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Weight Impacts Male Fertility, Too

AppleWaistThere are many factors that contribute to male fertility. Age, medical conditions, smoking, hormones, genetics—all of these considerations impact man’s ability to father a child. But recent studies have determined yet another factor: weight. It has been widely supposed that a woman’s weight impacts her fertility, but this issue crosses the gender line. A Man’s weight impacts his fertility, too. And it’s not just about losing those extra pounds. Even being underweight can reduce fertility.

Impacts of Being Overweight

A study done at Harvard1 looked at data from an infertility center, as well as the results from 14 studies on the subject of weight and sperm count. Researchers found that overweight and obese men are more likely to have lower sperm counts, or even to produce no sperm at all. This fact by itself might not be too surprising, but the numbers may come as a shock. Check out these figures unearthed by the study.

Overweight men are:

  • 11% more likely to have a low sperm count
  • 39% more likely to have no sperm in their ejaculate

Obese men are:

  • 42% more likely to have a low sperm count
  • 81% more likely to produce no sperm

Impacts of Being Underweight

Being underweight also has a significant impact on male fertility. Being too lean drives down sperm count and motility2. This is because sperm production is most effective when your body has the appropriate nutrients and protein that are a part of a healthy lifestyle and weight. Without these essential components, the body produces less sperm (and less mobile sperm).

Impacts of Over-Exercising

While you are seeking your ideal weight (weather you are shedding some pounds or building muscle), keep in mind that exercising too much can have its own risks. As you exercise, you raise your body temperature. This includes the temperature of your testicles. Raising your testicular temperature kills your sperm3, and raising the temperature too much and too often will lower your sperm count.

Finding an ideal weight is important to overall health of the body, and it is also an important factor in male fertility. If you are experiencing infertility and are over- or underweight, talk with a physician or nutritionist to find a healthful way to reach an ideal weight. This might just be the issue that is keeping you from optimal fertility.

References

1. Harvard School of Public Health News (2012). Excess weight may affect sperm production, reduce fertility in men. Retrieved from http://www.hsph.harvard.edu/news/hsph-in-the-news/excess-weight-sperm-fertility/

2. Levine, D. (1999). Boxers or briefs: Myths and facts about men’s infertility. Retrieved from http://www.webmd.com/infertility-and-reproduction/features/male-infertility-facts

3. UK Health Centre. Fertility and weight. Retrieved from http://www.healthcentre.org.uk/fertility-treatment/fertility-and-weight.html

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Testosterone and the aging male – Balancing risks and benefits

balance strong manLast 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.”

My vet is not alone in his opinion that 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.  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 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 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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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

A Man’s #1 Reason to Stop Smoking

ManSmokingAccording to the CDC1, Smoking causes more deaths each year than all of the following things combined:

  • Human immunodeficiency virus (HIV)
  • Illegal drug use
  • Alcohol use
  • Motor vehicle injuries
  • Firearm-related incidents

Smoking is a hard habit to break. But if the health hazards haven’t persuaded you to go cold turkey, this one fact just might: Smoking can hit you below the belt.

Erectile Dysfunction

When it comes to the bedroom, lightning up might not be so hot. Numerous studies2 have linked smoking to erectile dysfunction. Smoking restricts blood flow in your veins and arteries, and proper blood flow is essential for erectile function. If you smoke, you are at greater risk of developing this condition.

Reproductive Issues

If you are considering having a family, smoking might keep you from that goal. One study3 compared semen from smokers to semen of non-smokers and found that smokers suffered from the following complications:

  • low testosterone
  • low sperm motility
  • impaired sperm fertilizing capacity

Testicular Cancer

According to one study done in Canada4, smoking was shown to increase the risk of testicular cancer. The researchers stated that “smoking to any degree was suggestive of an increased risk.” They additionally noted that there was “no association with age of initiation and no reduction of risk with smoking cessation.” So what does that mean for you? If you have ever smoked, at any age, for any length of time, you have increased your risk of testicular cancer. Even if you have stopped smoking, you have permanently elevated your risk. And the longer you smoke (the higher your pack-year ratio), the more you increase your risk.

So the next time you consider taking a smoking break, think instead of taking a break from smoking. If you won’t do it for your lungs, do it for the family jewels.

References

1. Centers for Disease Control and Prevention (2014). Health effects of cigarette smoking. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

2. Gades, N. M., Nehra, A., Jacobson, D. J., McGree, M. E., Girman, C. J., Rhodes, T. . . . & Jacobsen, S. J. (2005). Association between Smoking and Erectile Dysfunction: A Population-based Study. Americal Journal of Epidemiology, 161(4), 346–351. doi: 10.1093/aje/kwi052

3. Sofikitis, N., Miyagawa, I., Dimitriadis, D., Zavos, P., Sikka, S., & Hellstrom, W. (1995). Effects of smoking on testicular function, semen quality and sperm fertilizing capacity. Journal of Urology, 154(3), 1030–4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7637048

4. Srivastava, A & Kreiger, N. (2004). Cigarette smoking and testicular cancer. Cancer Epidemiology, Biomarkers, and Prevention, 13; 49–54. doi: 10.1158/1055-9965.EPI-03-0133

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You Are What You Eat … And Your Children May Be Too

AbdObeseMaleLeaf through any magazine dedicated to health and wellness, whether its intended audience is the general consumer or a medical professional, and you will invariably come across an article whose focus is some obesity related health condition.  The CDC considers obesity an epidemic responsible for a host of chronic diseases affecting every major organ system of the body, and the male reproductive system is not immune. Over the last couple of years, researchers have linked obesity to several factors causing male infertility.

Obesity is an endocrine disrupter resulting in lower levels of reproductive hormones that are critical to spermatogenesis, the development of sperm cells. Spermatogenesis requires sufficient testosterone and properly functioning Sertoli cells, which provide physical and nutritional support to developing sperm cells. Luteinizing hormone (LH) stimulates testosterone production, which in turn stimulates sperm cell maturation under the “care and protection” of Sertoli cells. Follicle stimulating hormone (FSH) and Inhibin B regulate the function of Sertoli cells. Sub-optimal levels of any of these four hormones will lead to fewer mature sperm cells and a lower sperm count, and researchers have linked obesity to lower levels of all four. They are exploring the possibility that elevated insulin levels, a hallmark of metabolic syndrome, is a factor in the dysregulation of these reproductive hormones. (Metabolic syndrome is a group of risk factors, brought on by obesity, that increase an individual’s risk for cardiovascular disease and type-2 diabetes. These risk factors are high blood pressure, abnormal cholesterol levels, high blood sugar, elevated insulin levels, and excessive abdominal fat.)

Obesity has been linked to a higher level of sperm oxidative stress.  Oxidative stress is the damage caused by free radicals reacting with molecules in an organism. This happens when physical and environmental changes occur that prevent antioxidants from reacting with, and thus eliminating, these free radicals. Oxidative stress damages the molecular composition of sperm. It compromises DNA integrity and decreases the acrosome reaction. The acrosome reaction occurs in the head of sperm and involves the release of enzymes that enable sperm to penetrate an egg. Oxidative stress is also implicated in decreased motility and disrupted cell signaling (communication).  All these factors impair the ability of sperm to fertilize an egg.

The development and maturation of sperm is highly sensitive to heat. The presence of excessive fat around the testes elevates the temperature in the testes to damaging levels, reducing the amount of mature sperm produced. Higher gonadal temperatures also contribute to sperm oxidative stress.

Some of the most recent and quite possibly most disturbing research findings involve obesity and epigenetic inheritance. Epigenetic inheritance involves changes in gene expression, as opposed to physical changes to the genes themselves. Scientists are studying the link between obesity in fathers and reproductive and metabolic disturbances in their children.  Studies are being conducted on rats and mice that show a strong correlation between paternal obesity at the time of conception, and fertility and metabolism disorders in offspring. Altered methylation of sperm DNA and damage to sperm RNA from oxidative stress are being explored as possible culprits.

If you are an overweight male who is having trouble achieving a pregnancy with your partner, all is not lost.  Each of the outcomes described above can be improved with weight loss, proper nutrition, and exercise. Considering the devastating impact obesity has on all major organ systems, weight loss will not only be an investment in your future fertility, but also an investment in your future health and well-being.

 References:

Palmer NO, Hassan WB, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis. 2012; 2(4): 253-263.

McPherson NO, Fullston T, Hassan WB, Setchell BP, Lane M. Obese father’s metabolic state, adiposity, and reproductive capacity indicate son’s reproductive health. Fertil Steril. 2014; 101(3): 865-873.

Hammoud AO, Wilde N, et al. Male obesity and alteration in sperm parameters. Fertil Steril. 2008; 90(6): 2222-2225.

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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

Putting Off Having a Family? What Men Should Know

DadFamily planning includes not just determining how many kids to have, but also when to have them. You may decide to delay starting your family because you want to go back to school. Maybe you want to be more established in your career before you have kids. You might want to be a homeowner before you bring home a baby. Or maybe you just want to be debt-free before piling on hospital bills associated with pregnancy and birth. Whatever the case may be, before you decide to say “Not right now,” there are a few things you should consider.

Male Fertility Declines with Age

You probably know that your wife’s fertility declines as she grows older and eventually goes through menopause. But she’s not the only one with a biological clock. One study found that a man’s ability to reproduce declines sharply after the age of 41. According to researchers, fertility declines at a rate of 7% for each year after 41, with an even steeper rate of decline after the age of 45. In fact, in this short period, the rate of successful pregnancy drops from 60% (age 41) to just 35% (age 45)1. So if you wait until you are 45 to start your family, you may not like your chances.

Age Increases the Chance of Birth Defects

Not only is the chance of pregnancy reduced by age, but a father’s age can also introduce other complications. Studies have shown that older men are at higher risk to father children with birth defects and genetic abnormalities. One study found that, when both parents of a child with Down syndrome were over 35, the father’s age “played a significant role” in the child’s genetic abnormality. When the mother was over 40, the incidence of Down syndrome related to sperm was about 50%2.

Ditto schizophrenia. In one study, researchers concluded that “men between the ages of 45 to 49 were twice as likely to have children with schizophrenia as were men 25 and younger.” But for men over 50, the risk was three times as high2.

You Can Grow Old While Your Sperm Stays Young

Both of these concerns are related to the age of a man’s sperm, but not necessarily the man himself. You can keep your sperm young while you continue to mature toward your pre-family goals. Sperm banking allows you to cryopreserve your semen for later use. If you want a family, but not right now, you might consider banking your sperm. That way you can plan your family on your timetable while avoiding the complications that accompany the ticking of your biological clock.

References

1. Macrae, F. (2011, October 20). The male biological clock: After 41 your chances of becoming a father ‘declines rapidly’. Mail Online. Retrieved from http://www.dailymail.co.uk/health/article-2051041/MALE-biological-clock-After-41-chance-father-declines-rapidly.html

2. Heubeck, E. Reviewed by Brunilda Nazario, MD. Age raises infertility risk in men, too. Retrieved from http://www.webmd.com/infertility-and-reproduction/features/age-raises-infertility-risk-in-men-too

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CatSper the Friendly Ion Channel and Male Infertility

In sperm tail, CatSper is activated through alkalinization and perhaps other activators. Intracellular alkalinization can be potentially achieved through a Na+/H+ exchanger (NHE) that might be sensitive to cAMP [downstream of a soluble cyclic adenylyl cyclase (sACY)] and voltage. Activation of receptors (e.g., ZP receptors in sperm head) generates messengers that eventually lead to CatSper channel activation in the tail. Ca2+ ions entering the sperm tail through CatSper act not only locally on motor proteins to affect sperm motility but also globally to lead to [Ca2+]i increases in sperm midpiece and head. There are likely unidentified Ca2+-permeable channels responsible for the CatSper-independent, sustained [Ca2+]i increases important for the acrosome reaction. Many of the proposed signaling pathways have not been directly tested and are indicated by question marks.

“I’ve got swimmers!” One of our patients actually listed this as the reason he was ready to discard the sperm he had banked with us prior to starting cancer treatment. I laughed aloud when I read it. What a humorous way of telling us that he recently had a semen analysis that demonstrated good motility and forward progression.

Being a swimmer (good motility) is critical to sperm’s ability to fertilize an egg. Sperm start to move once they’ve been ejaculated from the male urethra. However just because they’re moving doesn’t mean they’re able to fertilize an egg. First sperm must undergo a maturation process called capacitation. Capacitation involves the movement of calcium ions into the sperm cell. The calcium ions move into the sperm cell through specialized ion channels named CatSper. Once inside the cell, the calcium ions trigger a series of events that will hyperactivate sperm motility. In the female reproductive tract, hyperactivated motility occurs right by the egg, at the site of fertilization, and enables the sperm to penetrate the egg and achieve fertilization.

Sperm that are unable to undergo capacitation cannot penetrate an egg and thus fertilize it.  Researchers have discovered two gene mutations that cause sperm to be produced without CatSper channels. These genes are CatSper1 and CatSper2. Men with either of these mutations are infertile.

Clinically diagnosing CatSper-related male infertility can be tricky.  Changes in motility caused by the absence of CatSper channels are frequently missed in standard semen analyses.  “A more rigorous clinical examination that includes measurement of sperm motility parameters like path velocity, progressive velocity, and track speed”1 is required to help determine if sperm cells are hyperactivated. Computer-aided sperm analysis (CASA) systems have been developed that are capable of performing this type of assessment of motility. Genetic testing is also available to confirm a diagnosis of CatSper-related male infertility.

If lack of CatSper channels is the cause of a couple’s fertility woes, there is no treatment option available that will enable them to achieve a pregnancy naturally. However, pregnancy can be achieved with intracytoplasmic sperm injection (ICSI) using sperm from ejaculate, testis tissue, or epididymal tissue.

References

Hildebrand MS, Avenarius MR, Fellous M, et al. Genetic male infertility and mutation of CatSper ion channels. European Journal of Human Genetics. 2010; 18(11): 1178-1184.

Calcium Signaling Through CatSper Channels in Mammalian Fertilization, Dejian Ren and Jingsheng Xia, Physiology June 1, 2010 vol. 25 no. 3 165-175

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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

Fertility and the Male Cancer Patient: The Need to Sperm Bank to Preserve Fertility

Couple in hug watching sunrise togetherMany people facing cancer know about some of the side effects of common treatment options. Chemotherapy can cause you to lose your hair and change the way food tastes to you. It can make you nauseous and fatigued. These are symptoms that cancer patients expect to face during treatment. But one side effect you may not have thought about is infertility. For both men and women, treatments can affect the ability to conceive children1. If you are planning on starting or expanding your family, this may be a concern you should talk about with your doctor. A medical professional can help you understand your risk for infertility due to cancer and treatments.

Sperm production can be temporarily reduced by certain cancers and treatments2. Some treatments, however, permanently alter your ability to reproduce. Cancer cells are fast growing. Cancer treatments are designed to target and eliminate fast-growing cells in the body. This is intended to eradicate cancer cells, but other fast-growing cells, like hair and sperm, are destroyed in the process3. Both radiation and chemotherapy treatments can slow or stop sperm production, and the effects can be permanent3. Additionally, chemotherapy and radiation therapy may alter the DNA of sperm, and it is recommended that a cancer survivor wait 1 to 2 years before trying to conceive a child for this effect to dissipate4.

If you have been diagnosed with cancer and are worried that treatment may interfere with your plans to have a family, there are options you can pursue to preserve your fertility before you begin treatment. Cryopreserving sperm is a simple, inexpensive process that can save sperm for years, in case you need it for intrauterine insemination or in vitro fertilization. Sperm must be collected and banked before your cancer treatment begins4 to ensure the best possible sample of undamaged cells.  Cryopreserving your sperm helps ensure your ability to have your own biological children in the event that cancer treatment has impacted your fertility or you are interested in having a child during or soon after treatment.

References

1. American Society of Clinical Oncology. Side effects of chemotherapy. Retrieved from http://www.cancer.net/all-about-cancer/cancernet-feature-articles/treatments-tests-and-procedures/side-effects-chemotherapy

2. Livestrong Foundation. Male fertility preservation. Retrieved from http://www.livestrong.org/we-can-help/just-diagnosed/male-fertility-preservation/

3. Roswell Park Cancer Institute. Cancer and male infertility. Retrieved from https://www.roswellpark.org/patients/fertility-guide/male-infertility

4. New York Cryo. FAQs: 3. When does one bank sperm? Retrieved from https://nycryo.com/faqs/

For additional information on Sperm Banking please visit NYCryo.com

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6/24/2013 Testosterone Supplementation: the Good, the Bad…the Facts!

Man In ThoughtThere is an advertising frenzy in the US in marketing of testosterone supplements…a multi-billion dollar business. To observers outside the US it must seem that all American men have Low T and suffer from sexual dysfunction, low energy, brittle bones, depression and obesity. Well, the obese part has some truth….the Centers for Disease Control tell us that more than 35% of US adults are obese with medical costs related to obesity amounting to over 147 billion dollars….more on this in a bit. No doubt about it, low serum testosterone also referred to as Low T, Hypogonadism and Andropause, is a real entity affecting over 40% of men 40 years and older. In fact, as men age the incidence of low testosterone goes up. The real issue however is: who should be treated? Men with breast cancer (yes men, although rare, do get breast cancer too) and those men with diagnosed, but not yet treated, prostate cancer should definitely not take testosterone supplements. To this group, I would add those men interested in maintaining their fertility (or ability to conceive a child) since testosterone and androsterone (collectively called androgens) will significantly decrease, or completely stop, sperm production. In fact, 10 to 20% of these men might not re-start sperm production after stopping testosterone therapy. In addition, many of the men that had been placed on testosterone therapy will not return to their pre-therapy production of sperm! So who might benefit from testosterone therapy? Well-respected professional societies, such as the American Urological Association, American Society for Andrology, American Society for Reproductive Medicine and the Endocrine Society, offer guidelines on who should receive testosterone supplementation. In my practice, as a Urologist specializing in male reproduction and sexual medicine, I consider treatment in men with a low serum testosterone level and at least one symptom of low testosterone that significantly affects the patient’s quality of life. Also, men with a decreased bone density and a low serum testosterone may benefit from supplementation. For men interested in fertility, non-testosterone options exist that will raise their testosterone and preserve, and possibly increase, their sperm production. …and yes, overweight men often do have a low testosterone. However, the best way to treat them is by lifestyle changes, not supplementation. By that, I am indeed referring to diet and exercise, leading to an improvement in serum testosterone by 15% in one recent study!

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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

4.26.10 – The Healing Art: The personal journey by one physician who has the privilege of being a healer. A personal Blog about being a physician written by Dr. Gilbert. Read more….

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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

“With all the rights, privileges and responsibilities” . . . Hippocrates and the Practice of Medicine – Part 3

For many of us, using unproven techniques, unless as part of an approved research protocol, is not even a consideration. However, many good and caring physicians continue to be drawn in by the hype surrounding these techniques. These new techniques may, in fact, prove to be valuable and worthy of widespread implementation. However, we must insist—no, we must demand— that these nonstandard approaches are performed only under clinical research protocols until data on efficacy, safety, and cost-effectiveness can be provided to our patients. As a modern version of the Hippocratic Oath instructs, “I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

Often in the practice of Medicine, the lack of specific regulation require us to accept the responsibility to self-regulate. We must always respect the patient’s rights to be completely informed of the treatment they are to undergo. Specifically, they must be apprised of the reason for the treatment, the expected results, the duration of treatment, potential side effects, and the total cost of treatment. Our patients, our colleagues, and the regulatory authorities hold us, as physicians to a higher level. We need to define what is and what is not standard treatment . . . or it will be defined for us. Nonstandard treatment may, in fact, be better then standard treatment, but we need to validate efficacy in approved protocols that protect the patient and the patient’s rights. From this, we cannot waiver. It is our responsibility. It is our Oath.

As I listened to the recitation of the Hippocratic Oath and reveled in the euphoria I shared with these new graduates, I realized that by upholding its doctrine to “ . . . respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow” that we will continue to answer a higher calling, serve and protect the needs of others, and maintain the responsibility we have as healers.

Bruce R. Gilbert MD PhD

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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