As we age Pregnenolone decreases as do the other hormones it produces. Why don’t we just take pregnenolone then? Because it is a complex system that requires many enzyme reactions and the presence of other glands to process pregnenolone into other hormones!

If you have a body mass index (BMI) of 40 or above, and do not have any other medical conditions, it is recommended that you have a bariatric surgery. If your BMI is 30 or above, and you have another medical problem such as diabetes, it is recommended that you have bariatric surgery. These surgeries require the services of a specialist who has been trained and has expertise in the study of these issues and interventions. In most cases, you will also need the follow-up attention of a plastic surgeon and a nutritional specialist.

References are made in this episode to Dr. Maupin's book, The Secret Female Hormone: How Testosterone Replacement Can Change Your Life

Both men and women can experience headaches associated with sexual activity (HSA), but some studies indicate a ratio of 3×1 male over female. They are more likely to occur in people who have migraine headaches, tension headaches, or exertional headaches. Alcohol use and medications used to reduce erectile dysfunction may cause headaches but these are not classified as HSA headaches.

In a study conducted by Dr. Pahan, of Rush University, mice with Parkinson’s pathology were given testosterone pellets and the Parkinson’s symptoms reversed. This study was funded by the NIH, and further studies will be forthcoming to see if comparable results can be expected or identified among humans.

There are many kinds of tremors, and each indicates different things and need to be treated differently from a medical or health standpoint.

Hormones involved in the process are primarily Oxytocin and testosterone, MSH (melanin stimulating hormone). As men age, all three of these hormones diminish. They are each manufactured in various organs of the body in differing amounts. These hormones work together to stimulate the ejaculatory fluid and expulsion that we call ejaculation. They also need to be present to stimulate orgasm. It is possible though to have orgasm without ejaculatory fluid or process.

In this episode we attempt to break this down into an understandable set of ideas rather than some strange and esoteric list of clinical terms. You will learn what PTSD is, how it happens, what it looks like and how it is treated.

When he first came to me for evaluation, I gave him his first dose of testosterone but told him that he could not continue until he saw his primary care doctor to work up some unusual findings in his blood tests. I knew his particular problem could be anything from minor to life-threatening. His regular doctor saw nothing wrong, and sent him back to me. I still refused to provide him with testosterone replacement because long-term testosterone could worsen some of the possible diagnoses that he might have had. I had made him concerned enough that he went to a specialist in hematology.

This specialist, a hematologist/oncologist, found that he had a genetic mutation that made his red blood count very high and never turn off. As a result, his blood was too thick and he needed to periodically donate and destroy a unit of blood to bring him from accumulating too much. This is called a Jak2 mutation and it is rare, but not unusual. The specialist was concerned that his regular doctor had missed it. Once he was treated for it, he sent the man back to me with the message: “Most men your age with this problem have already had strokes or heart attacks. This is potentially fatal and it is good that we caught it.” My patient had gotten a second lease on life, and the initial testosterone had made him feel young and healthy again.

First, ERT means that the patient is only getting estrogen of some kind (estradiol, synthetic estradiol, estrone, estriolm, or Premarin—estrogen from horses,) but is not receiving progestins, usually because they have had a hysterectomy.

HRT means that the patient is receiving estrogen of some kind and progestin, usually Provera. This is added to estrogen to protect the uterus from bleeding and to prevent uterine cancer.

Now for the falsehoods and generalizations: Many women, and even their doctors, still believe that replacing estrogen after menopause will increase their chance of developing breast cancer. This was the report from one study in 2002 by WHI, which has been re-visited and found to be a poor study, misrepresenting the risks of estrogen. The real findings were that estrogen-alone ERT, did not increase the risk of getting breast cancer and, in fact, the study group on ERT had fewer cases of breast cancer than the group who took nothing. This initiative was cancelled before it was finished and its conclusions were widely broadcast because the researchers felt that they had uncovered a major risk for women who were receiving HRT. The increase in breast cancer was among the HRT group who were taking progestins with their estrogen. So, it was really progestin that was the problem. I discuss this in detail in our book The Secret Female Hormone, if you want the whole story.

Last week, we were explaining these two philosophical orientations for physicians and their patients. This week, we want to further explore their differences by taking a look at a specific side effect that some—but not all—people experience.

A physician who embraces guideline-based medicine would be reluctant to replace testosterone in women because the guidelines established by the FDA do not authorize testosterone prescriptions for women. If, for some reason or perception of necessity, the physician who followed guidelines did decide to offer a female the option of replacing her lost testosterone, that physician would be very concerned about the mathematical possibility of having the return of facial hair as a side effect. Some women develop the same issues with facial hair that they had when they were teens. Others, develop no problems at all, while yet others fall on either end of the spectrum—from a little to a lot. In many ways, the issue is one of cosmetic interpretation.

The specialty groups that oversee doctors establish supervisory boards that determine the advised treatment for each problem cared for within that specialty. This treatment is meant to be the lowest level of treatment that is required to meet the standard of care, which is a legal term. Many physicians limit themselves to these guidelines in their practice, not realizing that they are meant to be a “minimum” level of care. However, in sticking to this minimum level, they follow a narrow path in their treatment. They are concerned about their exposure to liability lawsuits and believe that the governing body knows, in its collective wisdom, the best way to proceed—by treating each patient in the exact same way. Other doctors realize that not every patient is the same and they decide to adhere to the guidelines while focusing on what is called “personalized medicine.” Personalized medicine offers an individualized approach. The doctor pays attention to the patient by speaking with them, learning their history and their lifestyle concerns, and developing an individualized treatment plan. This plan may or may not adhere as strictly to the specialty guidelines. These doctors follow this path with the consent of their patients, who generally feel pretty good about the doctor spending time with them and using both the “science” and the “art” of medicine.

In his article, Dr. Kates says that there is both evidence that encourages the replacement of testosterone and evidence that discourages it. He recommends that patients take their time in making the decision of whether or not to undergo testosterone replacement therapy. All in all, I believe that to be an appropriate approach. But, what we want to discuss is the role that headlines play in patients’ medical decisions and reasoning. The headline of JAMA’s report suggests that taking testosterone replacements might cause you to have a heart attack. However, current research and scientific thought is contrary to that opinion. Harvard professor Dr. Abraham Morgenthaler—a leading expert on testosterone in men and the author of Testosterone for Life—recently gave a speech at the AMMG Conference in Orlando, FL regarding this very issue. In his speech, Dr Morgenthaler challenged the research behind the aforementioned article in JAMA. Specifically, he challenged the selection criteria for the population that was studied; all elderly male veterans that already had heart conditions and/or histories of strokes. He challenged the study because ten percent of those included in the study of men and cardio risks turned out to be women. He challenged the interpretation of the data on statistical methodology, and, finally, he asked that the article be taken down.

She was afraid because she did not know what was happening. She had never had a release of fluids that during an orgasm before. She did not know if she had lost bladder control and urinated on herself and her partner, or if there was something wrong with her internally. She was initially afraid that she might be bleeding or that something had “broken.” After realizing that this was not the case, she became afraid that her partner would be incensed or disgusted because of what had happened.

Female ejaculations are a normal part of what can happen for a woman as part of an orgasmic experience. Many women have this happen; sometimes it is only a random occurrence for them, and sometimes they can teach themselves to do it whenever they totally relax and allow the process to happen.

The August 2013 article presented us with a half dozen different techniques and experiments that are being utilized to create a “super athlete”. Part of why it is fascinating to of as caretakers of over-40 patients is that it investigates new ways to improve endurance and performance, as well as techniques for making individuals feel younger. Some of this work has potential for treating various illnesses and diseases such as Multiple Sclerosis. However, there are many concerns among the regulatory agencies about these techniques in regard to both medical experimentation and research. The standards and regulations should be different for athletes than they should be for the rest of us. For professional athletes, the rules are aimed at preventing unfair advantages in sports. Non-athletes, however, are more concerned with effectiveness and safety, which is a separate issue.

We try to respond specifically and individually to everyone who contacts us in an appropriate timeframe, and we periodically decide to use address our viewers’ questions on the podcast to address them. Some of the questions or points that are raised are universally applicable to other viewers. This week, we’re going to address several questions that have been prompted by our previous podcasts.

While this is becoming more true (women do tend to survive breast cancer now,) there are still a few women who do not. The best way to make sure that you are not one of these women is to continue to demand regular mammograms and ultrasounds. It is all well and good to talk about statistical averages, but not if you are the anomaly.

The thyroid is a critical part of the body’s maintenance and operational systems. It is the thermostat of the body, among other things. It stimulates and strengthens the muscles, particularly the heart muscle. When it is underperforming, you begin to show symptoms such as hair loss, eyebrow loss, weight gain, slowed heart rate, higher or lower blood pressure, and feeling cold. You also get swelling in your feet and hands. The function of the thyroid is to maintain a steady and consistent blood flow to all parts of the body by regulating the heart muscle. When the thyroid is off in either direction, there is concern and there should be intervention.

This week’s podcast is a discussion about my patient’s question. Hopefully, it will help reassure our listeners about the safety of replacing testosterone in men in general, as well as educate them about how to consider or evaluate “scientific” studies as they are presented in the mass media. One of the frustrations that I have is that people consume mass media from a perspective of the headlines. They tend to read and absorb the short, succinct message of a headline without digging into more detail in the article. There is also a well-documented tendency to believe things you see in the press. I would strongly encourage you to take more care in reaching conclusions about health care based on media representations of limited studies.