10 MISTAKES TO AVOID. Dr Kevin J Meuret

Transcription

1 REPORT: 10 MISTAKES TO AVOID WHEN ON LOW TESTOSTERONE TREATMENT PROGRAMS Dr Kevin J Meuret 1

2 10 MISTAKES TO AVOID WHEN ON LOW TESTOSTERONE TREATMENT PROGRAMS 2

3 OVERVIEW A diagnosis of low testosterone, or low T, can be the answer to a number of problems low energy, decreased sex drive, or feeling depressed. Men today will work longer, live longer, and have more stress than their fathers. You hear that 40 is the new 30 and 50 is the new 45 and there is some truth to that. The prime time of our lives seems to be extending further than in previous generations. Scientific advancements cannot only help us live longer, but we now have the ability to improve the quality of those added years. Although we are living longer, our testosterone is lower. In fact, studies show it is 20% lower just in the last two decades. There are several reasons for this decline: less physical lifestyle, increased stress, and the amount of estrogens our bodies are exposed to (this is a topic for another time.) Healthy testosterone levels extend lives; however, men need to feel great now since their 40s and 50s are when they need energy and stamina to run their lives. Our clients range from CEOs and business leaders to carpenters and public servants, as well as men married 25+ years to those who find themselves fathers again. Regardless of the situation, every man deserves to feel his best. 3

4 How to Treat & Manage Low Testosterone: First Steps What is causing testosterone levels to be low? In some cases, there are underlying conditions we can treat to restore normal testosterone levels. The most common conditions are: Obesity Type 2 diabetes Sleep apnea By treating the underlying condition, some cases will have their normal testosterone levels restored. When selecting a testosterone treatment team, make sure the physician is looking for any and all reasons your testosterone levels are not optimal. Treatment Options for Low Testosterone Compliance: It s Not How We Start but How We Finish That Matters The most effective form of treatment for low testosterone is testosterone replacement therapy (TRT). Testosterone replacement therapy is the addition of testosterone to restore your body s normal levels. Think of treating low testosterone the same as treating diabetes or high blood pressure. The body requires the appropriate medication, taken at the appropriate time, to allow for physiological homeostasis to return or your body will return to normal function with normal testosterone levels. Restoring testosterone levels are done most commonly through three methods: Pellets (small compounded medications inserted under the skin) Creams (testosterone cream applied daily at home) Injections (testosterone injected directly, which is immediately available for assimilation) Finding a testosterone replacement therapy method that fits into your lifestyle is very important. Consistent dosing and regimen are key to ensuring the maximum treatment benefits. Patient compliance as well as following the prescription and recommendations as prescribed are especially important early on in testosterone treatment. Minor adjustments to medication levels or application schedules will be necessary to determine the exact dose needed. Worth the Wait Restored testosterone levels will be achieved once the optimum levels of testosterone, application method, and dosing schedule is established. Men with normal testosterone levels should experience: Normal weight distribution Healthier muscle mass Less belly fat Upbeat mood and motivation Increased libido Increased lean muscle mass Improved sleep Improved energy levels 4

5 TOP 10 MISTAKES MADE BY MEN ON TESTOSTERONE THERAPY As previously discussed, the results of optimal testosterone can be life changing for men with low or sub-optimal testosterone levels. Many men do not see the results of testosterone replacement therapy and bail out before improvements occur. That s a shame. For men who need it, this is the only treatment that will help. But why are some men quitting? We believe it is misinformation and we intend to fix that here. In the thousands of men we have discussed this with, here are the top 10 mistakes that cause them to bail: 1. Acquiring Street-Sourced Testosterone Many men have been dismissed by their doctor when asked about testosterone treatment. This frustrates some men to the point that they have decided to take matters into their own hands by getting black market testosterone. Sometimes it is from a guy at the gym or God knows where. First of all, it is illegal. It is a controlled substance regulated by the Drug Enforcement Administration (DEA). If you have testosterone from a black market source, you can be arrested for possession of a controlled substance. If you have enough (if you were stocking up), then you could be charged with intent to distribute. Just not worth it. A medical physician can legally prescribe testosterone, but it is illegal to possess or use without a prescription in your name. Be aware that buying or using testosterone without a proper prescription may have legal consequences. The use of testosterone is illegal in the United States for those without a medical diagnosis that justifies its use. If you still decide to get testosterone on the black market, you could be set up by informants who may alert the DEA of your purchase. Importing testosterone even if you have a prescription is not legal. In a nutshell: only use testosterone after a physician gives you a prescription, and do not import it from other countries. If the legal ramifications are not a deterrent, then safety must be a consideration. Safety guidelines set up by the Food and Drug Administration (FDA) ensure not only are you getting the correctly prescribed dosage of testosterone, but that it is also safe to use. If you do not purchase it through your physician and a reputable pharmacy, you have no guarantees what you get. You are on your own. 2. Lack of Physician Involvement Close monitoring is required first for safety and second to maximize the benefits of your treatment. Starting, continuing, and stopping testosterone therapy require a physician s expertise. We recommend to our physicians a full physical examination, as well as the following blood tests: Total testosterone Free testosterone SHBG DHT Estradiol (E2) LH-Luteneizing hormone FSH-Folicle stimulating hormone Prolactin Cortisol Thyroid panel CBC-complete blood count Comprehensive metabolic panel Lipid profile/panel Vitamin D (not sure where you want this placed also, do not do in italics since none of the other lists are) 5

6 When undergoing testosterone therapy, modifications will need to be tweaked to maintain your normal testosterone production, as well as manage other blood factors. This is done through regular monitoring with the appropriately trained physician. We work with many of our clients primary care physicians to coordinate care. Even though some primary care doctors do not manage testosterone in their office, they are happy to work with qualified physicians to manage that portion of the care. This allows them to focus on the individual patient s overall health picture while the testosterone specialist focuses on hormone optimization. 3. Exploration of the Best Testosterone Options Q. What is the best option for testosterone treatment? A. The kind you can make your lifestyle. Patients who can be consistent with their testosterone dosing have the best results. Those who can also make it part of their lifestyle are able to enjoy years of vitality with optimized testosterone levels. Here are factors we consider when choosing a client s course of treatment: Health history Cost Insurance coverage Convenience Schedule preference for daily vs. weekly dosing Strict daily schedule adherence Fear of needle Physician comfort in managing pros and cons of each treatment option Treatment effectiveness is also a factor to consider. For instance, dosing is most accurate for testosterone treatment through injection. The precise dose of testosterone can be drawn and injected one time per week in the arm or leg just like a flu shot. This treatment, which has been found to be most accurate, is often covered by insurance if provided in a doctor s office. Make sure your physician can cover the different types of treatment options for you, as well as discuss the pros and cons of each type of treatment. Your doctor needs to be comfortable managing the treatment option that is most effective and can be a long-term part of your lifestyle. 4. The Wrong Dose Men tend to stop testosterone early because they perceive no immediate benefits. Once the appropriate dosing schedule has enough time for your body to assimilate to the new testosterone levels, you will feel an improvement in your symptoms. To achieve these results, men must have the appropriate dose levels as soon as possible and maintain them for a period of time to notice the changes. If a dose is either too small or too infrequent, then your testosterone levels never reach the optimal level to get the correct response. Many clients transfer into our program after being on testosterone treatment without getting results. The main reason behind the lack of results is not having the appropriate monitoring and accurate dosing schedule. Blood tests early in treatment are necessary to make sure that the total testosterone, free testosterone, and estradiol levels are all balanced from the start and even before you would feel the effects. Within four to five weeks, you should have blood drawn prior to administering the corresponding dose for that day or week. This will measure the amount of testosterone available before you supplement it. If dosing schedule or amount needs to change, it can be discovered at that critical junction and early on in care. 5. Cycling on and off Testosterone Testosterone replacement should be consistent month to month and year to year. Optimizing testosterone is a commitment, and long-term success requires consistency. Once you start, you need to stay on it unless you have an unmanageable side effect. Patients who do not understand the side effects of starting and stopping care believe they are helping give their body a breather like when you are running a marathon and a break would be beneficial to the body. The opposite is true. 6

7 It is incredibly stressful for the body to drop from optimal testosterone levels down to sub-physiological levels. In cases where the physician was not helping support natural testosterone production during testosterone replacement therapy, the new testosterone levels would come crashing down lower than they were before starting treatment. The physiological strain and hormonal axis taxing can cause months of titration to get the effects of this crash back to baseline. This drastic change in testosterone levels would bring on depression, declined energy, weight loss, lack of motivation, and loss of sex drive. Starting and stopping testosterone therapy needs close supervision by a physician trained in these techniques. Before you go on and certainly before you go off testosterone therapy, engage a physician and treatment team who can make this transition less stressful to your body and allow for support of your natural testosterone production. 6. Abruptly Stopping Testosterone Due to an Unrelated Signal If you are prescribed another medication for an unrelated health condition, you can have changes that some physicians blame on testosterone. Medications can affect testosterone or cholesterol levels, so here are medications you want to make sure the physician managing your testosterone is aware of: Cialis (tadalafil) I changed the type to match the rest of the copy and undid bold Crestor (rosuvastatin) Cymbalta (duloxetine) was listed twice before Fish oil (omega-3 polyunsaturated fatty acids) Lipitor (atorvastatin) Lyrica (pregabalin) Synthroid (levothyroxine) Vitamin B12 (cyanocobalamin) Vitamin D3 (cholecalciferol) The doctor managing your testosterone must be made fully aware of other medications you are taking and changes in those medications. We recommend coordinating your testosterone treatment with your primary physician. This will allow everyone involved to be aware of any changes and make sure the appropriate measures are taken. Testosterone optimization plays a vital role in an overall health plan. Optimization of testosterone will improve lean muscle mass, improve BMI (body mass index), and lower risk factors for heart disease including waist circumference. Properly adjusting your treatment, especially when other medications are added, lets you experience maximum benefits while managing your other conditions. 7. Potential Side Effect Management Let s be clear: the side effects of testosterone therapy are minimal when properly managed. The horror stories of men who experience swelling in their nipple area, acne, moodiness, perceived lack of benefit, hair loss, or an increased prostatic specific antigen (PSA) are out there. Similar reactions can be true in cases where the client is overdosing on testosterone and pushing testosterone to the supra-physiological limits. Appropriate dosing levels of testosterone to optimal levels will be within the normal range (they may be at the top end, but they will still be within that range.) If pushed to double the normal testosterone range, then you will have significant and at times severe symptoms. This is never the case when your care is properly monitored through regular blood work and interpreted by a qualified physician. If a client experiences a mild side effect, they are easily managed by a trained physician without interrupting testosterone treatment. Some of the effects can be treated with simple over-the-counter remedies and other prescriptions that can be shipped with testosterone directly to your house. As a resource, our clients can quickly get questions answered 24/7 for these solutions and to help them stay on track. 7

8 8. Unfriendly Testosterone Lifestyle What does a testosterone-friendly lifestyle look like? Surprisingly simple, but not always easy. People who experience the most success in testosterone therapy make some common choices: Don t smoke (cigarettes or pot) Don t drink excessively Aren t overweight (especially belly fat) Don t avoid exercise Don t have uncontrolled blood sugar and lipids Don t shorten their sleep schedule (solid eight hours of sack time sleep, not recreation) Get regular blood work Go to their doctor Everyone on the planet knows these are important to vital health. However, when testosterone is optimized, the upside impact is greater. Workout recovery is faster, results come quicker and stay longer, sleep is solid, mental acuity dialed in the effects of a healthy lifestyle are easier to notice and enjoy when testosterone is optimized. Our clients who struggled with maintaining the dos and avoiding the don ts became happier once they felt the effects of their body not working against them. When testosterone is sub-optimal no matter how hard you work out you won t make progress. No matter how much you restrict your food your belly grows. No matter how much you sleep you are still on edge. Suddenly when clients experience results, the self discipline to stick to a regimen is no longer a challenge. 9. The Wrong Medical Support Finding the right physician and team (nurses, support staff, and pharmacy) is key. Here are a few questions to ask your doctor when deciding whether or not to become a patient: Who does not qualify for testosterone therapy? Do you only have one type of recommended therapy (creams only, pellets only, etc.)? How often do you need to have blood drawn, and what are the labs they look at? What are the common side effects seen and how do you manage them? Will you be treated in a way that will preserve your natural testosterone production while on testosterone replacement? What is the best way to reach him/her, and is there a nurse to talk to if you are not available? Will you write a prescription for me and help manage my care so I can self administer at home? If the dosing or method of treatment? Not sure what this is supposed to mean. If I choose to discontinue therapy, what are your steps to help me transition off while preserving my natural testosterone? As far as cost, can I use my insurance? Do you have payment arrangements and hardship programs? Do you manage E.D. if testosterone alone does not improve my function to my satisfaction? Will you provide weight management medication if I am unable to lose the belly fat fast enough to make progress? Will you coordinate this care with my primary care physician? 8

9 There are answers to these questions that are grounded in solid medical literature. When picking a doctor to manage your care, look at the entire team to ensure you will have the necessary support through all aspects of your care. Our experience has shown that a treatment team should consist of: layers of qualified people from receptionists to nurses/doctors experts who are easily accessible and knowledgeable a team that is willing to safely monitor a range of treatments that fit your lifestyle Changing doctors can be even more difficult, especially if you don t know which one to call. We provide a 24 hour a day live chat to assist in locating physicians who are qualified to have this conversation. 10. Poor Compliance We are what we repeatedly do. Excellence then, is not an act, but a habit. Aristotle We discussed the importance of picking a method of testosterone therapy that will allow you to fit it into your lifestyle. The main reason is for consistency. The damage that built up over time from the testosterone either dropping or sub-par needs to be repaired. This repair requires you to first get your testosterone optimized, and second to keep it optimized over time to allow your body to repair the damage that accumulated. If we had to pick either our clients perfect method of testosterone replacement therapy or perfect compliance, we would pick perfect compliance every time. The effects we see in the body with consistent, healthy levels of testosterone provide a road map not only of how far they have come, but also what the trajectory will continue to be over the next few months of care. Make sure you keep an open dialogue with your testosterone treatment team as you experience changes in your life. With several treatment options available in our arsenal, we are able to help clients adapt to change in availability with work schedule to change in location to another state. Providing the flexibility to change with client s needs is vital to ensure that your guys have optimal testosterone regardless of change. Optimal testosterone gives you the best chance for optimal engagement in life which every man deserves. 9