Category Archives: Testosterone

EXETER Members of the LGBTQ+ community have specific health care concerns and often find it difficult to access a provider to meet their needs on the Seacoast.

Many patients, particularly teenagers and their parents, have needed to travel to large hospitals in urban areas like Boston to get the care they need.

This shortage of care became painfully obvious during the coronavirus pandemic, and a local medical group recently began to take on the challenge of serving this underserved community.

Dr. Robert Kelly, of Core Physicians, and several colleagues are addressing this with a more accessible practice at 21 Hampton Road.

Kelly said he took a look at area primary care practices and saw there was hesitation, or an unwillingness to become involved in treating the needs of LGBTQ patients. So he began to offer services and to bring in medical consultants as needed for his patients needs.

I began to move into gender-affirming care because we need this here, Kelly said.

He added he felt ready to take on the work that needed to happen, including work revolving around education.

I started doing consulting work, and the practice just evolved from there, he said.

How important is it for the medical community to offer care specific to this population?

New Hampshire hospitals and their providers play a critical role in advancing the health and equity of all patients, said Steve Ahnen, president of the New Hampshire Hospital Association. The New Hampshire Hospital Association is very proud of the safe and supportive environments that our providers have created in support of the health and well-being of all people and stands in absolute support of LGBTQ+ community and the clinicians providing their care.

People in the LGBTQ+ community say it is very important to find a provider who understands their needs.

I was lucky to find a primary care physician who is excellent with trans patients, but that was by word of mouth, and he does nothing to advertise himself as such, said Palana Belkin, a Rochester resident who is very active in her community. I got lucky. It is not uncommon for me to hear about folks traveling two or three hours from New Hampshire to access trans-competent health care in Boston. Clinics like Planned Parenthood, Equality Health Center, and Lovering Health all do a fantastic job providing hormone replacement therapy and sexual health services but LGBTQ folks also deserve compassionate primary care.

Gerri Cannon is a state representative from Somersworth and serves on the Somersworth School Board. She recently had gender confirmation surgery.

The best thing is having a medical practice that understands the needs of transgender people, she said. I have many specialists near me in Dover and they can care for me. But, Ive had to make sure they know my medical history and my future plans, like surgery.

Cannon said finding surgeons who can perform gender confirmation surgery procedures remains a challenge locally.

I had to travel to Boston, said Cannon. Ive had friends travel to Dartmouth Hitchcock. Working with transgender-knowledgeable surgeons and staff is incredibly uplifting. I constantly hear about transgender female to male people looking for top surgery or bottom surgery knowledgeable surgeons. Male to female people are looking for vaginoplasty surgical teams. We dont have any in our corner of New Hampshire yet.

Services offered in gender-affirming care

What is gender-affirming care?

As defined by the World Health Organization, Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individuals gender identity.

Dr. Kelly treats adults, not children, in his gender affirming practice. As a family physician, Kelly said he treats people from birth to death, and that includes all populations.

Kelly said, in the past, the focus on gender care was mainly in prevention.

HIV? Take a pill to help prevent it, he said. Anything more and patients are being referred to infectious disease doctors or other specialists, which carries a much higher price tag, higher co-pays. Thats simply because there is not a lot of care available.

Kelly said a percentage of gay men simply want peace of mind and to know they can have safe sex.

One treatment for gay men is PrEP (Pre-Exposure Prophylaxis). It is the use of antiretroviral medication to prevent HIV infection. PrEP is used by people without HIV who may be exposed to HIV through sex or injection drug use.

According to the CDC (Centers for Disease Control and Prevention), The U.S. Food and Drug Administration has approved three medications for use as PrEP. Two consist of a combination of drugs in a single oral tablet taken daily. The third medication is a medicine given by injection every two months.

Kelly also sees patients with gender dysphoria, a condition where a person is conflicted about their gender identity and the gender their body inhabits. He said counseling is used to help the patient come to a better understanding of the condition.

Physical traits are something treating gender affirming patients entails.

I have consulting colleagues who treat top and bottom, he said. We do hormone therapy and integrated behavioral health therapy. We do gender diverse care and referrals for surgery. We work closely with local providers.

Top and bottom can be defined as top dealing with breast removal or augmentation as needed. Bottom involves the genitalia that a patient feels is inappropriate for the person they identify as.

One colleague, Dr. Kimberly Marble, a plastic surgeon who does a lot of work with breast cancer patients, does top surgery for Kellys patients.

She does removal of breast tissue, or adding it, as the case calls for, said Kelly.

Marble, of the Kimberly Marble, MD Plastic Surgery, a Core Physicians practice, said she offers several services for the LGBTQ+ population.

I do all forms of top surgery, including FTM (female to male), MTF (male to female) and non-binary, said Dr. Marble. I also offer laser hair removal, as well as free makeup consultations and skin care consultations for general skin health, anti-aging, and treatment of acne that can occur when taking testosterone.

Dr. Evelyne Caron of Core Obstetrics and Gynecology does bottom surgery.

Shes skilled in transgender medicine, said Kelly. She does gender-affirming hysterectomies if desired. Many of the patients I see do not ultimately elect to do surgery.

I work with transgender woman-to-man patients, she said. I provide gender-affirming surgery. As part of my day-to-day practice, I do hysterectomies, for different reasons, painful periods, bleeding and cancer. A man trapped in a womans body can desire removal of the uterus and ovaries. Some patients who consider themselves gender neutral dont mind keeping their ovaries, but we will remove the fallopian tubes so they do not get pregnant. We can suppress menstruation.

Caron said she will require a person wanting the surgery to have been living as a man for about 12 months to be sure it is the right decision for them. During that time, they will work with a therapist.

I am the last step, said Caron. They will have worked with Dr. Marble for top surgery first. We work through the hormones. These are people who are uncomfortable with the body they are in.

Caron said she sees this type of patient a lot more than she used to. She does not yet give testosterone to women, but she said it is done through the practice by another provider.

This is more accepted now, she said. The more acceptance there is, the more services will follow.

Education ongoing in serving LGBTQ+ community

Tracie Baird is the clinical supervisor for the four Core practices located at Hampton Road. She said she loves the work done at Kellys office and is proud to be a part of it.

I do a lot of training with staff, Baird said. I also help with gender-affirming therapy like hormone injections. Some of those we can teach and the patient does at home. Others must be done in the office.

Baird said she works a lot with parents of younger adults. And she helps with insurance billing and serves as a liaison with practices who refer patients to Kelly.

I talk with parents, for whom this might be difficult, said Baird. We talk about the pronouns their person might prefer, about the name they want to be referred to as. We help foster a better understanding between family members. Sometimes parents ask, What did I do wrong? They did nothing wrong. I tell them this is who your child is.

Kelly works with all patient concerns.

Right now, I am fielding a lot of questions about monkeypox, said Kelly. Currently cases in gay men are in a higher percentage group, even though it is not a gay disease. I have had a few dozen patients asking me about the vaccine. There is a vaccine available but New Hampshire is in a state of flux as to how to administer it because there is not enough, and no mechanism to distribute it. The FDA is looking to authorize emergency use authority, as they did with COVID vaccines, using a smaller dose to make it go further.

Primarily now I see patients one day a week and they are ages 11-80, he said. This is just part of my practice, but I am happy to be able to provide the care.

In 2019, The NH Foundation for Healthy Communities bestowed its Noah Lord Patient & Family Engagement Award on Exeter Health Resources to honor the work done by their LGBTQ+ Advisory Council to improve the design and delivery of care for patients in the LGBTQ+ community.

Over the past several months, the Advisory Council has been instrumental in promoting a welcoming, gender-inclusive culture throughout the health system. They have worked to update the organizations websites to include information about these service offerings and to reflect gender-inclusive language and photos.

Other significant achievements include removing the words male and female from Hospital patient wristbands, changing all single stall bathrooms at Exeter Hospital to be gender neutral, and providing ongoing education to staff.

Kelly recently did a podcast with Sg2 Perspectives about his practice. To learn more visit https://sg2.podbean.com/e/exeter-health-resources-lgbtq-health-program-an-interview-with-dr-robert-kelly/

In addition to treating LGBTQ patients, Kelly offers addiction services including medically assisted treatment, another area he feels there are not enough practitioners of in New Hampshire.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

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'We Need This Here': Exeter Practice Offering LGBTQ+ Healthcare Services - eagletimes.com

Introduction

Hypogonadism (HG), or testosterone (T) deficiency, is referred to as the syndrome of symptoms resulting from insufficient serum levels of testosterone, which results in inadequate action in sensitive tissues. Its role has been investigated for thousands of years, and the Romans are reported to have observed its impact on energy, erectile function, and urination.1 The causes are several, but they can be categorized into two primary groups: primary hypogonadism or testicular failure, acquired or congenital and secondary hypogonadism, which implies the origin of the syndrome is found in the hypothalamus or the pituitary gland including complex mechanisms.2 Klinefelter syndrome (KS) represents one of the commonest, congenital causes of primary hypogonadism.3 Conversely, the aging of the testicles seems to be a natural phenomenon as men will experience roughly a 12% per year reduction of their circulating testosterone levels starting at the beginning of fifth decade, which eventually results in the development of the late-onset hypogonadism (LOH).4 The timing of the manifestations varies according to the cause as congenital causes will manifest primarily as incomplete or delayed sexual development at childhood whereas late-onset or acquired hypogonadism will present more frequently as loss of libido, fatigue, mood disorders, and erectile dysfunction in older age.5,6

Hypogonadism presents as a clinical syndrome. This includes a combination of a variety of nonspecific signs and symptoms is present in addition to the hormonal imbalance. Incomplete sexual development, erectile and sexual dysfunction, decreased energy, mood disorders, muscle weakness, fatigue, sleeping difficulties, infertility, and chronic pain are the main manifestations of testosterone deficiency, which alone or in combination will affect significantly the quality of life of affected men.710 In aged males, the condition warrants high suspicion as symptoms are not specific. A combination of low energy, sleep disturbances, loss of libido, underperformed sexual activity, and emotional stress should trigger screening for hypogonadism in men above (but not limited to) the age of 40.7,11

Testosterone replacement therapy (TRT) or supplementation therapy (TST) has positive effects on body weight and metabolism, bone and liver health, cardiovascular status, sexual, and micturition health, and sarcopenia.12 It has been offered in multiple pharmacological forms (oral administration, injections gel, transdermal patches, etc) for the restoration of normal testosterone levels in cases of both primary and secondary hypogonadism when clinically appropriate.1 When hypogonadism is complicated by infertility, special hormonal manipulations are needed as low testosterone interferes with the spermatogenesis, but pure TRT may negatively affect the reproductive axis.13,14 Testosterone replacement differs to treatment with human chorionic gonadotropin (HCG), which is used to treat secondary hypogonadism and improve spermatogenesis by stimulating the Leydig cells without the side effects on fertility seen in TRT.15 Apart from the beneficial effect on the hormonal status, TRT has been found efficient to improve the quality of life in hypogonadic men as part of a multidisciplinary team approach as illustrated in subjective tools and metrics.1618 Various questionnaires and scoring systems have been proposed as assessors for the standardized evaluation of the effect on quality of life (QoL) along with the measurement of clinical parameters and should comprise the routine approach as QoL endpoints might elude.19,20 Specific questionnaires such as the widespread used aging males symptom rating scale (AMS) have been well-established as they assess several views of quality of life including sexual, somatic, and psychological aspects.18 However, a more delicate and thorough tool might be needed in men where the chief complaint comes from the mental sphere, sexuality, or chronic pain.21,22 Moreover, lower urinary tract symptoms are quite common in aging men with hypogonadism, affecting quality of life warranting follow-up.23 However, a standard regime for monitoring the QoL in men on TRT is unknown and the optimal tools are yet to be established. So far, no specific tools affecting QoL in men on TRT has been suggested or included in international guidelines.24 In this paper, we review the indications and the rationality of the available tools monitoring QoL in adult men with LOH on TRT, and we provide the evidence for their usage.

A nonsystematic search in PubMed/Medline, Google Scholar, Web of Science, and Embase was performed using the terms testosterone replacement therapy and quality of life, chronic pain, lower urinary tract symptoms, general health, well-being, sexual health, questionnaire. Outstanding studies escaped from engine search were selected through the full texts of the reviewed papers. Exclusion criteria were non-English, animal, and retracted studies. We select the evidence related to the specialism of tools in the below domains: general health assessment, lower urinary tract symptoms, sexual health assessment, mental health, in men treated with TRT for LOH.

The aging males symptoms (AMS) scale was developed in 1999 as a tool to aid assessment of andropause including evaluation of symptoms, severity, and response to TRT. It consists of 17 questions of somatic, psychological, and sexual symptoms and the score varies from 17 (minimal significance) to 85 (severe symptoms consistent to TD).25 It has been one of the most extensively used assessors of quality of life in men treated with hypogonadism and reduction of the score indicates treatment success in terms of quality of life improvements.26 Domains of the questionnaires can also be used separately for the assessment of the chief complaint such as sleep disturbance/apnoea which is not an uncommon manifestation of HG.7 Furthermore, it seems that the tool follows reliably the severity of the symptoms and the complexity of HG. Jeong et al reported that men with metabolic syndrome showed less improvement in the AMS scale reflecting directly the effect of the complications on quality of life.27 Similarly, the androgen deficiency in the aging male (ADAM) questionnaire is another used tool initially designed for the screening of low testosterone. This questionnaire is shorter and consists of 10 questions with a binary response (yes/no) assessing sexual life, energy levels, mood, and activities performance. It has been used, but less frequently compared to AMS, for the assessment of the response to TRT and reduction in the score indicates improvement in quality of life.28 Similarly to AMS, the questionnaire can be used for the assessment of single complaints such as the psychological aspects and for the monitoring of men with chronic pain.22,29 Short-form health survey (SF) questionnaires have been developed for monitoring the QoL in patients with chronic conditions and other stressful circumstances.30 They assess aspects of general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and emotional status.31 The original questionnaire consisted of 36 questions (SF36) has been used in young male cancer survivors treated for hypogonadism. This study did not reveal any changes in QoL but the outcome might be the result of selection bias.32 A shorter version of eight questions, the SF-8 has also been reported to assess the response to individual symptoms and the treatment effect of testosterone.19

Evaluation of the QoL related to lower urinary tract symptoms (LUTS) in men treated for HG is clinically relevant as there is a theoretical effect of testosterone on prostate growth. A 12% significant increase on prostate volume in hypogonadic men (with no bothering urinary tract symptoms) treated with TRT has been reported.33 Moreover, LUTS are reported quite common in aging men treated for hypogonadism, likely the result of concurrent BPH.23 Although the association of hypogonadism and LUTS is weak, men with obstructive symptoms due for surgery and international prostate symptoms score IPSS >19 have been reported with higher testosterone concentrations compared with men with lower score.34 In contrast, a meta-analysis has reported that alterations in IPSS for an average follow-up of three years were similar between men who received TRT versus those not treated. As a result and compared to the previous dogma, TRT should not be regarded an absolute, but rather a relative, contraindication in men with severe BPH.23,35 However, a critical view in studies showing no deterioration in IPSS with TRT may reveal that relevant information regarding the anatomical risk factors (eg, prostate volume) were unreported, whereas in others, men with high IPSS were excluded.35 Therefore, it is advisable that assessment of urinary tract symptoms be included in the follow-up of hypogonadic men treated with testosterone replacement. In that regard, the IPSS represents a well-reported, reliable tool in monitoring and can facilitate as an indirect measure of quality of life.35 Using IPSS, changes in both voiding and storage type of symptoms can be detected promptly in men on moderate to severe scale, in the very early follow-up of treatment at three months and even if TRT is used as monotherapy without addition of BPH drugs.3638 Furthermore and of interest, alterations in urinary symptoms have been reported not to be linked with similar effects of testosterone on general body health such as weight loss and sexual health; thus, IPSS looks sensible to remain during follow-up and not to be substituted by other markers of clinical response.39

Hypogonadism has been a well-documented cause of loss of libido and reduction of sexual activity affecting the quality of life significantly and independently.40,41 TRT compared with placebo has been shown to achieve a significant improvement in sexual health in men with no comorbidities treated for over 30 weeks.42 For the assessment of the response and monitoring of QoL several questionnaires have been proposed. The International Index of Erectile Function (IIEF) is a validated assessment tool for the evaluation of the severity of sexual illness in the concept of hypogonadic men under treatment. It is the more widespread used tool for the assessment of sexual health outcomes.42 It is a self-reported questionnaire of 15 questions, which in its original form assess erectile function, orgasm, desire, intercourse satisfaction, and overall satisfaction. The lower the score, the higher the severity of the symptoms.43 A shorter version (IIEF-5) includes a series of five questions which has been used for the assessment of sexual health in men treated with TRT.20 Replacement therapy has been found to improve all domains of IEFF over a timespan of several weeks following improvements in quality of life.44 Derogatis interview for sexual functioning (DISF-SRII) - scored to 100, where 100 indicates better sexual function is a self-reporting tool which can also be used as an alternative for men in TRT.45 The psychosexual daily questionnaire (PDQ) is a six-question tool providing a useful aspect of the psychosexuality of men with hypogonadism.46 The limitation of the tool is the need of daily completion for a standard period of time, which may vary but should reflect the past period. However, the domains of the questionnaire (desire, pleasure, mood etc) can be used for the assessment of the response to TRT with adequate reproducibility.45 The brief male Sexual function inventory (BMSFI) is a similar questionnaire of 11 questions which include erectile function, ejaculation, personal view of the sexual problem, and overall satisfaction. It has been reported useful for the monitoring of QoL in terms of sexual health in men undergoing TRT.47 Other validated tools such as the mens sexual health questionnaire score could be potentially used, but they are infrequently reported in men on TRT. One study has assessed the usage of the tool in men with testosterone deficiency and profound ejaculatory dysfunction.48

Mental health disorders such as depression or mood fluctuations are one of the principal manifestations of hypogonadism.49 Older and andropause men may see their QoL decline as part of the syndrome.50 Younger men with congenital HG may experience more severe mental disorders (eg, alienation, shame) due to disrupted puberty, infertility issues, or delay to the final diagnosis.51 Much of this dysfunction in hypogonadism can be reversed or improved when appropriate with TRT.52 The domains from the short-form health survey (SF) questionnaires can be used for monitoring mental health in men under treatment.9 The symptom checklist 90 revised (SCL-90-R) is a sum of 90 questions which is used for the assessment of psychological well-being in patients with mental diseases or coming from traumatic situations.53 The questionnaire is quite analytic including questions related to feeling of guilt, agoraphobia, anger, etc. It has been used to assess the magnitude of psychological distress in men with Klinefelter syndrome. Fabrazzo et al reported that men with KS at their 40s experience significantly higher presence of obsessions, compulsions phobias and psychoticism compared to healthy controls based on the analysis by SCL-90-R.16 Domains of the AMS questionnaire (No. 4) can also be used for the assessment of mental health in periodical visits,54 whereas QoL associated with mental health has been found to remain significantly impaired in those with a high AMS score.19 When the chief complaint is depression, questionnaires such as the Hamilton depression rating scale (HAM-D) and the Endicott quality of life enjoyment and satisfaction scale (Q-LES-Q) can be used at diagnosis, follow-up and to alert for relapse.21 The first one assesses the short-term (past three days) anxiety and tension, fears, muscular tension and difficulty in concentration.55 Q-LES-Q comes in a long a short form; the latter one consists of 16 questions assessing the level of satisfaction of the past week related to general activities, feeling of strength and sociality, sexual drive, and others similar parameters. It has been reported to carry the highest specificity.56 It also exists in a pediatric form, which might make it attractive in young-onset hypogonadic patients for the assessment of depressive disorders.57 Finally, AMS and SF questionnaires include questions assessing mental health and well-being.32,58

Quality of life and the entity of hypogonadism are strongly related. Regardless of age of presentation and exact cause, hypogonadic men experience significant deterioration in their well-being. Therefore, both the assessment of the QoL at diagnosis and the re-evaluation during treatment should be regarded integral part of the management. Although all aspects of HG may affect QoL by causing disease-related symptoms, in this paper we focused on the four main domains.

The questionnaires are the cornerstone of the assessment of HG and response to TRT in terms of QoL as holding several advantages. They can be conducted quickly, with low-cost, can be easily repeated and can facilitate research. In contrast, it should be noted that they carry the risk of reporting bias, which may occur due to defensiveness, education, feeling of guilt, and may range from the underreporting edge up to the extreme response bias.59 Also, they lack specificity for HG and therefore, should be utilized after the diagnosis of HG through measurement of testosterone has been established.8 In that regard, if symptoms persist during follow-up other pathologies must be evaluated.

The optimal tool for the assessment of QoL is unknown as no comparison has been reported amongst questionnaires. The sum of the fundamental tools per domain is illustrated in Table 1. The AMS scale and the short-form health survey questionnaires look a wise choice for monitoring as they assess general, social, and mental health; AMS also assess sexual health, but SF does not. The AMS scale can provide rapidly the magnitude and the extent of the effects of HG and the course of TRT.60 Further on, specific tools could be selected according to patients main complaint. In men with profound erectile dysfunction, IIEF score should be used for the assessment of sexual health and repeated during treatment.20 If mental health is mostly impaired, the likelihood of a severe underlying mental condition should be considered. Questionnaires such as the HAM-D scale should be used to assess the possibility of depressive disorder within or additional to the spectrum of HG.21 Although the usage of such questionnaires is quite useful to the urologist, a referral to a specialized clinician should be considered prudent if any signs of mental illness. It is of outmost importance that an indisputable linkage of mental illness to HG be avoided and rather, further investigated. Finally, the presence of LUTS in men with HG is not uncommon, especially in older men. As aforesaid, the old dogma that TRT is contraindicated in men with BPH has been revoked. However, possible selection bias in the reported studies warrants a close follow-up in men with BPH until the safety of TRT is confirmed.35 In that regard, the IPSS should be regarded a great tool for the risk stratification of men on TRT. Furthermore, clinical assessment through biochemical markers (eg, serum testosterone, lipid markers, hematocrit, etc) should also be considered as indirect prognostic assessors of QoL as disease-related symptoms from untreatable disease may affect well-being significantly.61 The optimal schedule of re-evaluating QoL endpoints is not defined, but it would be sensible to be re-evaluated every 36 months as the routine assessment for men on TRT.24

Table 1 Tools for Monitoring QoL

Moreover, a special mention should be made regarding the association between TRT and prostate cancer. That diagnosis of prostatic malignancy is frequent in the male population might be a significant reason for QoL changes.62 It has been reported TRT may neither have an impact on decision-making nor undermine early diagnosis of prostate cancer as the effect on prostate specific antigen (PSA) readings is minimal.63 No effect on overall and specific mortality, and eventually in QoL is expected in selected men having received successful surgical treatment for prostate cancer who receive TRT.64 The findings are consistent with the so-called saturation model which supports that in normal and high testosterone levels prostate growth is insensitive; however, other authors advise that the available evidence should be critically reviewed and any decision-making in that concept should not be based on the model alone.65 Specific guidelines for the management of these patients are still under consideration.66 Given the limitations of our study, a suggested algorithm is illustrated in Table 2. Finally, the peculiarities regarding administration methods (gel, injections, patches, etc) needs to be appreciated as they may be related to patient experience, but the actual effect is unclear as recommendations may be guided by the clinicians.67 Cost and convenience may have an impact on choice, but satisfaction has been reported similar among gels, injections, and implantable pellets.67

Table 2 Suggestion for Monitoring QoL in Men on TRT

We appreciate some limitations in our study. We performed a narrative review, not a systematic one, and the selection of the discussed score systems and questionnaires was based on the panels judgment. Our goal was to present the strategy regarding the utilization of these tools and not to perform a comparative, qualitative, or quantitative analysis. Moreover, it must be noted that our research was focused on the clinical concept of LOH and the treatment with testosterone supplementation in the aging male. Our results may, or may not, have reproducibility in infertile men with secondary hypogonadism treated with HCG.15

Monitoring the QoL in men on TRT warrants a deep insight of the clinical spectrum of HG and thus, a cautious selection of surveillance tools. Questionnaires are the cornerstone, but the optimal tool is unknown. A tool assessing several domains of QoL should be selected. However, in order that all aspects of well-being are monitored, a clinician may need to combine the tools and target the chief complaint. Finally, as the clinical spectrum of HG is not specific, questionnaires can be used to unmask coexistent mental illness. In cases of high suspicion, a specialist referral must be considered.

The authors report no conflicts of interest in this work.

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33. Holmng S, Mrin P, Lindstedt G, Hedelin H. Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate. 1993;23:99106. doi:10.1002/pros.2990230203

34. Favilla V, Cimino S, Castelli T, et al. Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia. BJU Int. 2010;106:17001703. doi:10.1111/j.1464-410X.2010.09459.x

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39. Yassin D-J, El Douaihy Y, Yassin AA, et al. Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. World J Urol. 2014;32:10491054. doi:10.1007/s00345-013-1187-z

40. Corona G, Petrone L, Paggi F, et al. Sexual dysfunction in subjects with Klinefelter s syndrome. Int J Androl. 2010;33:574580. doi:10.1111/j.1365-2605.2009.00986.x

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44. Hackett G, Cole N, Bhartia M, et al. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. J Sex Med. 2013;10:16121627. doi:10.1111/jsm.12146

45. Wang C, Stephens-Shields AJ, DeRogatis LR, et al. Validity and clinically meaningful changes in the psychosexual daily questionnaire and derogatis interview for sexual function assessment: results from the testosterone trials. J Sex Med. 2018;15:9971009. doi:10.1016/j.jsxm.2018.05.008

46. Lee KK, Berman N, Alexander GM, et al. A simple self-report diary for assessing psychosexual function in hypogonadal men. J Androl. 2003;24:688698. doi:10.1002/j.1939-4640.2003.tb02728.x

47. Khera M, Bhattacharya RK, Blick G, et al. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). J Sex Med. 2011;8:32043213. doi:10.1111/j.1743-6109.2011.02436.x

48. Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: a randomized controlled trial. J Clin Endocrinol Metab. 2015;100:29562962. doi:10.1210/jc.2014-4434

49. Sharma A, UlHaq Z, Sindi E, et al. Clinical characteristics and comorbidities associated with testosterone prescribing in men. Clin Endocrinol. 2022;96:227235. doi:10.1111/cen.14643

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54. Shigehara K, Konaka H, Koh E, et al. Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan. Aging Male off J Int Soc Study Aging Male. 2015;18:169174. doi:10.3109/13685538.2015.1038990

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Testosterone Replacement Therapy in the Aged Male: Monitoring Patients | IJGM - Dove Medical Press

Estrogen and testosterone are two hormones that have a significant effect on your body. From mood, to sexual function, to bone health, these hormones are key players in your health and everyday life.

Hormone replacement therapy (HRT) is a medical treatment that boosts estrogen or testosterone for people whose levels are too low. This treatment causes a range of changes that can include changes to the skin.

Hormones play a role in your skins overall health. Hormone loss as we get older is linked to some of the signs of aging, including wrinkling and loss of skin volume. Thats part of why its so common to see claims that taking estrogen or testosterone will benefit skin appearance and health for people of any gender.

Although many people taking HRT do report seeing skin improvements, scientific studies dont always fully back up these claims. Lets look at how HRT might affect your skin.

Estrogen has been prescribed to cisgender women going through menopause for decades. Estrogen declines during menopause and this hormonal change is linked to skin thinning and wrinkles. Some studies have shown that estrogen can help promote skin health, increase skin thickness, and both prevent and reduce wrinkles.

However, the formulations and recommended dosages for estrogen therapy for cisgender women experiencing menopause have changed several times as medical science has gained a greater understanding of the effects of estrogen.

Anecdotal evidence suggests that newer formulations, both topical and oral, do provide skin benefits. Full studies on the skin benefits of estrogen at the current most commonly prescribed dosage and formulation are still needed.

The full estrogen skin health benefits for transgender women havent been fully studied. However, many transgender women report receiving skin benefits from taking estrogen.

Its common for transgender women to experience skin benefits such as increased hydration, softness, elasticity, and firmness after beginning estrogen.

The use of testosterone supplementation for cisgender men is still being studied, and its benefits are still being debated. Although HRT is often prescribed for cisgender men with conditions such as hypogonadism, experts dont agree on whether it should be prescribed for cisgender men whose testosterone has declined with age.

Some experts feel that prescribing testosterone can benefit heart, bone, muscle, brain, and sexual health. Others feel that testosterone levels in cisgender men can be increased without the use of HRT.

The specific benefits of testosterone on skin health in cisgender men havent been scientifically studied. However, some cisgender men who use testosterone supplementation report experiencing skin tightening and improved skin elasticity. Its also possible that if testosterone supplementation does improve overall health, improvements to skin health might follow.

However, its worth mentioning that cisgender men who are interested in conceiving should not take testosterone, as excess testosterone can decrease sperm production. If youre experiencing side effects of low testosterone and do not want any negative effects on your sperm, speak with a fertility specialist to discuss alternative ways to increase testosterone that dont harm sperm production.

Transgender men taking testosterone often experience changes to facial volume that can change the appearance of the skin on the face.

Other changes, such as facial hair growth, and temporary acne as the body adjusts to new hormonal levels, can also affect the skins appearance. Some transgender men report additional effects such as skin tightening and improved elasticity, but these are not fully researched and studied effects.

Intersex and nonbinary people sometimes take HRT for health or gender affirmation. Often, this is done at lower doses. It might also be taken for shorter lengths of time.

The effects of HRT on the skin at these doses arent well studied. Some people, on both estrogen and testosterone, do report skin improvements, such as increased firmness or elasticity, but there isnt data to fully support this.

Hormonal levels can also cause problems such as dryness, oil, acne, and early aging. When your hormones are out of balance, or when your body is adjusting to new hormones, skin problems can arise. This is why acne is so common during puberty. Its also why HRT often results in temporary skin problems.

Low estrogen can cause your skin to become dry, thin, and irritated. These are common complaints during menopause, and theyre a big reason why there are specialty skin care products formulated for cisgender women during and after menopause.

High estrogen levels wont directly affect your skin, but they can cause symptoms such as bloating and trouble sleeping that can damage your skin.

High testosterone levels can lead to oily skin and acne. This is common in transgender men when they first begin HRT and in anyone else taking testosterone HRT for any reason.

As the body adjusts to new and higher testosterone levels, acne almost always follows. This is because testosterone causes glands to make excess sebum, an oily substance that protects the skin. Excess sebum can clog your pores and cause acne.

HRT acne can sometimes be tough to fight. Some people have success using facial washes and serums with acne-targeting ingredients such as:

The right products for you depend on your skin, skin type, and the severity of your HRT acne. A product that works for one person with HRT acne might not help another person.

In cases of difficult-to-control HRT acne, visiting a dermatologist is often the best bet. A dermatologist can prescribe medicated washes and creams to better target and control your HRT acne.

If you believe that HRT is causing your acne, talk with your doctor about it. They may be able to adjust your dosage level or recommend a dermatologist experienced with HRT.

HRT has effects on the entire body. Some effects are well studied and well understood. Some effects, including those on the skin across all genders, need additional research.

People of all genders taking HRT report benefits such as more youthful skin, improved skin elasticity, and increased skin firmness. Some data backs up these reports for cisgender women who are experiencing menopause and taking estrogen HRT, but there isnt yet data on forms of HRT for other populations.

Testosterone HRT causes acne in most people. This is a result of your body adjusting to new hormonal levels. It often reduces and resolves with time. Until it does, acne-fighting creams and cleansers can be used to manage acne. A dermatologist can help with difficult-to-control or severe acne.

People who are considering using HRT should talk with their doctor before starting any form of hormonal therapy. HRT is not without side effects and risks and the dosages used are very important. Do not start any hormonal regimen without the supervision and guidance of a doctor or healthcare professional, as it could drastically change your risk for serious health conditions.

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The Effects of HRT on Your Skin and Acne - Healthline

Powerlifter Larry Wheels is an open book about his recent decision to stop using steroids. Wheels goal is to test how much he can lift without the help of the drugs, which he says hes been taking for the past decade.

The flip side is that Wheels is now on testosterone replacement therapy (TRT) because he says his body can no longer produce the hormone naturally. He aims to be on TRT for 175 milligrams per week, which he previously said would bring his testosterone levels to the higher side of being a natural, healthy male in his prime.

On September 7, 2022, Wheels took to his YouTube channel to test his squat and bench press strength while on TRT. Heres how it went:

[Related: Powerlifter Heather Connor (47KG) Deadlifts 200.5 Kilograms (442 Pounds) in Training]

Editors Note: BarBend does not intend to make a moral or ethical statement regarding the athletes actions. This article reports on the information laid out by the athlete(s). BarBend is not a medical resource and does not endorse the recreational use of performance-enhancing drugs.

Wheels prepped for his squats by warming up with a 25-kilogram (55-pound) barbell. While breezing through the reps, he noted that his body feels far more flexible now that hes four kilograms (nine pounds) lighter.

Wheels next progressed to 65.8 kilograms (145 pounds) and 106 kilograms (235 pounds) before the video cut to him talking with bodybuilder Simon Fan about the differences between lifting on and off steroids.

[I feel] flatter, lighter on my feet, significantly less pump, Wheels says. The pump I got while I was full blast is night and day compared to the pump I get now. Its hard to even call it a pump on TRT.

After more sets at heavier weights, Wheels capped his squats with a set of five at 269.9 kilograms (595.1 pounds). That was Wheels first time squatting that heavy in six months due to strongman training and a back injury. He intended to leave a few reps in the tank. Still, he called his final set a reasonable place to be. In the past, Wheels squatted 410 kilograms (900 pounds).

[Related: Larry Wheels Reveals a Physique Update One Month After Getting Off Steroids and On TRT]

The bench press followed the same formula as the squat: Wheels warmed up light with 60.8 kilograms (134 pounds) before moving to sets of 101.7 kilograms (224.1 pounds) and 165 kilograms (364.1 pounds).

The final set weighed 224 kilograms (494 pounds), which Wheels powered through for five paused reps. For reference, an Instagram post from May 28, 2022, showed Wheels hitting a one-rep max of 307 kilograms (675 pounds) for what he called the biggest bench of my life.

Though Wheels has noticed some loss of strength, the weight loss has led to easier workouts, faster recovery between sets, and better stamina.

[Im] really, really ecstatic with the numbers I pulled off today, Wheels says at the end of the video. Still, for confirmation, in a couple weeks time, Im [going to get] my blood tested to make sure they are within normal range and that Im not too over where I should be because I dont want to be on a mini cycle.

[Related: Sherine Marcelle (90KG) Squats a 257.6-Kilogram (568-Pound) Raw Double In Training 1.6 Kilograms Over Current World Record]

The range that Wheels referred to is the aforementioned 175 milligrams per week. He said that if he can maintain and build upon the strength he displayed during this workout on those testosterone levels, hell be over the moon.

Featured Image courtesy of Larry Wheels YouTube channel.

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Powerlifter Larry Wheels Tests His Bench and Squat Strength After Going Off Steroids and On TRT - BarBend

Male menopause (andropause) is seen due to low levels of testosterone due to hormonal changes in men as they age. In women, menopause causes a complete end to ovulation over a relatively shorter period of time. In men, the decreased testosterone levels and hormone production happens slowly and gradually. So, once a man is 30 or above, there is a slow decline in testosterone around 1% each passing year. This means that the testes will not completely stop producing testosterone. Also, due to ageing, chronic ailments like diabetes, HTN, there are certain changes in the function of the testes when one becomes 45 to 50 years old. Once a man is above 70, he may experience around a 50% decline in testosterone levels. Moreover, obesity, type 2 diabetes, hormonal disorders, liver or kidney disease, and infections may also lead to andropause earlier than usual.

Low testosterone production, age, and too much production of the hormone known as SHBG (Sex Hormone Binding Globulin) can invite andropause.

High percentage of body fat, erectile dysfunction, decreased libido (low sex drive), lack of sleep, thinning of the skin, dry skin, depression, low energy, hot flashes, muscle mass reduction, inability to concentrate, and too much sweating or Hyperhidrosis. Some men can also suffer from severe complications such as osteoporosis and cardiovascular problems.

It is diagnosed with the help of a urologist or a male fertility expert (Andrologist), via physical examination and symptoms. It is advised not to delay further treatment after the diagnosis.

Skin patches are helpful. People who wear a testosterone patch will be able to receive the hormone through the skin. Testosterone Gel can be applied directly to the skin, that is on the arms, and must be washed from hands after every use to avoid transferring to others. Capsules can be twice daily after meals but men suffering from other serious health conditions such as heart disease must abstain from using these capsules. Moreover, lifestyle changes like exercise, good nutrition, and stress reduction also help to manage the symptoms of andropause. Medication or testosterone replacement therapy can also be recommended for some men. You need to follow the guidelines given by the doctor only. Do not self-medicate as it can be risky.

(With inputs from Dr. Pavan Devendra Bendale, fertility consultant, Nova IVF Pune)

Continued here:
Male Menopause: Signs, Symptoms And Treatment That Men Should be AWARE of - India.com

Powerlifter Larry Wheels recently took to his YouTube channel to discuss his decision to stop using anabolic steroids. Wheels said hes been on all kinds of performance-enhancing drugs (PEDs) for the past decade, but he decided to take an indefinite break from the PEDs to challenge himself and see what he can lift without them.

But since he says his body can no longer produce testosterone naturally, Wheels revealed that he is now on testosterone replacement therapy (TRT). TRT is a medical treatment for people who produce irregular amounts of testosterone, and he intends to go on 175 milligrams per week, which he says is on the higher side of being a natural, healthy male in his prime.

He recently posted a physique update after a month of TRT, and its easy to see that he already looks leaner:

[Related: NFL Hall of Famer Shannon Sharpe Bench Presses 365 Pounds for Reps at 54 Years Old]

Editors Note: BarBend does not intend to make a moral or ethical statement regarding the athletes actions. This article is reporting on the information laid out by the athlete themselves. BarBend is not a medical resource and does not endorse the recreational use of performance-enhancing drugs.

Wheels didnt share what he weighs now, but compared to posts from earlier in the year, hes far more trim, with more noticeable veins and striations and less bulk. One of the biggest differences is in his face, which looks a good deal thinner than photos from just a few weeks ago.

In an Instagram post from August 16, 2022, Wheels wrote about going from 300 pounds down to 240. That was before his steroid and TRT announcements, so its possible hes even lighter now.

[Related: 10 Lower-Body Exercises Named After People to Add to Your Workout Routine]

Wheels mentioned recently that he is pumping the brakes on his journey to deadlift 1,000 pounds which is in part due to his decision to stop taking steroids. A recent back injury played a part in it, too. In the meantime, he recently posted a video of himself and bodybuilder Andrew Jacked working out shoulders and bicepsin Dubai.

In the video, Wheels mentions that his skin has cleared up now that hes off a steroid cycle and that hes expecting to start dropping more water weight soon after. He also says that his strength in the gym hasnt been impacted yet, but hes expecting that to come in the next few weeks.

With Wheels being such an open book on social media, expect more updates on his post-steroid life in the months to come.

Featured Image: @larrywheels on Instagram

View original post here:
Larry Wheels Reveals a Physique Update One Month After Getting Off Steroids and On TRT - BarBend

Naturopathic Physician Dr. Michelle Sands transforms menopause and perimenopause care with a holistic approach to hormone replacement therapy and midlife menopause support. Dr. Sands believes all women deserve to feel amazing in their bodies and seeks to achieve this by providing affordable and accessible personalized care through her virtual health platform, Glow Natural Wellness.

Every woman will go through menopause, but Dr. Michelle Sands founded GLOW Natural Wellness because she believes that no woman should have to suffer through hot flashes, night sweats, intimate dryness, weight gain, and other change-of-life symptoms. These symptoms directly result from the dramatic drop in hormones such as estrogen, progesterone, and testosterone during the menopause transition.

Even more important is that women understand the importance of maintaining optimized hormone levels when it comes to protecting themselves from chronic disease. Without adequate estrogen levels, a womans risk of heart disease, diabetes, osteoporosis, Alzheimers, and all-cause mortality increases. Bioidentical Hormone Replacement, when dosed and delivered correctly, can reduce those risks and extend life. The problem is that this conversation is not happening in most doctors offices.

Studies show that when women seek medical care for the symptoms of menopause, 75 percent of them are sent home without treatment, Dr. Sands said. An estimated 1.3 million women enter menopause every year in the U.S. alone. Yet less than 20 percent of physicians, including OB/GYNs, are trained to treat them properly.

Dr. Sands, a licensed Naturopathic Physician, and Female Health and Hormone Expert, has created The Healthy Hormone Club to provide affordable and accessible testing, treatment, and education for this underserved demographic.

What is menopause

Menopause is a point in time 12 months after a woman's last period. The 10-15 years leading up to that point are called Perimenopause. During this period, women may have changes in their monthly cycles due to declining levels of estrogen and progesterone. By the time they reach menopause, estrogen and progesterone have plummeted to barely-there levels. Common symptoms include hot flashes, night sweats, mood swings, osteoporosis, fatigue, and more.

Menopause is one day, Dr. Sands said. The next day, you are postmenopausal for the rest of your life. Hormone replacement therapy is a great way to support the body through the menopause transition and throughout post-menopause.

Answering the most asked menopause and perimenopause questions

Hormone Harmony

Dr. Michelle Sands published a book, Hormone Harmony Over 35: A New, Natural, Whole-Body Approach to Limitless Female Health, to share her approach to optimal health with the public. She reveals her evidence-based 21-day plan to restore hormonal balance, reduce stress, and naturally detoxify the body.

A womans body can no longer make vital hormones once she is postmenopausal, and it can quickly affect her quality of life, Dr. Sands said. The GLOW Natural Wellness team helps clients understand their symptoms and how to navigate them using a personalized and holistic approach. A typical protocol will consider a patients health history, current symptoms, laboratory test results, and health goals. In addition to bioidentical hormone replacement therapy, a focus on nutrition, stress reduction, movement, nutraceuticals, and mindfulness is key for the best possible outcomes.

Conclusion

A mother herself, Dr. Michelle Sands, knows how draining life can be for women struggling with menopause symptoms. She is passionate about helping women harness the power of their DNA to elevate their genetic expression and live vibrantly, not just by optimizing health physically, but also mentally, emotionally, and spiritually.

Women experiencing menopause or perimenopause symptoms are encouraged to visit the GLOW Natural Wellness website to learn more about bioidentical hormone replacement therapy.

Glow Natural Wellness

Dr. Michelle Sands

United States

Read more from the original source:
Dr. Michelle Sands Treats Menopause Symptoms Through GLOW Natural Wellness Hormone Replacement Therapy - Benzinga

Larry Wheels has released a new YouTube video announcing that he has decided to stop using steroids. The announcement comes after news of Wheels suffering a back injury. Wheels is known by many to be one of the strongest men in the world with epic lifting videos never fail to motivate. He has also been very open about his steroid use in the past. Which is why he decided to be transparent about his decision to give up on steroids.

Earlier this summer, Larry Wheels set a goal to be the lightest person to deadlift 1,000 pounds. In his training towards that goal, he recent suffered a back injury. He admits that this injury was due to rushing the training process towards his goal. The injury has also led to Wheels withdrawing from the 2022 Middle East Strongest Man competition. The injury was an eye opener for Wheels about his personal health. The fallout from the injury and path to recovery became the biggest factor in Wheels deciding to quit steroid use.

You can watch Larry Wheels video where he makes the announcement below:

In the announcement video, Larry Wheels reflects on having used steroids for over a decade. And how his consistent use of PEDs has made it impossible for him to know what kind of lifting he is capable of off-cycle.

Much like you dont know, I dont know what I am capable of off-cycle. Now, going completely off isnt an option for me. I cannot produce testosterone naturally. So, I am going to be on testosterone replacement therapy (TRT). I tried pull cycle therapy several times when I began cycling and I was unable to recover.

Larry Wheels mentions a big caveat here. He cannot completely go off of steroid use because his body is no longer capable of producing testosterone naturally. This is a well known side effect from prolonged steroid use. So when Larry Wheels says he is quitting steroids he is still going to be implementing testosterone into his system via TRT.

Testosterone Replacement Therapy is a very different cycle compared to traditional steroid use as we know it in bodybuilding. TRT is a medical approach to simply bringing testosterone levels to normal since the body cannot do this on its own anymore. So while Larry Wheels will be using testosterone drugs it will only be to bring him to a natural state.

Larry Wheels continues to explain the process:

TRT for me would be anywhere from as low as 70 milligrams per week, as high as 175 I think 175 is a good place for me to start. If I speak with my doctor and we get my bloods done and we see that its more than whats necessary then I will decrease it, but I certainly wont increase it.

That last comment in the quote above is a key statement. Larry Wheels wants to keep his testosterone levels as minimal as possible while still staying in normal levels. He does not want to abuse TRT to bring his testosterone to more enhanced levels. After some initial bloodwork Larry Wheels will lower his t-levels as far as he can while staying healthy.

Now that Larry Wheels has realigned how he wants to handle his health will he still be aiming for a 1,000 pound deadlift? The short answer is yes but not anytime soon. Wheels comments that the deadlift goal will always be a passion of his. But he also knows that there is no way he would be able to accomplish the feat without using steroids in his current transition.

It was seem, in fact, that Larry Wheels isnt planning to stay steroid free forever. He hints at the notion of returning to steroid use after stabilizing his body, learning his off-cycle limits, and solidifying his overall health.

I am not calling quits on it, but I am putting the brakes on attempting PRs like that at the moment

Despite this hint, Larry Wheels seems to have no plans to switch back to steroid use anytime in the near future. After rushing over the past year and leading into injury, Wheels is ready to take it slow. He wants to focus on training, diet, and recovery off-cycle. Learn his new limits, learn where he can push the. And improve his overall health before taking any unnecessary risks.

The Strength Wars starpromises that his new regimen will also be the subject to new videos and updates on social media. So that his fans can get an insider look into transitioning away from steroids and onto TRT. Wheels expects to take on new training regimens to best align with his new lifestyle. It will be interesting to follow along as he remains transparent with his life both on and off steroids.

Only time will tell if he maintains this longterm goal. But much like many of his impressive lifts over the years, theres no challenge that Larry Wheels gives up on. This new challenge may be different from his past endeavors but it will be exciting and motivating to watch him face a new kind of challenge.

Stay tuned to the Generation Iron Fitness Network for updates on this story and more news on all things bodybuilding, fitness, and strength sports.

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Larry Wheels Gives Up Steroids, Goes On Testosterone Replacement Therapy - Generation Iron Fitness Network

In 2018, I decided to stop using testosterone replacement therapy due to the side effects I was experiencing, most notably, increasingly aggressive behavior.

One concern I had at the time, though, was that ending the treatment would cause an increase in Cushings-related symptoms, because other hormones might be affected. This treatment had addressed my low testosterone levels caused by a pituitary tumor.

I do not recommend abruptly stopping treatment like I did without consulting a professional first. Although I am now seeing the benefits of my decision, it was not an easy road, and at one point, I began to question if my choice was the right one.

The first thing I noticed when I stopped taking my injections was that my mood deteriorated. Feelings of sadness led to an occasional lack of motivation. This sadness was partly due to my reluctance to stop the treatment. While I believed the medication was working, I became aware of how the side effects were affecting both me and those around me. Also, my body had grown accustomed to it over the past year, which led to more emotional imbalance.

The lows in my mood started to improve with effort, such as doing more research on ways to naturally balance testosterone levels, tinkering with areas of my life that were affected by testosterone, and being more active. Eventually, these strategies led to drastic change.

The second effect of stopping treatment was fatigue. The best way to describe it is like working outside all day in the heat. To combat it, what worked well for me was a combination of a plant-based caffeinated green drink, vitamin C, and vitamin B12. This drink has been part of my morning routine for the past four years, since ending testosterone replacement therapy.

I dont like coffee, so it was a good alternative. I also wanted to stay away from most store-bought caffeinated drinks due to their high sugar content.

Other issues I had to deal with again were pain and stiffness, mainly in my feet and lower back. If I was sitting or lying down, my feet would ache when I got up or tried to move. When standing, my lower back would get stiff. It didnt matter how long I was standing, it just appeared to happen randomly.Of the various side effects, the pain and stiffness took the longest to overcome.

To relieve the pain, my wife bought me some braces. I used them for a while but didnt experience much of a change. Then, one day, I started noticing that there was no more pain. This continued to improve each day. I suspect that the amount of weight I had been carrying due to Cushings disease was creating stress on the lower parts of my body, such as my knees. That might have compressed my spine, ankles, and feet. Once I began stretching and being more active including walking 2 miles a day these areas of my body grew stronger, which helped to alleviate the pain.

Given all of these experiences, I eventually learned that I had to give myself time. Quitting testosterone therapy wasnt a process with quick results. It helps to stay positive and motivated, and to take things one day at a time. The peaks and valleys of our journeys shouldnt discourage us from the goal of getting back to optimum health.

The decision to stop any treatment is not one to take lightly. Its always important to talk to your healthcare team before making any changes to a treatment regimen. Doctors can also help you develop a plan of action to replace a particular treatment, if needed.

Today, my energy levels are up again, Ive seen no signs of aggression in my behavior, and my overall sense of well-being has improved. For me, stopping testosterone replacement therapy was worth the trouble because it forced me to look at my mind and body as a whole. The trade-off has been beneficial, and it allowed me to live a healthier lifestyle.

Note:Cushings Disease Newsis strictly a news and information website about the disease. It does not provide medical advice,diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice,diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those ofCushings Disease Newsor its parent company, BioNews, and are intended to spark discussion about issues pertaining to Cushings.

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What I Learned When I Stopped Testosterone Replacement Therapy |... - Cushing's Disease News

Whether you search for SARMs results 1 month or results after using them for a few months, we assure you these are some miraculous compounds that are recently proven to be more effective than anabolic steroids. SARMs results popularity has outgrown many bodybuilding supplements and this is because they can help pack on mass, ripped physique, and exhilarating strength in a faster manner.

Checkout Best SARMs Alternatives online that works without any side effects!

In this article, we will talk about the worlds best and most renowned SARMs for Bulking and Cutting. We will also point out multiple SARMs there are for female bodybuilders and those who simply want to lose weight using bodybuilding exercises.

What are SARMs?Recently, many people with no background in scientific studies asking are SARM a drug? This is in fact a fair question because SARMs have infiltrated bodybuilding and somehow managed to replace anabolic steroids.SARMs are actually Selective Androgenic Receptor Modulators, they do resemble to anabolic steroids structure wise but their binding capacity is what makes them different from them. SARMs are unlike steroids in bodybuilding which means they only act on selective receptors without alerting other biological processes in the body.SARMs are less risky than steroids because they do not convert into DHT or Estrogen which is the reason why many male bodybuilders get the side effects. In terms of testosterone suppression, SARMs only cause this phase for a shorter time than steroids which results in prolonged testosterone suppression for bodybuilders.

SARMs Before and After ResultsSome obvious changes/results that you can experience after the intake of SARM are mentioned below. Highlighted Muscle GrowthMost athletes and bodybuilders do take SARMs because they work like a magic for outrageous muscle mass growth. Most of them expect to gain over 30 pounds of lean muscle which they achieved within 4 months time frame, but for this legit SARM supplement with proper prescribed dosage shall be taken into account. For example, regular use of 20mg Ostarine considerably helps with muscle growth which has been experienced by thousands of bodybuilders in the US alone. Weight/Fat lossBest SARMs for fat burning is amongst the top searches on Google and this is because SARMs are capable of incinerating the fat reservoir in the body. Not the healthy fat but the lipids that your body has been storing for years. In recent days, SARMs are more preferred than Clenbuterol a steroid which is used to get rid of extra fat in the body because of less risk associated with Andarine, one of the best SARM for fat loss. Escalated StaminaWhat is the use of SARMs if not for improved stamina and physical power? Nearly every SARM works on physical power and maximized strength which is the demand of every athlete and sportsman. Under the right dosage, SARMs not only amplify the stamina in men and women but also keeps them energetic, focused, and alert throughout the day. Stops Muscle Wasting SyndromeMany bodybuilders during working out with peak performance tend to lose healthy muscle tissues which arent supposed to be this way. This will also accumulate the water content in muscles which gives your arms and chest a flabby appearance. SARMs allocate the muscle and hydro content in a suitable way that will stop muscle wasting. Faster and Superior Recovery against Muscle FatigueStudies have shown that SARMs long-term use makes the body endure the pain and pressure efficiently. SARMs improve the energy production in muscles which also makes them resistant to sprains, injury, and fatigue during the workout or in the outside world.

Bulking SARMS Before and After ResultsHere are the most effective SARMs for bulking in 2022 which are currently being used by bodybuilders and athletes to compliment muscle mass growth.1. Testolone (RAD140)2. Ligandrol (LGD-4033)3. Ibutamoren (MK 677)

Testolone RAD 140 SARM Before and After ResultsTestolone is regarded as one of the latest and potentially active SARM for muscle growth and bulking cycle. RAD 140 is still under many clinical studies and is not been approved by the FDA yet. Bodybuilders like Testolone so much because of the rapid results and it resembles a testosterone steroid.The main use of Testolone RAD140 is in chemotherapy patients whove lost significant muscle mass, this SARM is given to them for rapid recovery by halting the muscle degenerative disorder. Many physicians around the world refer to RAD 140 as an alternative to Testosterone Replacement Therapy (TRT).Speaking of Testolone results, a vast majority of its user reported elevated energy levels and significant improvements in muscle growth. The mechanism hints at escalated protein synthesis which is very beneficial for bulking workouts. Although RAD 140 results take some time occasionally the gains are reportedly permanent and more solid. With the use of RAD140, users tend to feel nauseated and have other symptoms very little.

The best way to take Testolone is by taking it for 60 days straight (if you are looking for 10-20 lbs muscle gain), but it also depends on the dosage of the compounds. For more remarkable results, Testolone is often combined with other SARM for bulking named Ligandrol.

Ligandrol LGD 4033 SARM Before and After ResultsIn 2022, a vast group of bodybuilders prefers Ligandrol for the best-looking body. The SARM is typically run for 12 weeks straight in a 10-20mg per day dosage after which you can expect to achieve 20 pounds of lean mass.First-time Ligandrol LGD 4033 SARM users take it in little dosage i.e. 6-10 mg for 6 weeks which is to experience a very little amount of side effects. As a suitable SARM for bulking cycle, Ligandrol is also being used for improved fat loss, the SARM binds to the androgen receptors located in the adipose tissues which tend to fasten the metabolism and this will lead rapid weight loss.Ligandrol is sometimes compared to Trenbolone because both compounds stimulate the production of trep muscles. Following a calorie-restricted diet and another regular workout, there are many results you can expect while using Ligandrol. Increased energy, sharpened focus, and lean abs are some of them.

Ibutamoren MK 677 SARM Before and After ResultsNot always a SARM but MK 677 sometimes referred to as Growth Hormone Secretagogue which produces growth hormone and protein in the body. In dire need of supplements, bodybuilders occasionally take Somatropin steroids for HGH stimulation but Ibutamoren is replacing the steroids as we know. Thats because very few side effects are associated with Ligandrol than Somatropin.Ibutamoren MK 677 SARM is the ideal compound for power-lifters who dont take no for an answer when it comes to showing their full body potential. You can also observe increased fertility while consuming Ibutamoren.In the latest reviews about Ibutamoren SARM, it was concluded that it may not be too much helpful to prevent muscle soreness and injury. It can shorten the muscle healing time but thats nothing compared to what Testolone RAD 140 does.In addition, the growth hormone stimulator like MK 677 aids peaceful and sound sleep which is another useful gimmick for muscle recovery. Ibutamoren users reportedly take a brief amount of sleep but they wake up feeling energetic and fresh like they have been sleeping for a day. You can experience the same Ibutamoren result but the condition is to take it in the evening. Stacking Ibutamoren is easy with other SARMs and the surprising part about the compound is there are no need for Post Cycle Therapy. In fact, some users take MK 677 SARM as a part of their PCT which is to replenish the dropped testosterone and HGH levels.Cutting SARM Before and After ResultsBest SARMs for Cutting in 2022 are reviewed by the experts on the reddit forum and other notable platforms online. Some of these SARMs are perplexedly made but the science justifies the results.

Cardarine Before and After ResultsMany reviews about Cardarine GW-501516 SARM say its not a proper SARM but rather a PPAR receptor agonist. The function of such molecules is to provide the fat-burning effects to the body by burning fats and not glucose entirely. The fat cells fulfill the energy demands more efficiently than glucose does and by this, we mean better muscle definition and improved stamina ahead.Cardarine is used by exceptional types of bodybuilders who want to build an ethos out of themselves. GW 501516 tells us about the eradication of stubborn fat from the belly, only 15mg daily dosage for 8 weeks is sufficient for the desired results. You can see at the end of the first month that your body begins to react to strenuous workouts and that it also loses around 5% of body fats.Most people in 2022 are looking for a supplement that can help them shrink their love handles, after spending a sedentary lifestyle most of us get determined to the workout that only stays for a few days. SARMs like Cardarine is the name of the game when you keep wanting to be dedicated and punctual to the workout without any compunction for laters.

Ostarine Before and After ResultsAn athletic physique means you will develop cuts as well as muscle mass which is a pleasant sight for the viewers. With the help of the Ostarine cycle, many users reportedly gained over 8 pounds of lean muscle mass but they also get immense energy levels that help them with fat eradication.Ostarine cycle results in improved bone density, and insulin resistance and it does not interfere with the hormonal system. Many steroids and SARMs end up disturbing the levels of Testosterone, Progesterone, Growth Hormones, and Estrogen but Ostarine is exempted from all those nasty side effects.Ostarine is considered the mildest SARM which means its also safer than most bodybuilding SARMs available in 2022. So many clinical trials are already done on Ostarine and its awaiting FDA approval, there are fewer side effects than any other SARMs. You can take Ostarine in conjunction with RAD 140 Testolone or Ligandrol but you have to be punctual during the workout sessions.

Stenabolic SR9009 SARM Before and After ResultsStenabolic SARM is an ideal SARM for every type of body whether endomorphs or ectomorphs, the SARM is greatest in fat eradiation while replacing them with healthy muscle mass. Recently, the SR9009 Stenabolic cycle has taken a new turn in which bodybuilders are taking it as a weight loss supplement.Stenabolic is indeed a REV-ERB agonist which means it manages and regulates a special type of protein called REV-ERB. This protein is located throughout the body, especially in the muscle tissue, upon activation the regulation of fat metabolism and energy generation takes place and this turns the user into a more energetic, result-oriented, and literally a beast in the gym.Stenabolic is the best SARM for females in order to accomplish their weight loss goals. Different men and women athletes are getting fond of gene expression effects of Stenabolic which seems to increase the mitochondrial energy in each muscle cell. Mitochondria are frequently referred to as the "powerhouses" of cells because they produce most of the cell's energy. Therefore, by increasing the number of mitochondria in muscle cells, Stenabolic SR9009 may help a woman's muscles to produce more energy and become stronger.

Conclusion - Are SARMs Before and After Results Real?You have the liberty to not believe what they say about mere bodybuilding supplements, but SARMs or steroids are not just any other bodybuilding supplements. It took years of research and critical studies to define them and make them available in the consumer market. Just like the SARMs results, SARM side effects are also real which takes a heavy toll on the body at times.To avoid such outcomes, you may start with the minimum dosage of any SARM that you have chosen, also make sure to stick with a healthy diet plan and workout session which gets the most out of the SARMs before and after results.(Disclaimer : The above is a sponsored post, the views expressed are those of the sponsor/author and do not represent the stand and views of Outlook editorial.)

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SARMs Before And After Results Real SARM Results And Users Review In 2022 - Outlook India