe symptoms associated with hypogonadism, it decreases the body’s productionof LH and FSH. This is because when the brain detects that testosterone levels have increased, it will cut down the production of GnRH. The result is that the pituitary gland no longer produces FSH and LH at normal levels, so sperm production also declines. A lower sperm count means that a man’s chance of impregnating his partner will be lower.Before the Jump, Assess your health globally firstHave you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?If erectile dysfunction has caused you to suspect “low T” as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.Get an Accurate AssessmentInaccurate or misinterpreted test results can either falsely diagnose or miss a case oftestosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it’s at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone,or the amount of the hormone that is able to have effects on the body. After starting therapy, follow-up with your physician periodically to have testosterone checksand other lab tests to make sure the therapy is not causing any problems withyour prostate or blood chemistry.Be Mindful of Unknown RisksApproach testosterone therapy with caution if you areat high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, ormultiple risk factors for heart problems.Ask your doctor to explain the various side effects for the different 
formulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.Have Realistic ExpectationsTestosterone therapy is not an elixir of youth. There is no proof that it will restore youto the level of physical fitness or make you live longer, prevent heart diseaseor prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with theseexpectations in mind.If erectile function has been a problem, testosterone therapy might not fix it. Infact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections. Please Remember there are only two people who can prescribe Testosterone Replacement, a Urologist-Andrologist or an Endocrinologist. A general physician or gym instructor or a friend are not people who can prescribe Testosterone Replacement.

8 Ways To Avoid Knee Replacement

Dr. Brijbhushan Mahajan, Orthopedist
Undergoing a knee replacement for knee arthritis can be a very effective quality-of-life decision. Patients are able to get back to recreational activities and a severely reduced painful lifestyle.  Methods of avoiding the replacement with the arthritis.Weight loss – Over 65% of Americans & over 30% of Indians are either overweight or obese. The problem with this is that a lot of stress goes through the joint during ambulation. This excess weight can lead to increased pain and/or increased arthritis. Losing weight allows the patient to decrease joint pain by decreasing stress over joint, and an increased ability to perform activities of daily living, along with other substantial health benefits such as lower blood sugars and lowered blood pressure.Benign neglect – The patient is able to do most of the things that he or she wants to do, the most appropriate answer at that point may be to simply ignore the problem. One additional aspect to consider may be to modify one’s activities. This may include switching from jogging to fast walking, or shifting from skiing to an activity that is less stressful on the joints such as swimming. Physical therapy – Physical  therapy may have significant benefits. Therapy can strengthen up the muscles around the knee joint, which has  beneficial effect of unloading the pressure from the knee joint and dissipating it into the surrounding musculature. This can reduce pain.Acetaminophen and NSAIDS – These medications are predominantly available without prescription and they can be extremely beneficial for alleviating the pain. They have a low risk profile, as long as patients stick to the manufacturers dosing on the box, and don’t combine those medications that can have an additive effect and lead to a bleeding ulcer.Knee injections – Injections into arthritic knee can help substantially relieve the pain. Presently the bulk of these injections consist of cortisone, which is a hefty anti-inflammatory substance, but not one that is going to alter the course of the disease. There are some newer medications consisting of regenerative substances, which contain components such as stem cells, hyaluronic acid, and cytokines. These may in fact alter the course of the arthritis.Bracing  – Off-loading braces take pressure off of the arthritic area of the knee joint and promote pain relief. These braces are typically custom fit after seeing your doctor, and should be worn whenever the patient is up and about when the pain would typically be felt. Narcotic medications – These should not be used on a chronic basis. They should be utilized only for an acute type of situation where patients are having an exacerbation of their arthritis pain. Narcotic medication on a chronic basis has the risk of tolerance, addiction, constipation, etc. So it should be avoided. Utilizing them for exacerbations can however be very effective.Non-narcotic medications – Medications that are non-addictive such as Tramadol can be very effective for knee pain. In addition there are modulating medications such as gabapentin that can help a lot with decreasing the pain that is coming into the arthritic knee joint from the surrounding nerve endings.

Sex Therapy

Dr. Ramesh Maheshwari, Sexologist
Sex therapy is based on behavior therapy. It is a type of re-educative therapy. The fundamental of behavior therapy is that all the behaviors are learned, even the maladaptive behaviors. The behavior therapist helps the client to unlearn the unadaptive behavior and replaces it with newly learned adaptive behavior. The aims of behavior therapy are primarily educational and techniques facilitate improved self control.From amongst several techniques that are used in behavior therapy, ‘systematic desensitization technique’ is used in sex therapy. Prior to 1970, sexual dysfunctions were managed by psychiatrists. After  1970, the masters and Johnson model of sex therapy made it possible to treat sexual dysfunction by psychologists, social workers, nurses, counsellors, and medical doctors.Their approach included :Instead of treating the affected individual, the couple is treated. It is the relationship that is affected. This strategy provides an opportunity to gain  the co-operation and understanding of both the partners in overcoming the problem.Two therapist-a man and a woman work together as a team. This gives each partner a same sex therapist to whom he or she can relate more easily.Masters and Jonson recognized that it was important to identify organic conditions that might require medical or surgical treatment instead of sex therapy.They also found that explanining the anatomy and physiology of sexual response to the clients often had important therapeutic benefits.To individualize the therapy so as to meet the specific needs of each couple.The therapist must avoid imposing his own values on the client.The fear of performance and ‘spectatoring’ are often central to the cases of sexual dysfunction. The pressure of performance is removed initially by banning sexual contact. Couples are then helped to rediscover the sensual pleasures of touching and being touched without the goal of particular sexual response (Sensate Focus Exercise).Blaming each other for the sexual problem is discouraged.When a couple’s relationship improves outside the bedroom, it is apt to have positive results in the bedroom too.Basis : Sexual response is the function of Autonomic nervous system and is a physiological change when effective sexual stimuli are present , and a person is psychologically prepared to respond to them. All the sense organs are to be used to create a situation conducive to sexual response . (touch is most important).Systematic Desensitization : A mode of psychotherapy where all the anxiety provoking stimuli are arranged in an ascending level, and the client is exposed to, one by one, both the partners are to be involvedRelaxation: Deep breathing, deep muscle relaxation and plesant imagery are incorporated.Reassurance.Stages :Sensate focusWoman superior positionLateral positionMen superior positionFormat: No rigid format Variations in time, frequency and structure depending upon the dysfunction, the patient and the therapist.Results: Not as definite as in pharmacotherapy.As you shall sow and water, so you shall reap: A skilled and knowledgeable therapist is like a good seed. Client’s receptive mind is like fertile soil. Compliance and co-operation by wife is like watering by gardner. When all the three factors combine, the results are good. When sex therapy works, it does wonders and results are unparalleled for that particular couple.Contraindications:Severe DepressionActive psychopathologySubstance abuseIIInessHostility in couple-interaction

Facts and Fallacies-Knee Joint Replacement Surgery

Dr. Purushottam Reddy Padala, Orthopedist
Knee Replacement Surgery- Who Needs It?Generally, but not always, joint replacement is done after the age of 50 yrs.  Having said that, no age should be exempted or delayed from surgery for want of a way out of the misery of pain from arthritis.Anybody who has end stage arthritis due to a variety of diseases-osteoarthritis, rheumatoid arthritis, joint damage due to injury etc should have joint replacement surgery.WHEN QUALITY OF LIFE IS AFFECTED TO AN EXTENT WHERE THE PATIENT IS DEPENDENT ON CRUTCHES, WHEELCHAIR OR IS UNABLE TO MOBILIZE AND ALMOST HOUSE-BOUND DUE TO PAIN, STIFFNESS AND DEFORMITY, THEN PERHAPS, JOINT REPLACEMENT IS MANDATED.What Is Available?Unless you need to squat due to religion or a job requirement, you require the usual knee- the one used for 80 % of people. The extra cost for marked knee bending provided by new knees( which is more expensive also) is possibly not required for you.Always ask your doctor to go for a reputed company. The money spent on quality is worth while in the long run.General Questions1. How long does it take after the surgery to be able to walk?Generally 2 days 2. How long before I get back to normal outdoor life?By 6 weeks you will be able to do most things like shopping, travelling etc.3. Period of stay in hospital?4-5 days.4. Do I need to do exercise?Physio is an integral part of joint surgery, to strengthen the muscles, so that normal balancing can take place. Physio for upto a month might be required.5. Can my father have surgery at the age of  seventy? No age is too old for surgery. As long as patient is fit for anaesthesia, which will be done by our anaesthetist, no age is bar from surgery.Where should I get it done?Some centres with no training are claiming 100% guarantee. Remember there is no 100 % in medical specialties. Out of the thousands that are done, a few are likely to get infected, loosen and become painful after surgery. It is recommended that you go to someone who has received advanced training abroad and practiced in Europe or the States, so that all or any eventualities are covered by that surgeon.Replace fear with confidence as joint replacement is now a well entrenched surgery, with very few complications and high success rate.Wish you all the best!Dr Purushotta Reddy 

Ayurvedic Leech Therapy

Dr. Phanindra V V, Ayurveda
Leeches are used in the medical practice since ancient times to treat many diseases. It is a method in which localized impure blood is let out to heal the tissue. Leech therapy is Para-surgical treatment modality according to Ayurveda. Due to its therapeutic effects, this is successful even today. The description of using leech for therapy can be found in Sushruta Samhita written by Acharya Sushruta. He has described the nature of leeches, their habitat, the method of application, diseases indicated like Visarpa (Herpes), Skin diseases etc., in detail. Though there are hundreds leech species, only 15 are used for therapy. In the medieval ages, this was very popular. According to Ayurveda, Leech only sucks impure blood. Leech is used to relieve venous congestion and to improve blood circulation.Indications: Skin diseases, Vascular Problems, Varicose Veins, Acne, Non-healing Ulcers, Diabetic wounds, Boils and abscess, Herpes, Thrombosis, Arthritis, Sciatica, Dermatitis, Psoriasis, Alopecia, etc..Steps for application of LeechSnehana and swedana to the patient.Leech activation.Patient’s skin is cleaned.The leeches are applied.Cover the leech with wet cotton.Remove the leech once it has finished sucking the blood.Remove the blood from leech by inducing vomiting to the leech and then put back in fresh water container.The area should be cleaned and bandaged.Mode of Action: Leech have many distinct enzymes in its saliva, through which they act. The enzymes enter the blood through the place the leech sucks the blood. The most important is the Hirudin, which acts as an anti-coagulant. This leech enzymes also has the ability to stay in the blood and do vasodilation and further facilitate the blood supply to the surrounding tissue and prevent necrosis and healing. Some anti allergic factors ensure reduction in the lesions.

Hormones in Sex

Dr. Ramesh Maheshwari, Sexologist
In regard to sex and reproduction the most important endocrine glands are pituitary gland and the gonads or sex glands –Testes in male and ovaries in female. The anterior pituitary gland secretes two gonadotropic hormones:Follicle stimulating  Hormone (FSH) and Luteinizing hormone (LH).They play major roles in the function of male and female function. During pregnancy placenta secretes human chorionic gonadotropic hormone that has the same property as LH. This hormone stimulates the interstitial cells of fetal testis and  produces testosterone which promotes formation of male sexual organs. No testosterone is produced during childhood until the age of 10 to 13 years and lasts throughout life. On stimulation by LH from anterior pituitary, Testosterone is produced by the interstitial cells  of Leydig in the testes. FSH from anterior pituitary stimulates conversion of primary spermatocytes into secondary spermatocytes in the seminiferous tubules of testis. However, for complete formation of spermatozoa testosterone is needed. Thus FSH iniates proliferative process of spermatogenesis and testosterone does final maturation of spermatozoa. Testosterone secretion, after puberty, causes the penis, scrotum and testis to enlarge until the age of 20. Testosterone causes secondary sex characteristics of the male. In female, the anterior  pituitary produces gonadotropic hormones FSH and LH which act on ovaries and produce estrogen and progesterone. During the reproductive years there is monthly rhythmic changes in the rate of section of female hormones and as menstrual cycle, is of 28 days.Variation from   20 days to 36 days is taken as normal. At the age of about 8, the anterior pituitary begins secreting gonadotropic hormones, FSH & LH. These act on the ovaries. One of the follicles grows and ovulation takes place on the 14th day (counting from the first day of menstruation). During the growth of the follicle, estrogen is secreted. Following ovulation, the follicle develops into corpus luteum degenerates. The ovarian hormones, estrogen and progesterone decrease greatly and menstruation begins. Estrogen is responsible for secondary sex characters of the female. Progesterone is concerned with final preparation of uterus for pregnancy and the breasts for lactation. Male’s capacity to be stimulated sexually shows a marked increase  with the approach of adolescence. The frequencies of response to the point of orgasm reach the peak within three or four years after the onset of adolescence. Frequencies of sexual response in the male begin to decline after early thirties and drop steadily into old age. Among females, the median frequencies of sexual activities remain constant from late teens into the fifties and sixties. In maximum incidences of sexual response are not approached until some time late twenties and thirties. Individuals who are physically exhausted or in ill health are not easily aroused sexually if aroused they may not be capable of effective action and may fail reach orgasm. Estrogen occurs in equal amount in pre-adolescent female and male. But at the time of adolescence, estrogen increases abruptly in female. At the onset of adolescence there is no upsurge of sexual activities in the female. It is the male who suddenly becomes sexually active at adolescences. Androgen are found in both males and females. Adrenal glands also produce androgens. In preadolescence, the androgen levels begin to rise more markedly in the male. There is sudden upsurge of sexual  responsiveness and sexual activity are among males. In females, the levels of sexual  response and sexual activity are much lower than the levels in the males.When Testosterone is given to normal male, there is increase in frequency of morning erection, the frequency of erotic response to various stimuli and the frequency of masturbation. Testosterone is also used to increase the low rate of coitus which results in infertility. Sperm count also may increase by administration of Testosterone. However, indiscriminate use of testosterone may involve some danger like inhibited pituitary function and damage to the gonads. It may accelerate malignancy of prostate. Serum prostatic specific antigen estimation and  a digital examination of prostate are mandatory prior to administration of Testosterone. Both, androgen occur simultaneously in both the female and male bodies. There is a theory that estrogens counteract the effectiveness of androgens. Some clinicians use estrogen in effort to reduce the levels of responsiveness of males convicted as sex offenders. Though estrogens reduce the amount of androgens, the use of estrogens to lower sexual responses is debated. The adrenal cortex produces androgens and estrogens in both the males and females . In menopause when the estrogen level falls, the androgen produced by the adrenal glands is responsible for the growth of hair on the face females. Similarly, When the level of androgen falls in elderly males, the estrogen from the adrenal glands dominate and produce enlargement of breasts in the males. Hormonal levels may affect the intensity and frequency of response, the frequency of sexual activity , but there is no relationship between the hormone and individual response to particular sort of psychological stimuli. There is no evidence to prove that the patterns of sexual behavior can be modified by hormone therapy.

5 Priceless Benefits of Salt Therapy for All Your Respiratory Troubles!

Mrs. Anju Chandna, Yoga and Naturopathy
Salt therapy is fast catching everyone’s attention. A therapy that was born within the confines of natural salt caves in the Eastern European countries like Poland and Romania around 150 years ago is now on its way to become one of the most revolutionary treatments of all time for all respiratory allergies like Asthma, Bronchitis,Sinusitis, Allergic cough, Dry cough, COPD and many others. A lot can be attributed to the fact that the treatment is natural.So let me give you a 5 point count as to what makes this therapy different from the conventional methods of treatment that we’ve known all these years. Salt therapy is a 100% natural treatment. The main ingredient that does all the trick is salt. The salt room has around 3-4 tons of salt on the walls, the ceiling, the floor and the aerosol that you inhale while sitting inside this artificial salt cave is also pharma-grade salt. Old age wisdom says that consuming too much salt is not good for our body but what needs to be understood is that this salt does not enter your digestive tract. So any side effect could arise of consuming salt directly is absent here. This salt aerosol enters only the respiratory tract through the nasal passage and goes directly into your lungs. It cleanses the mucous along its way and reaches the smallest bronchioles of the lungs. All naturally with no medicines.Salt therapy is absolutely safe for infants, the elderly and pregnant women. Since there is no medicine involved in the treatment, everyone from a 6 month old baby to an 80 year old adult can take the therapy without bothering about any negative fallout. Even pregnant women who are otherwise not advised medication can take this therapy and get relief from any allergy arising during their pregnancy. Salt therapy has no side effects. There is nothing entering your digestive tract that can possibly cause any side effect. Salt enters the lungs, reacts with the mucous present there and comes out of the body along with that mucous.  Presence of tons of salt in the salt room makes the environment absolutely clean and no allergens can find their way into it. People with respiratory disorders need such a clean atmosphere so that a one hour salt room session helps to cleanse their system and not irritate it. That is the reason why people with very chronic allergic cough can also endure the salt spray and benefit from it.Salt therapy offers long term relief. The basic function of salt therapy is to cleanse your lungs. So once your treatment is complete and your lungs get cleansed, the chances that they will remain that way are very high. But here we cannot ignore the fact that we are living in one of the most polluted regions of the world and you are constant being exposed to allergens. One might need maintenance sessions once every 3 months to keep your lungs clean and healthy.  Salt therapy de-stresses and calms the mind. Salt is inherently negatively ionized. Nature has made it this way.Negative ions are considered to be ‘cleansers of the air’ and salt has the property of negative ionization. Negative ionization of the air relieves stress, so spending an hour inside the salt room not just cleanses your lungs but also relieves your mind of stress. De-stressing the mind is considered to be an important step towards treating any kind of respiratory problem.So what are you waiting for? Come to the salt room and soak in the benefits of this miracle mineral!

Knee Injection - Synovial Fluid Replacement Therapy

Dr. A Mohan Krishna, Orthopedist
In patients suffering with Osteoarthritis of knee joint, the cartilage lining  protecting the ends of bones gradually wears off, reduction in quantity of joint fluid (Synovial fluid), and bone ends rub against each other – all of which can cause the pain.The usual complaints are pain,stiffness, grinding sensation, swelling in and around the knee. Sometimes there is difficulty in walking for short distances and locking symptoms.Osteoarthritis of knee can be graded / staged based amount of damage to cartilage lining. An X- ray can be useful in staging osteoarthritis of knee. It’s not only the grade but level of pain had to considered before starting a treatment.What is Hyaluronic acid?Hyaluronic acid is a visco-supplementation injection that lubricates and cushions your joint. It can provide pain relief in Osteoarthritic knee up to nine months to two years with just one injection. Patients with knee Osteoarthritis who have tried diet,exercise but still have pain can get benefit from this injection. The main aim of giving Hyaluronic acid injections is to decrease pain and improve functions in patients with joint pain. Hyaluronic acid injections have been shown to have the following beneficial effects on joints:They replace some of the normal ingredients found in the synovial fluid improving the lubricating ability.They help to stimulate the joint lining (the synovium) manufacture more normal synovial fluid.The Hyaluronic acid coats the lining of damaged joint surfaces, covering pain nerve endings. This reduces pain and protects the joint surfaces from joint inflammation.Hyaluronic acid also acts directly to reduce inflammation in a joint, like steroid.How is Hyaluronic acid given?It comes as a single injection as sterile pack from the manufactures. It is administered by intra-articluar route (directly into the knee joint). It’s a simple out- patient procedure that only takes a few minutes. You can continue with day to day normal activities after the injection. Try to avoid strenuous activities for about 48 hours.Procedure:-  It is done in outpatient department in clean dressing room or sometimes in minor operation theater.-  Doctor prepares the knee by cleaning it with Iodine solution.-  Give local anesthesia.-  Sometimes doctor may aspirate excess fluid inside the joint.-  He then injection into the joint directly-  You can walk out immediately after the procedure.Frequently asked questions?1. What you can expect following a hyaluronic acid injection?Hyaluronic acid can provide pain relief upto nine months to two years. 2. Will the injection be painful?Since the injection is given through small needle and directly into the joint there wouldn’t be severe pain. Sometimes doctor can give local anaesthesia to numb the area before giving injection.You may feel mild pain and swelling of knee after injection which is normal.  Place an ice pack on your knee for 10 min at regular intervals.3. What happens after the injection?During the first couple of days- Return to normal day to day activities.Avoid strenuous activities such as jogging lifting weights for first 48 hours.During following months –The intensity of osteoarthritic pain comes down and pain relief varies from patient to patient. The benefits of injection can last for 9 months to 2 years depending on stage of osteoarthritis, vary with patients. These injections can be repeated safely.4. What are the side effects of injection?Before taking the injection you should inform your doctor about any allergic reactions to Hyaluronan products or avian proteins (Chicken).  Some side effects are mild and temporary likeAllergic reactions, pain, swelling, stiffness.There are chances of getting knee joint infection in rare cases.