Dr Levine's Medical Hour 08/02/25--Dr L talks Low T

• Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.

Episode Transcript

Speaker 1 (00:00):
All right, welcome Southeast Texas Internet radio listeners. Good morning.
This is your regular host, doctor Levine coming to you
live from the studios of kov I here in Beaumont, Texas,
taking your phone calls, answering questions about healthcare and medicine.
Hopefully having a wonderful Saturday morning. Weather. It looks pretty
cooperative for now. I was told by a little bird

(00:23):
that it might rain today. I had some rain this
past week. Is no big deal. We need a little
bit of wetness periodically. You don't want it too dry.
Here helps with that heat because we're right in the
middle of it. I's open eight nine six kV I
win one hundred and three to three zero klv I. Yeah,

(00:45):
it's hot, and it's every year that it's hot like
this and we're getting into our hurrycane season. Concerns you normally, Yes,
this time of year, we're looking at the weather channel
looking for those hurricanes to start popping up. So hopefully
we have a good year and we don't have to

(01:07):
deal with that weather formation. Oh my god, it's terrible,
and hopefully we can just get through the summer, stay cool,
and then get to the winter, which is maybe a
month or two off, So just hang in there and
stay hydrated and stay out of that heat. You know,
necessarily have to be out there in the heat all

(01:30):
day long, succumbing yourself to the effects of heat exposure,
which we see a ton of that stuff. We've seen
it already. We always see a spike, like in the
winter time we get our respiratory infection spike, and then
in the summertime we get sort of our heat related
illness spike. Just people who are out there in the

(01:52):
heat for various reasons, just after a while, their bodies
succumb to the impact of the constant exposure to heat.
If you're out there doing the day, just walking, maybe
cutting your grass or whatever you're doing out there in
the heat. If you work on the road, you work

(02:12):
at the plants, you work on houses, and you just
sort of expose to the elements. Sometimes, yeah, that heat
can get to you start sweating a lot and losing
electro lights, and blood pressure can fall, especially if you're
on blood pressure medications already, and but you get out
there in the heat, it can exacerbate or it can

(02:37):
make the medication stronger, so your blood pressure gets lower.
And when your blood pressure falls in the human body.
Then all chaos breaks loose, and vital organs get angry
and upset and they stop working, and then other organs
stop working because you know, one organ stop working. They
all communicate with each other. It's almost like they get

(02:59):
upset that they're being injured and harmed and they let
other organs know. That's why a lot of times when
patients come in with low blood pressure, it's sort of
a multiple physical complaints that they might have, such as
confusion or disorientation, vomiting, not being able to urinate, or

(03:21):
maybe have not urinated in several hours. Most people sort of,
I guess, keep a running log of how often they urinate,
or they realize that, hey, I haven't had I haven't
urinated all day today. I mean, they sort of get
that that they should be urinated all day. Same thing
with bob movements, not as concerning for most people. They

(03:44):
most some people can go several days without having a
bow movement. They don't get too concerned, but certainly urination,
that's hey, I hadn't urinated all day, And that's what
happens when you become dehydrated. You're out there in the
heat all day and that's one of the first symptoms
of maybe heat related illness. So try to stay out

(04:04):
of that heat, take frequent breaks, and stay hydrated as
much as possible. And most businesses, companies, the health of
their employees has become very important just because when employees
get sick, I mean, there is some changes that most

(04:25):
businesses have to go through in order to deal with
that loss. And so there's now some responsibility on the
employers back to try and make sure that their employees
are healthy. And so they've gone through a lot of
different measures, especially those that work out in the heat.

(04:46):
You've sort of seen work crews at nighttime right certainly
working on the highway, because man, that can get pretty
hot if you work on the highway and the concrete
and the sun is reflecting off that surface and that
can get warm. And so yeah, if you've ever driven

(05:07):
at night, you see sometimes work crews work at nighttime
when it's not hot, and they just have bright, bright,
bright lights to sort of light up the air that
they're working on, but they don't have that exposure to
the heat. That's one strategy. Or they have sort of
cooling stations where there's some sort of covered area certainly

(05:28):
with fans or ice water that they have close by
where they can go and get a break from the
sun for a brief moment. There's a lot of different
things like that. I remember I was a high school athlete,
I was a college athlete, and that was part of
playing football is exposing your body to the heat. And

(05:54):
that's something what we did prior to the football season
starting was going to training camp. They used to call
it two A days. Two A days. You were going
the morning and then in the evening the morning wasn't
so bad, then you would circle back around in the
evening have another practice. When I went to college, we

(06:16):
had three A days. We're out there three times a day.
It's an incredible and even though you train and you
try to get ready for the season, getting exposed to
that sun and running in that sun all day and
then tackling and getting hit, oh my god, your body

(06:37):
was so sore, so it it was crazy. But at
that time, that was what was thought to be the
best way to get prepared for the season, is to
put you through this sort of heat crisis and get
toughen up your body, get ready for the season, get
you in this heat, get you ready for it, exposure

(06:59):
to it. They were promoting staying hydrated at that time.
That was sort of the move at that point, just
to keep a bunch of water in you. We had
all these rags that they would sort of dump in
ice water and then they would dump it on your head.
Oh my god, it was the best to get that
towel wrapped around your head, or that ice water dumped

(07:22):
underneath your paths cool off your skin. Got it felt
so good. I felt like being on vacation. So they
would have all these things out on the field and
we would come off to the sideline. If we wanted
that towel, all we had to do was ask for it.
It was incredible, was the best. But they pushed hydration.

(07:42):
I drunk so much gatorade. You just got sick of it.
Gatorade just got just drinking it all day long. You
just got sick of it. God. Yeah, it was doing
three days. Some good memories, but staut of that heat.
Phone lines are opened eight nine to six K three
zero o kayo. Yeah. One thing I get a lot

(08:02):
in the office from my guys is they come in
concerned about their testosterone level. You know, if if you're
a guy listening to the show and you're getting up
in age forties, fifties, sixties, seventies. Testostrum replacement has become
very popular and a lot of guys are doing it

(08:25):
for good reason. We all know about female menopause, right
when women get older, they get into their late forties,
early fifties, their hormonal organs start to sort of wear
out and they're not pumping out as much of their
female hormone as much as they're accustomed to, and there

(08:49):
is a physical reaction to that when the estrogen hormone,
the female hormone as we're calling it, starts to decline
again normally in the eight forties, early fifties. It's a
natural part of aging, right, lose your hair, gray hair,
losing stamina, losing muscle mass, it's all part of that

(09:11):
aging process that israel which I try to tell you
that it's a real process. It's programmed into us from
the time we are born. The human cells have a
program in them, and that program says at a certain age,

(09:31):
the cells start to change how they function and what
they are doing. And the innercrirene glands, which is sort
of what generates these hormones, primarily the gynecological inc glands,
the ovaries for men, and satesticles. They are responsible for

(09:52):
sort of generating these hormones estrogen, testosterone. Men can have
sort of a male menopause, if you will, where the
level of testosterone does fall to a critical level, and
men can have physical symptoms related to that. And I
think in talking with men, that is the key. That

(10:16):
is the key. So you can be sixty seventy feel fine,
do you need testosterone replacement? Even though if we check
your levels they're low or they're below low. Do you
need necessarily testosterone placement? Same thing with females. Some females
can sort of float through menopause and not feel bad

(10:40):
about it other than they certainly don't have sort of
the monthly experience anymore. And I think most women are
okay with that one. They don't complain about that one. Man,
what a scene, right that you have to do that
as a female every month? Dealing with that? You know,
we don't have to deal with that. They do, God

(11:03):
bless them. And so as they get older, that's wanting
to look far too. Man don't how to deal with that.
But some ladies can just sort of float through menopause
and not really feel bad. I mean they almost feel
kind of normal, there's no major physical symptoms. But some ladies, yeah,
it makes them feel terrible. Headaches, mood swings, fatigue, increase

(11:27):
in pain, weight gain, palpitations, change in the way their
skin looks. I mean, it can be a number of things.
And they come in normally, Yeah, and at that age
group just really concerned about why they feel the way
they do. And we certainly have to do testing lab

(11:51):
X rays, sometimes maybe see some other doctors to exclude
some other more pressing diseases, just because that's just the
way doctor during is. We have what we call a
differential differential diagnosis list some diseases that we have in mind,
but we're not quite sure exactly what it is, so

(12:12):
we have to go through the process of elimination. So
normally that it's going to involve some blood work, some
X rays, maybe even some trial of some medications, and then, yes,
maybe referrals to some other consultants to get their opinion
about your physical symptoms. Not always right. Some practitioners, yes,

(12:33):
they've had enough experience and exposure to certain diseases. Once
they listen to your story, they know fairly certain what's
going on, and they implement the plan of care and
you get better and everybody's happy. But that really doesn't
happen one hundred percent of the time. It just doesn't,
and there is for some patients. It's a time consuming

(12:56):
endeavor to try and figure out why you have a
certain physical see, just because sometimes we just don't figure
it out quickly and it just it takes a while,
and you have to be cooperative and participate in that
process if you want to get diagnosed. Yes, it's time spent.
Sometimes it's financial little burdensome, but certainly the time and

(13:17):
the anguish to go through just trying to get an
answer to what is wrong with you. Man, that can
be a struggle, and I feel for you. Know, from
a doctor's standpoint, we certainly want to give you the
right diagnosis as soon as possible. I mean, we want
to be successful, just like you want a diagnosis. It
makes us feel good. So we are right along with

(13:38):
you when you're struggling to get some answers, and we're
struggling to give you the answers, we are right along
with you in terms of the mental anguish that it causes.
Because man, we feel like we're smart, We feel like
we have all these tools that are available to us
and we want to get you the right diagnosis. But

(13:59):
just work out sometimes like that and it's frustrating. But
just because you have low T, which again as a
part of aging, that's the term now, low T, which
is low testosterone basically most of us as we get older, yeah,
we will have a decline. It's part of aging. We
get older, and you have to be ready for that process.

(14:23):
But just because you have low test soshal does not
mean you need medication. And that's the question most guys have,
Do I need medicines or not. We'll get to that
on or get to that on a return of our
first break. Phone lines are open eight nine six kV
I won one hundred and three to three zero. Okay,
I'll be back in two minutes. All right, welcome back

(14:58):
to doctor Memerica. Our phone line to open eight nine
to six one, one hundred and three to three zero
ko v I. Talking about low T. This new term
that you hear all the time, and it's mainly for
the guys who are maybe suffering from low testosterone. Male
menopause is what they call that, and it is real,

(15:20):
and the question is whether or not you need testosterone
replacement and maybe what might be the best sort of
way to do that. For most guys who really need medication,
Just like females, there needs to be some physical symptoms
that you are experiencing that warrant replacing your testosterone. Just

(15:40):
because low T in and of itself does not mean
you need replacement, just like females, just because your estrogen
low does not mean you need estrogen replacement. So it's
got to be some physical symptoms related to that. And
for most guys, it it has to do with sort
of their vigor, you know, my energy. Most men want

(16:00):
to certainly feel like they have a certain level of
strength and physical endurance and vigor about them on a
regular basis. Right carrying the groceries in, cutting grass, maybe
working outside, picking up things, pulling things. Low te can
sometimes sap your energy, your vigor, your endurance, and doing

(16:24):
that it's a noticeable difference. Guys just don't feel like
men like they used to. They could stay all day
outside and do all this physical labor and it'd be fun. Right,
come in, drink your can of beer and watch the TV.
Each a dinner and go to bed and do it

(16:44):
again the next day. Right, But when you get low
tee man, you can't be out there that long. You
need help now, can't bend over getting dizzy and tired,
and so you have to have some sort of physical symptom,
maybe depression, Maybe you feel this sense of psychological depression.

(17:07):
Certainly some sexual dysfunction. That's a big one. Guys come
in with that all the time as they get old,
I shouldn't say all the time. Sometimes when they get
older and they want to know if low T is
associated with that, and yes, it can be related to that.
So normally to properly diagnose someone with low T, we

(17:29):
have to get two that's two two two testosteron levels,
typically in the morning. Right. Sometimes that can be hard,
just guys have schedules just like everybody else, and that
can sometimes be a hard thing to accomplish when your
work and you still have responsibility. You're not retired yet, right,

(17:52):
You're still working to get two values in the morning.
But that is the more efficial way to do that.
Most men just at one value. They go to the
doctor's office, healthcare professional. It could be three o'clock. They
get a TESTASM level it's low or below the cutoff,
which is normally less than two hundred. Two hundred is
sort of the low normal floor, if you will. An

(18:16):
eight hundred is sort of the high ceiling for that,
and then everyone is in between. So normally, if we
can get one R two testosterone values less, you know,
close to two hundred, less than two hundred, we sort
of are concerned about low T syndrome or low T

(18:37):
issues and we can certainly start you on replacement. So
again for the main thing is you have to have
symptoms first, and vigor is normally the biggest one that
I see talking to guys, and sexual decline that's the
other one. That's the one I see. And so once
we have that information, then we can and offer you

(19:01):
some replacement for that. And normally it comes in two
different popular forms. One is an injection, yes, right, a
needle goes into your muscle, and some guys like, hey,
don't I don't want to inject that. I have a
problem with needles. I don't want to get no injection.
I can't do it. I'm scared. I don't have anybody

(19:23):
else to help me. So there is a topical gel
and I guess if I took testops from I would
probably do the gel just because it's a daily application.
It's not painful. And even with my guys who are
doing the injection, they don't really talk a lot about
pain when it comes to these injections. Either they get

(19:46):
used to it or that they are so desperate to
get their bodies feeling the way they do. They just
tolerate and they don't complain about it. I'm not quite
sure which one it is, but they don't really complain
about it too much, so you know it is. It
is a good option. And I think just the whole
idea of injecting your body with this chemical it psychologically

(20:09):
it seems like it's gonna work better. Right, You got
this long needle and it's it's in there, and I'm
pushing the juice in there. Right. Just the whole scene
just for men, works a lot better in my opinion
versus Oh, let me get this little little gel out
of this tube and after I brush my teeth, I'm

(20:30):
just gonna rub it on. Like lotion just seems so light, right,
just doesn't have that physicality behind it, you know, like
injecting a chemical in your muscle that has a better
psychological look to it. Right. So, I don't know, but
it seems talking with my guys that the injections do

(20:55):
work better in general. More guys come back saying, yeah,
I'm feeling better with the injection versus the gel. It
seems like it takes them a little bit longer to
achieve their physical experience that they're looking for with the gel.
But for me, the gel is it's a daily topical application.

(21:17):
It is easier to do, and it just seems a
little bit more natural. But again it's up to the
patient which one they want. In my experience, normally the
injection is more affordable. We get more headache or more
denial issues with the gels. I don't know why. It's
been like that for a long time. So the injections

(21:38):
normally are a lot cheaper than that. I'm sorry. The
injections are more cheaper than the gels in general, and
there are issues with both of them. Right. One issue
with the injection is other than what I've mentioned, is
sometimes you get these sort of big highs and big

(21:59):
lows in terms of how you feel, and that is
a bit unnatural because again you get sort of this big,
huge walloping dose of the testosterone. So there's this huge
spike in your testosterone in your bloodstream, your body reacts
to that and then it sort of slowly wanes and
dissipates until your next injection. So that can be a

(22:21):
very choppy experience, and it can be very displeasing to
the patient because the patient just wants to feel good
every single day. They want to feel the same every day.
They don't sort of want to go through these cycles
of well, a few days, I'm good, and then man,
I just sink until my next injection. So there are

(22:42):
ways that you can dose the injection so that it's
a bit more smooth, and I do see that popularity
in terms of dosing. I've seen that coming down the
pipeline in terms of trying different things, because it used
to we just, like I said, get this big dose
every three or four weeks. But I've seen some crafty

(23:04):
practitioners who do a lot of this where you're sort
of getting a dose maybe twice a week, but it's
a lower dose of the testos from per injection, so
that you're not getting this big, wallopping dose. You're just
sort of getting a small amount every few days. And
that seems to work out a lot better. It's smoother,

(23:27):
and patients tend to feel better that things are more
natural with injection when they sort of dose it, maybe
every two injections a week of small dose versus this
huge injection every three weeks. So that's what I've seen.
It seems to have made a bigger difference, a better difference.
Guys tolerate those injections like that a lot better. The

(23:51):
thing I've heard about the jails is this concern that
you can sort of transfer the medication to other people
and maybe animals as well, you know, pets. We well,
not all of us, but some patients have dogs and
cats and they like to hug on their dogs and cats.
Even guys, yes that would include me, We like to

(24:15):
hug in our dogs and cats. And yeah, they have
been reports that if you're using the testosterone jail, because
normally you rub it sort of on your chest, sort
of with on the front part of your chest is
where you rub it, and that's where a lot of
times if you want to hug someone, that's that area
is going to be included. And yeah, when you use

(24:37):
the jail, they have been reports that the person that
you're the animal or the person that you're hugging kids.
I forgot about that as well. They can sometimes get
transferred chemical to that person, the animal or your spouse
female and can start getting some physical symptoms that's very disturbing, right, So,

(25:02):
but if you do that, they have some recommendations on
how to prevent transferring of the medication to someone else,
you know, like washing your hands after you apply the
cream and wearing clothing over the application site is another
way you can do that. And then another one is
sort of avoid sharing clothing towels, that sort of thing.

(25:25):
A little bit more cumbersome, right, got to do this
and do that, I mean again, I think that's one
reason why patients hate taking medications. Now, you've got to
put it on the list, right, you have to remember it.
It's got to be put into your routine. And sometimes yeah,
you don't remember. You forget that your shirt is off

(25:47):
and you just put the test hosphe on and your
wife comes by, the pet runs through the house, and
maybe kids around you who want to hug them touch them, right,
you forget and so a little bit it seems like
a little bit more cumbersome to do it that way,
and injection seems to have some bigger advantages. It's cheaper,

(26:11):
it seems to work a little bit better. You don't
have all these issues with transferring, and yeah, it makes
you feel better. So it's everybody. It's a choice, just
like with all these medications. So phone lines are opened
eight nine six. Kalov I won one hundred three three
zero Kova. I'll be back in two minutes. All right,

(26:41):
welcome back to Dockravia Medica. Our phone lines are open
eight nine six. Kovy I went one hundred three three
zero kov Ya Talking about low T for you guys
out there, don't feel as well as you used to,
don't have the vigor, the energy, the stamina, maybe some
sexual dysfunction, like what's going on? Oh no, yeah, load

(27:01):
T is the real thing. And remember you have to
normally have two values demonstrating a load test tossed from
Most just have one. They've relaxed those recommendations for a
long time, so it's very easy go in, get checked out.
Normally they want the lab to be in the morning,

(27:22):
but again that's sometimes hard to orchestrate. And then you
have to choose which one you want, the jail or
the injection, most of the time guys are choosing the injections,
and my lovely wife mentioned that what they call that
is microdosing is how they title the test tossed from

(27:43):
the smaller doses throughout the week. Again, it works very well,
but the jails that have their own issues as well,
so most of the time give it several weeks of
testas from replacement and sort of see how you feel.
And if you don't feel any different and you're on

(28:03):
the jail, you're on the injection. We check your level.
It's now up. Let's say it's five hundred, four hundred,
six hundred, and you don't feel any different, then your
physical symptoms are not related to low T. That's how
you figure that out. But if you feel better, you're
functioning better, you like the experience, and you stay on

(28:27):
the testosterone. Now, anytime we're injecting our bodies with anything
on a regular basis, as always concern for adverse reaction
or complications from the medicine. Right, So, some of the
things that I've been mentioned about testosterone is that it
might increase your risk of cardiovascular disease. And I heard

(28:50):
that a lot when it first sort of hit the scene.
That it would make you have a heart attack or
a stroke. But that sort of died down and I
don't hear much of that concern anymore, and more guys
are on testosterone at this time. I just think if

(29:12):
that was a real issue, that we would be seeing
a lot more heart attacks these days. And I just
don't see it. I mean, I'm out there in the
streets so to speak, every day, I'm in the hospital
in my office just about every day, and I don't
see it. Meaning, you know, and we talk to guys

(29:33):
or if you've ever been involved with in talking with
the healthcare professional, there's always sort of this question period, right,
We're like, what's going on? How are you doing? What
brought you here? Right? And I know sometimes I get
aggravated at us, especially if you're in the ear or something.
You might get two or three healthcare professionals at see

(29:53):
and they all ask you the same thing, what's going
on with you? Well? Why are you here? Like didn't
I just told that other person that we just had
this long conversation. You want me to do that again?
You know, it can be exhausting talking and giving all
your information, trying to remember all these names and dates,
and physical symptoms. Just get tired of it. I know

(30:17):
that I see it in my patient's face. They get quiet,
like go talk to the other guy, go look in
the record. I don't feel like repeating this again, remembering
all these names, especially when you're nauseated, you got headache,
maybe your stomach is hurting like you know, ugh, you
don't feel like talking. I mean that requires a lot

(30:38):
of energy, and you're just trying to hold on right
and feel better, not get grilled by doctor Levine. And
when he's asking you ten thousand questions which you've already
answered a number of times by the r physician, the
nursing staff, maybe the consultant's been by already. But it's

(31:00):
how they teach us to interact with patients. I go
through that question and the answering session that we have
to go through, so I try to keep it to
a minimum if I see that, not to bother them.
I know they're feeling bad, but anyway, I haven't found
that to be an issue. The testosterone causing a lot
of heart disease. So again, I guess when we first

(31:25):
started this whole thing, we were a little bit more concerned.
And so if a guy had some risk factors who
might not be as open to giving them the testosum,
but now it seems like that's relaxed, and so now
more guys are eligible. Just about every persons eligible for it.
Other than my understanding is prostate cancer just because prostac

(31:48):
cancer is fed by testosterone presence, and one of the
major ways they treat prosec cancer is to block the
prostates exposure to testoso because even though you might get
into some male menipause or low T testosphone is still
being produced, just at a lower rate. So when you

(32:11):
have prostate cancer, they don't want any testosphone around a
lot of times depending on the stage of your prostate cancer.
Because if you've ever been diagnosed with procesec cancer, just
because you know it. Man, the options have grown over
the years compared to when I graduated from medical school

(32:33):
and became a doctor, the options are now more, which
is good, right. Healthcare science always investigating trying to figure
out what's the best way to do things. I mean,
you talk about breast cancer. Breast cancer used to be
very crude in terms of its approach, but now it's
a very delicate, intricate decision making tree by the healthcare

(32:54):
professional and the patient. Just all these options. Now, outcomes
are better, right, that's always the goal is to improve outcomes.
Prostate cancer is no different. I mean, it's a big
major topic in the urology world as well as the
incollege world is prostate cancer. And so a lot of

(33:14):
experts just study prostat cancer. They do it all the time.
And so the options are better. And one option which
might probably irrit I shouldn't say irritate, but concern the
patient is yes, you do have cancer, and we're not
gonna do anything about it. Yeah, it's gonna watch it,

(33:37):
watch it. You're just gonna watch my cancer get bigger
and kill me? Is what what? No? I want it out.
I want treatment, right, because you think about cancer, you
want that sucker out of there. Man, you don't want
to live with cancer. No, get it out. But studies

(33:58):
have shown certain types of prosec cancer it's better to
just wait that you don't have to do anything about it.
You can just monitor it. They call it surveillance, and
just monitor it. Monitor in terms of the values. And
they're now using MRIs to visualize the prostate. Remember the

(34:20):
old rectal exam that everybody would get you know guys,
you know I'm talking about and you get into your fifties, right,
that was your wake up call that oh I'm fifty now,
you know when I went into my doctor's office. Yeah,
he would just talk with me and do it physical,
maybe take my blood pressure and everything and do some

(34:41):
lap pat in the back and I'm out the door.
But now at fifty, yeah, I got to get my
wake up call physical. It'd be dreading it the whole
day prior to the visit. This is when we did
it more often. That rectal exam, which we call a
DRE DRE that stands for digital digit is the finger

(35:04):
digital rectal exam DRE was how we when I graduated.
That was a major part of a physical exam for
someone fifty year above, or if you had some genital
you're inner complaints, or if you've been in an er
for gashin testine problems or they thought you were bleeding,
you get a rectal exam. Yeah, not very pleasant. But

(35:28):
the latest research, again because of our better understanding of
prossect cancer, my understanding reading the latest research is it's
not a critical part of the examination anymore. I mean,
there's certainly some practitioners that still do the DRES, but
it's falling out of favor just because of modern technology

(35:49):
and better understanding of how prostate cancer progresses and starts
and all these things. They're using MRI I technology to
really visualize the whole prostate, which is the best way
to do things because the rectal examination that very sensitive,
somewhat painful exam that guys had to go through back

(36:12):
in the day and are still going through to this
day because again some doctors are still doing them. You
don't actually examine the entire prostate. You're only examining a
portion of the prostate, and so some cancers are not
in that portion that's examined. So why are you putting
the patient through this uncomfortable exam If it's inefficient, it's

(36:35):
not a good exam, And now you have MRI technology
that can visualize everything. It's painless, there's a little bit
exposure to radiation, not much, why not do that? So
a lot of times that's how people are getting their
prostate looked at. It's just through X ray and then

(36:56):
we have the blood test a psa prostate specific antigen
for a long time, so we sort of use all
that to make a decision. Then a lot of times
patients will go through a prostate bopsy that still is
a little uncomfortable and if it does come back again.
And I'm not the best at this right now because

(37:16):
i don't follow with that much. I've sort of gotten
out of the habit of looking at prose cancer research
and where the latest guidelines are. But there are certain
types of prosect cancer, especially if it's a low grade
it's not advanced, well, they just just watch it. They
don't do anything. And again, in those situations, they don't

(37:37):
necessarily shut your testosterone down or give you something to
prevent testosterone from exposing yourself to the prostate. They don't
really do anything. But there are some prosect cancers where yeah,
that is part of the treatment is we got to
shut down the prostates exposure to testosterone. So they give
you sort of a testosterone blocker. Lupron is the name

(37:59):
of that medicine, lu p r o in. They just
shut it down. We don't want to prosta getting any
exposure test to testosterone. So it makes you feel terrible.
That's a guy, because it's blocking some other receptors in
your body from getting exposure to test testosterone so you
feel bad and patients come in like, hey, I want

(38:21):
I need something. I'm feeling bad. Hey, I'm sorry. I
can't give you a testosterone. We don't want it to
affect your prostate cancer. So if you have a history
process cancer, normally you're not a candidate for testosterone replacement.
At least that's my understanding. Phone lines are open eight
nine six kV I one hundred three to three zero
k l v I will be in our last break,
be back in two miny. All right, welcome back to

(38:50):
Doctament Medical. Our phone lines are open eight nine to
six kov I one one hundred three three zero k
o v I. Toward the end of the show, spend
some time time talking about low tea. If you have that,
go get your lab work checked and if it is
toward the two hundred or less than two hundred on
one or two separate occasions. Yes, you have injections, you

(39:12):
have gels, and you can undergo microdosing of the testosterone
to make you feel better. But certainly anytime you inject something,
or drink something, or take something on a regular basis
got to be concerned about adverse reaction. And some of
the things have been brought up with testosterone. Does it
increase risk of cardiovascular disease if you're in the jail,

(39:36):
can you transfer it to another person? Which all these
are concerns, but there's things that you can do to
lessen the impact of that. And I don't think it's
the cardiovascular issue has not been proven. That was a
concern of whether or not it raised your blood pressure.
I have not seen that either, especially if you keep
it within the range that it's supposed to be. Certainly,

(39:58):
if you go above a hundred and you keep it
up there, yes you do typically develop some toxicity issues.
Based on my experience. The blood pressure will go up,
you might get weight gain, It can affect your blood work,
It can make your cholesterol a lot higher, it can
make your blood thicker, it can impact your liver function tests.

(40:19):
So yes, super high doses of testosterone on a regular
basis can do that. Now, sometimes when if you're doing injections,
the amount that you give could spike your level above
one hundred briefly and then it goes back down to
more normal range. That probably is okay, doesn't cause a
whole lot of problems. It's just sort of that constant

(40:42):
level of testosterone on a high level that can sometimes
generate these physical symptoms. So for the most part, it's
well tolerated and is very beneficial to most guys who
decide to take testosterone. Does it cause or increase hair loss?
That was another concern from guys. I've had that conversation before. Again,

(41:06):
I have not seen that, meaning when they start to
testoshune they come in saying I'm losing more of my hair.
I haven't heard that either. Again, the idea is to
keep it within that range, right between two three hundred
to eight hundred, So keep it within that realm that's
considered sort of a normal, more physiological level of testosterone.

(41:28):
If you keep it there, everything tends to work out
very well, at least from my experience working with guys
who have low t issues. And yes, certainly it can
increase their sexual function. That's a big concern for a
lot of my guys. But you don't want to take

(41:49):
too much. I mean more is not better in this
situation because you have to be concerned about taking a
long term and just sort of fitting it into your routine.
You don't want to over medicate because and that's what
anything you don't want to overmedicate, and doctors their goal,
honestly when medicating someone is to make you feel unmedicated. Right.

(42:12):
We want you to feel normal, and we're always trying
to achieve that balance, especially if you're on more than
two or three medicines. We're trying to achieve the balance
of not making you feel like a machine or making
you feel like you're medicated drugged. If you will, it
make you feel natural and light and like you feel

(42:34):
like you should anyway, thank you for listening to another
edition of The Dark or Lavie Medical. I will remember,
don't drink and drive. Drink some water, eat a cucumber.
We'll see you next week. Take care,