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Testosterone replacement and the aging male

I recently read the following about testosterone and testosterone replacement  “Last summer I took Bruno, my ten-year-old cairn terrier, to the vet for his annual check-up.  “Wow, he has some energy level for an older dog,” commented my vet as he watched Bruno dart around the exam room. My vet started to examine Bruno. “Aha”, he exclaimed. “He’s intact. That’s why he’s still so quick moving and trim. It’s all that testosterone.”

The Vet’s findings are similar to what we find in men. Adequate testosterone levels benefit the aging male. Over the last ten years, prescriptions for testosterone for men over forty have tripled. Testosterone is essential for maintaining muscle and lean body mass, strength and energy levels, fertility, libido and sexual performance. It is needed to maintain normal bone density and prevent osteoporosis. It also positively impacts cognitive function and mood. Unfortunately for men, testosterone progressively declines as they age. Sometimes to levels low enough to impair the numerous functions listed above, leading to adverse health conditions and significant changes in quality of life. So it is easy to see why healthcare providers and their aging male patients would consider testosterone replacement therapy to reverse symptoms related to low testosterone and restore better quality of life.

Several recent studies, however, indicate that testosterone replacement therapy may not be as beneficial to the aging male as originally thought. We need to consider the balance between the risks and benefits.  Their findings link testosterone replacement therapy to an increase in cardiovascular problems. The New York Times and several other national news outlets ran features last month highlighting the findings of a recent study that showed a correlation between testosterone replacement therapy and increased cardiac risk, setting off a bit of a frenzy over the need to better scrutinize how and to whom this medication should be dispensed. There is also discussion over the need for pharmaceutical companies to put a warning label on testosterone replacement therapies and their relevant advertising material, and for doctors to have patients sign a consent indicating an awareness of the potential side effects of testosterone prior to being prescribed this drug.

So how concerned should you be if you are currently on testosterone replacement therapy, or you are experiencing symptoms of low testosterone and are considering discussing testosterone replacement therapy with your health care provider? Will testosterone replacement therapy increase your risk of having an adverse cardiac event?

The study receiving so much recent media attention was funded by the National Institute of Health (NIH) and was published in the journal PLoS ONE. It found that men over the age of 65 had double the rate of heart attacks within the first 90 days of starting testosterone. Men younger than 65 with a history of heart disease had triple the rate of heart attacks within the first 90 days of starting testosterone. Men younger than 65 with no history of heart disease showed no increased risk of heart attack.  Other studies have also produced similar findings. None of these studies have been able to demonstrate specifically how testosterone is causing adverse cardiovascular incidents. Some are suggesting increased physical activity elicited by the physical improvements gained from testosterone replacement therapy is placing too much stress on the cardiovascular systems of men already at risk. However, if you are over 65 or have a history of cardiovascular disease, testosterone replacement therapy may not be for you.

Another source of concern is the growing number of health clinics that cater to the needs of men interested in extending the vigor and virility of youth into old age with the help of testosterone replacement therapy.  Many of these “male rejuvenation” clinics are billing testosterone as a panacea for all that ails the aging male. These clinics are prescribing testosterone without properly screening for this condition and without properly following up with those patients given prescriptions and refills.  Testosterone replacement therapy benefits many aging men, but it is not for all.  Like all medications, testosterone can pose health risks if prescribed to men who do not need it or have pre-existing conditions that contradict it.

Because of the steep increase in the number of prescriptions being written for testosterone, as well as the number of clinics actively marketing testosterone replacement to aging men, the Endocrine Society updated its clinical practice guideline in 2010 to provide a better protocol for evaluating and treating patients with low testosterone.

If you are currently on testosterone replacement therapy (TRT) or considering seeing a healthcare professional about starting it, your initial and follow-up evaluations should adhere to the Endocrine Society’s guidelines.  A healthcare professional should never, ever prescribe testosterone based solely on a patient having symptoms of low testosterone. Your initial examination should include a serum (blood) sample evaluated by a reference lab using a standardized method for testosterone measurement. Initial blood tests often include a total and free testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), prostate specific antigen (PSA), prolactin, and hematocrit (measurement of red blood cells). The sample should be drawn between 7:00am and 11:00am particularly for men under 50, as testosterone levels are highest in the morning.

Due to the lack of standardization in testosterone measurement there is not a level below which testosterone is considered ‘low’.  However, a total testosterone level below 300 ng/dl is usually considered the lower limit of normal.  If your total testosterone level is low, evaluating hormones secreted by the pituitary, LH and FSH will help your healthcare provider determine if the cause is impaired production in the testes (primary hypogonadism) or a problem with the hypothalamus and/or pituitary (secondary hypogonadism). If secondary hypogonadism is suspected, additional testing should be done to determine the cause. If your total testosterone level is low or borderline-low, bone mineral density should be evaluated with a DEXA scan to determine if you have decreased bone density (eg osteopenia or osteoporosis).

A clinical diagnosis of low testosterone based on symptoms and blood work demonstrating low serum testosterone makes you a good candidate for TRT. However your healthcare provider might not suggest TRT if:

  1. You are 65 years of age and older.
  2. You have a history of cardiovascular disease.
  3. You have prostate cancer or a PSA level above 4 ng/ml. (TRT can stimulate the growth of prostate cancer in men with prostate cancer.)
  4. You have severe lower urinary tract symptoms.
  5. You have who have a history of breast cancer.
  6. You have hematocrit above 50%. (TRT stimulates the production of red blood cells. Excessive levels can cause formation of blood clots.)
  7. You have severe sleep apnea. (Severe sleep apnea might be a sign of cardiovascular disease.)
  8. You are concerned about your fertility. (TRT impairs sperm production in testes.)

Once you have started testosterone replacement therapy, your healthcare provider should monitor your progress. You should be evaluated every three to six months to determine if your symptoms are improving. Your serum testosterone level and several other hormones should be measured, and the goal should be to maintain a testosterone level in mid-normal range (ie, 400 to 600 ng/dl). You should be assessed for any adverse effects (cardiovascular disease, PSA/prostate cancer, hematocrit/erythrocytosis). You bone density should be re-evaluated by DEXA scan every one to two years.  Your healthcare provider should not be refilling your prescription without doing this type of periodic assessment.

Before I end this blog, I want to mention that life style interventions have been shown to improve testosterone levels. Studies show there is a link between obesity and low testosterone. Men who are overweight tend to have lower testosterone levels than men who are normal weight. Weight loss, improved diet, and exercise have been shown to boost testosterone levels.

Testosterone replacement therapy, when prescribed and monitored properly, has been proven to be safe and effective for men over forty with low testosterone. It has been shown to improve energy level, libido, muscle and bone loss, and mood. Studies have shown it can lower blood pressure and blood sugar and can improve cholesterol levels.  Studies also demonstrate that men with normal testosterone levels have a 40% lower death rate compared with men who have low testosterone levels.  If you think you suffer from low testosterone, testosterone replacement therapy could be of great benefit. Just make sure you are evaluated and monitored by a physician who is experienced with hormone replacement therapy in men.

References:

 Bhasin S, Cunningham GR, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun; 95(6): 2536-2559.

Finkel W, Greenland S, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLOS ONE. 2014 Jan; DOI: 10.1371.

Brawer MK. Testosterone replacement in men with andropause: an overview. Rev Urol. 2004; 6(Suppl 6): S9-S15.

O’Connor A. New concern about testosterone and heart risks. NYT, Jan 29, 2014.

La Puma J. Don’t ask your doctor about low T. NYT, Feb 3, 2014.

Male menopause: testosterone therapy marketing frenzy draws skepticism. From voxxi.com, Sep 9, 2012.

 

 

 

 

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Zika virus found inside spermatozoa

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Spermatozoa infected by Zika virus (green; arrowhead)

The Zika virus has been shown to be present in semen for as long as 6 months. However, recent work by Martin-Blondel et al  of the Infectious and Tropical Diseases Department of Toulouse University Hospital are the first to demonstrate the presence of the Zika virus in sperm. What is facinating is that in their index case the “ Zika virus was found to be present in all sperm samples only up to the 37th day. Beyond that point, the virus was found only in the semen, where it persisted for over 130 days.”

 

Implications of this does not change the recommendations for use of a barrier contraceptive however does support the use of washed sperm in in vitro fertilization sooner than 6 months after male exposure to the Zika virus. It also gives more impetus to test sperm donations for the Zika virus in fertility clinics. http://bit.ly/2cYlhrF

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ZIKA Alert: Should Men be Banking Sperm?

A Liquid Nitrogen refrigerator containing sperm and eggs samples. High tech lab equipment used in the in vitro fertilization process.

A Liquid Nitrogen refrigerator containing sperm and eggs samples. High tech lab equipment used in the in vitro fertilization process.

As a specialist in male fertility and owner/director of a sperm bank (http://NYCryo.com) , I have been increasingly asked this question by my colleagues and patients over the past several weeks. Interest in the Zika has been ignited recently by news coverage of celebrities including Pau Gasol of the Chicago Bulls talking about freezing his sperm in the Washington post (http://wapo.st/293BkUP) ….if he even decides to go to the Olympic games. In fact, golf greats like Jason Day, Dustin Johnson, Shane Lowry and Rory McIlroy together with Basketball legends LeBron James and Stephen Curry have pulled out of the  games entirely (http://wapo.st/293Cob5, http://wapo.st/29g036u) while others like Jordan Spieth are weighing their options (http://wapo.st/293DG5U). To add to this concern, the Center for Disease Control (CDC) had issued warnings earlier this year on travel for pregnant women and continue to monitor/update their recommendations (http://bit.ly/29ewocX) . In this brief blog I will try to provide a well referenced overview of what is known about the Zika virus to help you decide what is best for you and your future family. A great review article on Zika virus in pregnancy can be found at http://bit.ly/29dWhfn .

 

First the facts provided by the CDC (http://1.usa.gov/294JyZ0) .

  • A man with Zika virus can pass it to his female or male sex partners through their semen….even if they have never had symptoms. In addition, Zika viral RNA level were higher in semen samples then in blood urine or saliva (http://bit.ly/29dkujA) .
  • Using condoms or delaying sex can reduce the risk of getting Zika from sex…however it is not known where saliva or vaginal fluids can pass the virus on.
  • Zika virus RNA has been detected in semen up to 62 days after the onset of symptoms (http://bit.ly/299BJBd) . CDC therefore recommends that men who have been diagnosed with Zika should consider using condoms or not having sex for at least 6 months.

 

It is clear from these statements that we need to know much more about how the Zika virus. In particular, how the virus is transmitted and even more about the longevity of the virus in the human host. So how should men interested in their future fertility protect themselves? Should they bank their sperm as Pau Gasol believes one should? That question is not a simple one to answer given the paucity of data presently available on the Zika virus. Many questions remain before a definitive answer can be given. In fact, there are more questions then there are answers.

  1. Should all pregnant couples be screened for the Zika virus and what exactly should be tested? One problem is that not also tests are as sensitive and many correctly performed tests yield incorrect results (http://n.pr/299L93j) .
  2. What are the best methods to test for the ZiKa virus (http://bit.ly/29kyR9s) ? There are most sensitive test is the Reverse Transcription-Polymerase Chain Reaction which tests for the presence of a piece of the virus. However, it is only positive for 1 to at most 4 weeks after the virus is in the host. The Zika MAC-ELISA is a better test which detects the virus for up to 12 weeks after exposure. However, the possibility still exists that the virus is present after this time but just not detectable.
  3. Should pregnant women have screening during pregnancy and if so at what frequency? Although there are recommendations for screening during pregnancy (http://bit.ly/29kyyeT) who to handle positive results is still evolving.
  4. Does screening guarantee the absence of virus RNA (http://bit.ly/29kyR9s) ? The answer is no. In addition, since screening is usually done on symptomatic individuals and the Zika virus can be asymptomatic in a large number of men, we would need to screen all men considering conceiving with their partner…which is not practical or even possible.
  5. What fluid type should be screened? Cerebrospinal fluid, blood, urine, saliva and semen all seem to have the virus in them…however, which is the best to test is not yet known.
  6. Does the virus directly affect the sperm or egg cell or the genetic material in these cells is also not yet known. However the FDA has imposed restrictions (http://bit.ly/29p4fAF)  on the freezing of sperm and eggs (oocytes) from men and/or women that have had:
    1. A diagnosis of Zika in the past 6 months
    2. A residence, in or travel to, an area with active Zika transmission within the past 6 months
    3. Sex within the past 6 months with a partner who is known to have lived, traveled, or has been diagnosed with Zika in the past 6 months?

 

Men have been banking sperm prior to therapy that might affect their fertility as well as a protection form hazards to their reproductive health from their occupation. It is therefore entirely appropriate for them to bank sperm prior to travel to an area known to have the Zika virus. However, as discussed above, even if they undergo testing for the Zika virus prior to freezing sperm there is no guarantee that the specimen stored is free of the virus from possible prior exposure. In addition, sexual relations with their partner anytime during the 6 months after their return from an area endemic for the Zika virus might predispose their partner to the infection. No easy answers at this time…..just more questions.

 

 

 

 

 

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Zika Virus and Sperm Banking: What you need to know

The Aedes aegypti mosquito in action.

The Aedes aegypti mosquito in action.

In May 2015 the Pan American Health Organization issued an alert regarding the first confirmed Zika virus infection in Brazil.   In less than a year, the World Health Organization declared the Zika virus a public health emergency of international concern.

Although the first human cases of Zika virus were detected in 1947, the outbreaks were limited to tropical Africa, Southeast Asia, and the Pacific Islands. Currently there is renewed concern about this disease due to its recent association with birth defects, with reports of Zika transmission through sexual activity, as well as with the spread of Zika virus to the US.  In addition, the potential for this disease to be transmitted through blood and semen has resulted in the FDA’s recent guidance to the Blood and tissue banking industry.

In this post we present an overview of what we know and the recommendations that have been made by the FDA.

What is Zika?

Zika is a virus that is transmitted to humans by a mosquito (Aedes Aegypti/Aedes Albopictus). The time between exposure to the Zika virus and infection is not known but is thought to be a few days to a week or so. Most people that have the disease don’t have symptoms. In those that do, the most common symptoms of the Zika virus infection are fever, joint pain, rash, headache, and conjunctivitis. Less frequently observed symptoms include digestive problems, abdominal pain, diarrhea and constipation, mucous membrane ulcerations, and itchiness.  Some cases of Guillain-Barré Syndrome (ascending paralysis) have been associated with Zika virus.

It is important to emphasize that 80% of the patients infected with Zika are asymptomatic (without symptoms) and may not be aware that they carry the disease. Once a person has been infected, he or she is likely to be protected from future infections.

Babies born from mothers infected with Zika virus appear to have a risk of being born with smaller sized heads (Microcephaly).

Transmission

The following is a list of the reported means of transmission:

  • Mosquito bites – The risks of being infected by a mosquito bite includes traveling to areas where the virus is known to exist. Please refer to the CDC website for a complete list of these countries. http://www.cdc.gov/zika/geo/index.html
  • Sexual transmission – There have been reported cases where the virus has been sexually transmitted by an infected partner (by a man to his sex partners).
  • Transfusion-transmission – There are possible cases that have been described in Brazil. These reports are currently being investigated.
  • Mother to child – Infected pregnant women can pass on the virus to their fetus during the pregnancy and during delivery to their newborn.

Zika virus has been found in semen at least 2 weeks and possibly up to 10 weeks after the illness onset. The virus is present in semen longer than in blood, but the persistence of Zika in the semen remains unknown.

There is therefore a risk for transmission of Zika Virus by HCT/Ps (Humans Cells, Tissues, and Cellular and Tissue-Based Products), which include, among others, corneas, bone, skin, heart valves, hematopoietic stem/progenitor cells (HPCs) from cord blood and peripheral blood, and reproductive tissues such as semen and oocytes. However, this is presently based on limited information.

What are the FDA recommendations for Sperm and Blood donors including mothers who donate their umbilical cord blood to public banks?

FDA’s guidance suggest that donors should be considered ineligible if they have any of the following risk factors:

  1. Medical Diagnosis of Zika virus infection in the past 6 months.
  2. Residence in, or travel to, an area with active Zika virus transmission within the past 6 months.
  3. Sex within the past 6 months with a male who is known to have either the risk factors listed in the items 1 or 2 above.

Additionally, donors of umbilical cord blood, placenta, or other gestational tissues should be considered ineligible if the birth mother who seeks to donate gestational tissues has any of the following risk factors:

  1. Medical diagnosis of Zika infection at any point during that pregnancy.
  2. Residence in, or travel to, an area with active Zika transmission at any point during that pregnancy.
  3. Sex at any point during that pregnancy with a male who is known to have either of the risk factors listed in items 1 or 2, above.

What should I do if I think I have symptoms of Zika Virus?

Contact your healthcare provider if you develop the symptoms described above and have visited an area where Zika is found. If you have recently traveled, tell your healthcare provider when and where you traveled.

Can I be tested for the Zika virus?

Your healthcare provider my order a blood tests to look for Zika virus infection.

FDA has issued an Emergency Use Authorization (EUA) for a diagnostic tool for Zika virus that will be distributed to qualified laboratories and, in the United States, those that are certified to perform high-complexity tests.

http://www.cdc.gov/zika/hc-providers/diagnostic.html

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Patient Brochures (English and Spanish)

These brochures are provided for our patients and offer answers to frequently asked questions. If you would like additional topics covered in future brochures please let us know. – Estos folletos se proporcionan para nuestros pacientes y ofrecen respuestas a las preguntas más frecuentes . Si desea consultar otros temas tratados en futuros folletos por favor sepamos .

  1. Preserving you fertility: Questions and Answers on Sperm Banking
  2. ¿Qué es preservar la fertilidad?: Preguntas y respuestas sobre el Banco de Esperma
  3. Semen Analysis: What you need to know
  4. Análisis del semen : Lo que usted necesita saber

Questions and further Information Please call: 516-487-2700 – Preguntas y más información por favor llame al: 516-487-2700

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Categories:

Bruce Gilbert

I am a Urologist/Andrologist practicing in Great Neck, New York for the past 30 years. I am also the Medical and Laboratory Director of New York Cryo, an andrology laboratory and long-term reproductive tissue bank on Long Island. Please send ideas and comments to me at bgilbert@nycryo.com

Stem Cell Basics #1 – By Danielle L. King

Human Lungs isolated. X-Ray effectHannah Warren, a 2-year old girl born without a trachea made recent news for receiving a synthetic windpipe generated from her own stem cells. The stem cells were taken from Hannah’s bone marrow and placed onto an artificial scaffold, where the stem cells divided and replicated themselves into a new windpipe. Hannah survived 3 months with a normally functioning trachea succumbing to problems with other organs that could not be replaced. This is just one of many cases of the use of stem cells in modern medicine.

What are stem cells?

Stem cells are relatively unspecialized cells that have the ability to develop and differentiate into different cell types with a specific function. In other words, they are not devoted to a specific function, however they have the potential to differentiate into a specialized cell. Stem cells work to renew and restore cells in specific tissues and organs, by means of cell division. The division of a stem cell can result in an undifferentiated stem cell or a specialized cell. These specialized cells can be used towards further understanding of infections, cancer and many other diseases. In addition stem cells can aid in the study of new drugs and are the forefront in the future of tissue engineering and regenerative medicine, as displayed in the case of Hannah’s windpipe.

Types of Stem Cells:

There are two main sources of stem cells, which are embryonic stem cells and non-embryonic (also known as somatic, tissue, or adult stem cells). Embryonic stem cells are cells derived from an embryo that can differentiate into all specialized cells of the body. Non-embryonic stem cells are undifferentiated cells derived from a tissue or organ with the ability to differentiate into specialized cells for that specific tissue or organ. Owing to the fact embryonic stem cells can produce any type of cell in the body, they have a greater potency than adult stem cells. Thus, the potential for a stem cell to differentiate into a specialized cell varies. Therefore, stem cells are categorized into groups based on their capability to specialize, which is listed as follows: totipotent, pluripotent, multipotent, oligopotent and unipotent.

 

Stem Cell Sources:

Stem cells can be taken from specific sources in the body:

-Bone Marrow

-Peripheral Blood

-Umbilical Cord Blood and Tissue

-Tissue Stem Cells

-Teeth

-Adipose Tissue

-Testis

 

References:

1. Fitzgerald, Kelly. “Two-Year-Old Girl Born Without A Windpipe Receives Artificial

Trachea Grown From Stem Cells.” . N.p., 2 May 2013. Web. . <http://www.medicalnewstoday.com/articles/259942.php>.

2. Stöppler, Melissa. “Stem Cells.” . Medicine Net Inc., 13 July 2014. Web. .

<http://www.medicinenet.com/stem_cells/article.htm>.

3. “Stem Cell Information.” National Institutes of Health. National Institutes of Health, 04

Apr 2013. Web. <http://stemcells.nih.gov/Pages/Default.asp&xgt;.

4. “What are stem cells.” CHXA. CHXA, n.d. Web. <http://www.chxa.com/what-are-stem-

cells/>.

 

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Threats to Male Fertility: Pesticides

farmer spraying pesticide in the rice fieldIf you have read our previous blogs, you know that some plastic chemicals and recreational drugs are threats to male fertility. These gonadotoxins either directly affect the testes or affect the hormones that produce sperm. Chemicals in pesticides have been shown to impact male fertility, though recent articles have suggested more research needs to be done in this area.

Effects of Pesticides

Since the early 2000s, the majority of studies linking male infertility to pesticides have reported that pesticide exposure leads to poor sperm quality and reduced sperm concentrations.1 Clear effects on sperm quality, for example, have been demonstrated for dibromochloropropane (DBCP) and ethylene dibromide, the active ingredients in some agricultural fumigants.2 Not all pesticides are so clear-cut, though. One article in particular notes that many of these studies are inconsistent, citing problems with sample populations, pesticide exposure, and study design.1

Research published as recently as 2011, however, strengthens the connection between pesticides and infertility. Scientists at the University of London tested 34 widely-used pesticides with high exposures through diet and found that 23 of them reduced fertility. The researchers recommend additional testing, but the study again points to the negative effect of pesticide exposure on fertility.3

Treatment

In many cases, gonadotoxic effects are reversible once exposure to the pesticide is eliminated, but because there are hundreds of pesticides, it can be difficult and even impossible to know exactly which one may be impacting your fertility. Still, there are some measures you can take to reduce exposure:

  • Thoroughly wash produce before eating, as many pesticides and fungicides used on agricultural crops contain gonadotoxins.
  • Limit exposure to wood preservatives and industrial chemical applications, if possible.

If you think pesticides might be the reason for your infertility, you should talk to your doctor about possible treatments.

References

  1. Roeleveld, N., & Bretveld, R. (2008, June). The impact of pesticides on male fertility. Curr Opin Obstet Gynecol, 20(3), 229–33. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18460936
  2. Bretveld, R., Brouwers, M., Ebisch, I., & Roeleveld, N. (2007, February). Influence of pesticides on male fertility. Scand J Work Environ Health, 33(1), 13–28. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17353961
  3. Tal, T. (2011, May 17). Widely used but just tested pesticides may contribute to infertility. Environmental Health News. Retrieved from http://www.environmentalhealthnews.org/ehs/newscience/test-show-current-pesticides-block-androgen-receptor-actions/
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Threats to Male Fertility: Recreational Drugs

In a previous postDrugFreeZone, we talked about what gonadotoxins are and how chemicals found in everyday plastics can impact male fertility. But plastic chemicals aren’t the only toxins out there affecting sperm production. Drugs, such as nicotine, alcohol, marijuana, and steroids are common substances that can negatively impact fertility.

Recreational Drug Use

When you consider fertility, sperm count is not the only number that matters. Sperm quality, such as the size and shape of the sperm and the quality of the DNA they carry, are also factors that have been linked to male infertility. These recreational drugs may affect your fertility, especially if you are struggling with infertility. Here’s a list of common drugs and their known effects on fertility:

  • Tobacco smoke: Lowers sperm count among men who smoke and possibly men who breathe secondhand smoke.
  • Alcohol: Lowers testosterone levels, causes erectile dysfunction, and decreases sperm production. Liver disease caused by excessive drinking may lead to fertility problems as well.
  • Cocaine and marijuana: May temporarily reduce the number and quality of sperm.Long-term use of marijuana may result in low sperm count and abnormally-developed sperm.
  • Steroids: Anabolic steroids taken to stimulate muscle strength can cause the testicles to shrink and sperm production to significantly decrease.

Treatment

If you think recreational drug use might be the reason for your infertility, you should talk to your doctor about possible treatments. In many cases, gonadotoxic effects are reversible once exposure to the toxin is eliminated (in this case, once recreational drugs use has ceased). Your doctor may, however, recommend additional treatments, to help improve these and additional adverse effects of recreational drugs such as erectile dysfunction, or decreased testosterone, among others.

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Threats to Male Fertility: Plastics

Environmental contaminationA gonadotoxin is a chemical or substance that affects sperm production by the testis….one of several threats to male fertility. You may have heard this term in relation to cancer treatment or prescription medications, but the doctor’s office is not the only place to run across gonadotoxic agents. There are things you interact with every day that may bring you into contact with chemicals that have a negative impact on your fertility.

Two studies published this year indicate that phthalates, a common ingredient in many plastics, contribute to male infertility.1 In the first study, published in Fertility and Sterility, male exposure to the chemical was associated with an approximately 20% reduction in fertility.2 The second study, published in Environmental Science and Pollution Research, indicates why there might be such a reduction: Exposure to phthalates correlates with a significant decrease in sperm motility and sperm concentration. Additionally, phthalates seem to contribute to DNA damage and may influence the reproductive hormone testosterone.3

What and Where are Phthalates?

Phthalates (pronounced THA-lates) are a group of chemicals often called plasticizers because they are used to make plastics more flexible and difficult to break; polyvinyl chloride (PVC) plastics are a common source. They are also used as dissolving agents for other materials. This is just a short list of the kinds of products that often use phthalates:4

  • plastic packaging
  • garden hoses
  • inflatable toys
  • medical tubing
  • vinyl flooring
  • adhesives
  • detergents
  • lubricating oils
  • automotive plastics
  • plastic clothes, such as raincoats
  • personal-care products, such as soaps, shampoos, hairsprays, and perfumes2

Because phthalates aren’t chemically connected with plastics, they can leach out of the products that contain them, and direct contact with these products exposes a person to the leached chemical.5

What Can I Do to Avoid Phthalates?

Although the authors of the second study point out that their small sample size limits the findings of their report, the fact that these two studies were conducted and published separately indicates that there may be some cause for concern. Below are some suggestions for reducing your exposure to phthalates:5

  • Use alternatives to PVC plastics whenever possible.
  • Use glass containers for storing food whenever possible, or choose plastic containers that aren’t manufactured with phthalates. Plastic products with recycling codes 3 and 7 may contain phthalates or BPA. Look for plastic with recycling codes 1, 2, or 5. Refer to the American Chemistry Council for a description of recycling codes and plastics used in packaging.
  • When in doubt about the type of plastic you are using, ask the manufacturer whether their product contain phthalates.
  • Check the ingredients of any personal-care products you use, such as soaps, shampoos, hairsprays, and perfumes; these products should be labeled with their ingredients. For example, dibutyl phthalate and diethyl phthalate are two phthalates you might commonly see in an ingredient list.

References

  1. Jones, B. (2014, May 18). Male infertility may partially result from chemicals in plastic. Liberty Voice. Retrieved from http://guardianlv.com/2014/05/male-infertility-may-partially-result-from-chemicals-in-plastic/
  2. Louis, G., Sundaram, R., Sweeney, A., Schisterman, E., Maisog, J., & Kannan, K. (2014, February 17). Urinary bisphenol A, phthalates, and couple fecundity: The Longitudinal Investigation of Fertility and the Environment (LIFE) Study. Fertility and Sterility, 101(5), 1359–1366. Retrieved from http://www.fertstert.org/article/S0015-0282%2814%2900067-3/abstract
  3. Pant, N., Kumar, G., Upadhyay, A., Patel, D., Gupta, Y., & Chaturvedi, P. (2014). Reproductive toxicity of lead, cadmium, and phthalate exposure in men. Environmental Science and Pollution Research. Retrieved from http://link.springer.com/article/10.1007/s11356-014-2986-5#
  4. CDC. (2013, July 16). Factsheet: Phthalates. Retrieved from http://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html
  5. Canadian Cancer Society (n.d.). Phthalates. Retrieved from http://www.cancer.ca/en/prevention-and-screening/be-aware/harmful-substances-and-environmental-risks/phthalates/?region=on
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Andropause: Should I be worried?

Young, sad man deep in thought, troubled by bad newsAfter age 30, men begin to produce decreased levels of androgen, or the hormones that control the development and maintenance of male sex organs and secondary sex characteristics, such as facial hair, increased muscle mass, and low percentage of body fat. This aging is often compared to menopause in women and is commonly referred to as “andropause.” Some scientists, however, more appropriately use the term “androgen decline in the aging male,” or ADAM.1

Unlike menopause, ADAM is a slowly progressive condition, and it is somewhat difficult to diagnose because there is disagreement about what the normal level of testosterone is for any given patient. Additionally, many symptoms may indicate the presence of other disorders or diseases, such as diabetes or high blood pressure, or medications.2 Still, researchers have noticed links between low androgen levels and abnormal health.3

Testosterone’s Role

The most well-known androgen is testosterone, and when it is on the decline, there are several adverse health effects.2

Physiological changes include:

  • diminished libido, sexual activity, and erections
  • decreased lean body mass and increased fat
  • reduced muscle strength
  • reduced energy
  • osteoporosis
  • lower quality of sleep

Psychological and cognitive changes include:

  • mood changes and depression
  • reduced cognitive function
  • reduced sense of well-being

Testosterone Therapy

Although there have been no long-term studies conducted to determine prolonged safety, several clinical studies have shown supplemental testosterone, or testosterone replacement therapy, to be beneficial and safe, alleviating symptoms and sometimes even reversing them.2 However, testosterone supplementation is not without its own concerns4.

If you are experiencing any of these physiological, psychological, or cognitive symptoms, you may want to talk to your doctor about testosterone therapy. If a blood test confirms a low testosterone level, you can choose one of a number of testosterone treatments, depending on individual benefits, side effects, and cost. Treatments include oral tablets, injections, subcutaneous implants, skin patches, or topical gels.5

One thing to keep in mind, however, is that testosterone therapy is not advised for men who have or have had prostate cancer or breast cancer. Associations between testosterone therapy and prostate health are being studied, so it is important to talk with your doctor about the potential benefits and risks of treatment.6

References

  1. Morales, A., Heaton, J., & Carson, C. (2000). Andropause: A misnomer for a true clinical entity. The Journal of Urology163(3), 705–712. Retrieved from http://www.jurology.com/article/S0022-5347(05)67788-9/abstract
  2. Brawer, M. (2004). Testosterone replacement in men with andropause: An overview. Reviews in Urology, 6(Suppl. 6), S9–S15. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472881/
  3. Testosterone and the aging male – Balancing risks and benefits http://bit.ly/1p0X1B7
  4. WebMD (n.d.). Low testosterone and your health. Retrieved from http://www.webmd.com/men/what-low-testosterone-can-mean-your-health
  5. WebMD (n.d.). Erectile dysfunction: Testosterone replacement therapy. Retrieved from http://www.webmd.com/erectile-dysfunction/guide/testosterone-replacement-therapy
  6. WebMD (n.d.). Low testosterone: How do you know when levels are too low? Retrieved from http://www.webmd.com/men/features/low-testosterone-explained-how-do-you-know-when-levels-are-too-low
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