Misconceptions About Testosterone
Popular beliefs and faulty lab tests stop many men from getting needed treatments
Lowered energy levels, heart problems, an inability to exercise, and depression in men can often be traced back to one single source—testosterone; yet for various reasons, over a third of men go untreated.
It’s a common misconception that testosterone therapies are used merely to boost sex drive and build excessive muscles, said Dr. David Shusterman, the chief physician at New York Urology. On top of that, most patients don’t even realize when they have low testosterone after a medical checkup because of the way lab reports are written.
Another misconception is that the problem only affects older men.
“A lot of times, people don’t check their testosterone. They can be very young guys walking around with a lot of the symptoms,” Shusterman said. It can occur in men as early as their 20s.
“Some people realize it because they have a low sex drive, and they talk to doctors and then get to see me—but many people just live with it, don’t talk about it, don’t say anything,” Shusterman said.
Testosterone therapy typically includes three types of treatments: pellets, salves, or pills.
“There are two broad ways to treat low testosterone. One is giving back testosterone itself,” Shusterman said. “Another way is to give a stimulating hormone that stimulates the body to produce more testosterone.”
For men who plan to have children, Shusterman recommends treatment to stimulate the body’s natural production, which is typically done with pills.
“Not only does it increase the testosterone level, but it will increase their fertility level because low testosterone can cause low fertility as well,” Shusterman said.
The stimulating hormone causes the body to produce more testosterone, which doctors divide into two categories: free testosterone and testosterone-binding hormones, which account for the bulk of the testosterone produced but actually have little effect on the body.
Free testosterone is what the body needs to balance everything from mood to metabolism. Treatments that give back testosterone only increase the free testosterone.
For men not concerned with fertility, Shusterman recommends a subcutaneous pellet.
“Once you put it in underneath the skin, they dissolve over four months,” Shusterman said. “You set it and forget it. … It’s very easy. Three times a year you come to a doctor, and you’re basically at a normal testosterone state.”
The pellet treatment typically costs half has much as pills or salves, which oftentimes patients don’t keep up with because they need to take or reapply them so frequently. Salves, like creams or jellies, can also rub off the skin onto clothes or other people, and can get messy
Unlike estrogen, which has complications with malignancies, testosterone does not cause prostate cancer, contrary to belief, Shusterman said.
“If someone has prostate cancer, their PSA (Prostate Specific Antigen) level is artificially high,” Shusterman said. When testosterone is raised, PSA levels also rise, which can cause already present prostate cancer to grow, making it detectable. Shusterman said that they always monitor PSA levels at New York Urology for this reason.
“It’s safe to use in almost all situations; it’s even safe to use in people who’ve had prostate cancer but have been treated for it,” he said.
Oftentimes a patient will get his results back from the lab and see a testosterone level lower than 300 but still labeled normal by the lab, despite that being half of what their levels should be.
Lab numbers vary, but some disregard the patients’ age and use a range that shows the average testosterone level for men over 80. Other charts might disregard sex and show a minimum figure for a normal level of testosterone for females, meaning no male checkup would come out as abnormal despite being too low for their age.
Low testosterone also slows your metabolism.
“The main thing it does is it creates a low level of basal metabolic activity,” Shusterman said. Your basal metabolic rate (BMR) is the minimum calorie requirement needed to sustain your body, and when it’s unbalanced, it makes it hard for people to exercise as well.
“Their BMR is low artificially because their testosterone level is low,” Shusterman said. The patient may feel sluggish but also find himself unable to exercise and see no results when he does.
Once patients start their treatments, Shusterman said he’s had people see results from within a day to six months.
Along with the testosterone treatment, Shusterman also guides patients to make diet and lifestyle changes that support their health.
“And I don’t just give people testosterone treatment, toss them out there, and hope they do the best. I give them an exercise regiment. I tell them what foods to eat. I tell them how to maximize their newfound BMR and improved exercise capacity,” he said.
“There’s a lot of unnecessary issues and suffering that goes on when the levels [of testosterone] aren’t adequately checked, monitored, and regulated,” Shusterman said.
He adds this is largely because it’s not an area most doctors or patients are interested in to begin with. It tends to be out of their field, and when symptoms such as low energy or low sex drive show up, doctors prescribe something for that one symptom rather than suspecting low testosterone.
“Don’t let people give you some medication and hope it goes away,” Shusterman said. “This is an important thing to check, and people aren’t checking it. They’re just giving people Viagra, Cialis.” But if you treat the root cause, you don’t need a variety of medications, he said, and testosterone replacement therapy is almost always covered by insurance.
“Once people start checking it and people have good response, people appreciate it,” he said. Many of his patients have returned to tell him how much better they feel.
“I’ve seen many patients just come in and they say they feel better,” Shusterman said.
Testosterone replacement therapy can also reduce the chance of cardiovascular disease, according to a study published recently by the Boston University School of Medicine.
Thus the consequences of not treating testosterone deficiencies are serious, Shusterman takes the time to educate his patients and fellow doctors. Through word of mouth, more men are getting their testosterone levels checked in the clinic, he said, and it’s becoming an easier issue to talk about.
What to Do for Leaky Bladder After Childbirth
Urinary incontinence is a loss of bladder control that results in unwanted leakage of urine. There are various types from stress incontinence to overactive bladder, which result in different amounts of leakage.
During pregnancy, women commonly develop transient stress incontinence. Due to an increase of fluid in the bladder combined with the weight of the baby on the abdomen, urine can accidentally spurt out when a woman coughs, laughs, or sneezes. And there are other risks that may predispose a woman to incontinence.
Fortunately, many instances of incontinence during pregnancy resolve within a month after childbirth, said Dr. David Shusterman, the managing urologist at Advanced New York Urology in Manhattan. But even if the leaking stops, a woman is likely to have the problem again later in life, he said.
However, she doesn’t have to keep it a secret or feel embarrassed, because there are treatment options that can resolve or significantly reduce leaking.
According to the Urology Care Foundation, pregnancy, delivery, and having more children increase the risk of incontinence in women. And it doesn’t matter whether the woman has vaginal delivery or a C-section. Surgery doesn’t reduce the risk states the Urology Care Foundation.
So it’s important to get a complete urological evaluation after childbirth.
Dr. Shusterman said he takes an accurate history and physical as well as a pelvic ultrasound because there are different variables that could be the cause of leakage. “Not every leaking episode is the same and a lot of it all changes with the circumstances,” he said. Older women are more likely to have incontinence than younger women during pregnancy. As a woman ages, the muscle tone of the pelvic floor, which supports the bladder, begins to weaken and limits her ability to sustain the extra pressure of pregnancy.
Also, underlying diseases such as kidney stones or Parkinson’s disease may trigger urine leakage.
Dr. Shusterman recommends getting treatment early rather than waiting until the symptoms worsen.
“I try to have them proactive in improving their health,” he said. “By doing that they’ll keep from surgery later on in life.” He first advises patients to stop smoking and lose weight. Studies have shown that women who smoke are twice as likely to develop stress incontinence as women who don’t. And women who lose 8 percent of body fat can reduce episodes of stress incontinence by 47 percent, according to a New England Journal of Medicine study.
For the occasional leaker, Dr. Shusterman suggests wearing a pad or using InTone, a device women can use at home. A probe inserted in the vagina stimulates and strengthens the pelvic muscles as a woman performs kegel exercises. Since kegel exercises require contracting and holding pelvic floor muscles for 5- to 10-second intervals, women often don’t perform them properly without the device, so they aren’t effective. InTone provides biofeedback and recorded session data to let the patient know if she has completed the exercises most effectively.
Women who urinate more frequently or have an overactive bladder can also benefit from InTone or take medication to relax the bladder. Another option Dr. Shusterman recommends for frequent urination is Urgent PC neuromodulation system, “a type of acupuncture for the bladder,” he said. It’s a device that stimulates the nerves to the bladder. During this 30-minute, in-office treatment a small, slim needle electrode is inserted near the ankle. The electrode is then connected to a battery-powered stimulator. Mild impulses travel along your leg and into the pelvic nerves that control bladder function.
Although this treatment doesn’t require medication or have side effects, it may not be sufficient for more serious cases. For persistent leaking, the patient can be fitted with a pessary, a small silicone ring inserted in the vagina to act as additional support for the bladder to limit leaking. If the patient’s conditions worsens, surgery may be indicated. The most common surgery involves inserting a narrow ribbon-shaped mesh under the urethra—the tube that carries urine to the bladder—to help keep it closed if you cough or sneeze so urine won’t leak out. In cases where the bladder has dropped, surgery can be performed to reposition and secure it with string attached to muscle, ligament, or bone.
According to Dr. Shusterman, the worse thing a woman can do is ignore the problem or self-treat by drinking less water.
“If it doesn’t get treated, you have a higher chance of getting bladder cancer, … [or] having other things, like kidney [stones] because you’re not drinking enough water,” he said.
Don’t Mess with Your Kidneys – A Personal Experience
I am so so happy and feel so lucky to have my health. My story below is a reminder on how quickly it could be taken away from you. My recent experience drives it home on how important it is to take action when you recognize something is wrong. Even if you have a tiny inkling there might be something not so positive with your health, be proactive and see a doctor. Health is never out of style!
I had a personal run-in with what could have quickly become a disastrous health circumstance – A kidney Infection. Below my experience I’ve included tips from one of NYC’s best Urologists, Dr. David Shusterman, on how to prevent my story from happening to you.
About a month ago I was having mild symptoms of what I thought could be a UTI. I’ve only ever had one UTI in my life so I wasn’t all that familiar with what the symptoms were in the first place. I did feel frequent urgency to pee and had a little bit of pain in the abdomen. Regardless, I ignored the symptoms thinking it wasn’t an urgent matter and then just few days later, on a Friday, the symptoms disappeared as quickly as they had come. Being that I wasn’t that concerned in the first place I barely celebrated the relief and I figured if I had had a UTI, it must have cured itself. ( For your future reference.. UTI’s very rarely cure themselves.)
Over the weekend I went to the gym a few times, spin class and yoga.. by the end of day Sunday I was starting to feel some pain in my back, right under my rib-cage. I dismissed the pain for something relating to my intense workouts.. that maybe I worked out some muscle group I rarely get to.
Monday came along and I was pumped to continue on my great workout routine. However, I was now feeling pretty extreme pain in the same area of my back and seriously considered skipping Monday’s workout. However, I pressured myself and with a little encouragement from my workout buddy (my boyfriend) I ended up taking a bootcamp class. After the class I felt great, refreshed.. but I still had that pain in my back that I was starting to get concerned about. I even at that point mentioned, to my workout buddy, hmmm I hope I didn’t do something to my kidneys.. knowing that the pain was right around the area your Kidneys are supposed to be. But, I ignored my intuition and decided to go on with life, pop some painkillers and put a veil over the pain.
It wasn’t until I got back from a dinner Tuesday night and went to bed that I realized something was really wrong. As soon as I hit the sheets I started getting extreme chills and was sweating, profusely. I’m talking it looked like my skin was raining.. huge drops of water all over my body. I had had a few drinks during dinner and I figured maybe that had exacerbated some other kind of illness I had.. maybe a cold turned bad.. the kidneys were in the back of my mind.
The next day, after sweating through a few changes of blankets overnight, I notified staff that I would be out of work for the day. I scheduled a doctor appointment for Thursday after deciding to wait out a day to see if I would get better on my own (not a good idea!).
All day and the next night were basically a repeat – sweating through sheets (and probably 10 outfits of sweats) and crazy chills and some constant shivering spells. I finally made it to the doctor Thursday morning – at this point I needed a chaperone I was in such bad shape and extreme pain.
The doctor confirmed my 103 degree fever and sure enough, I had a high grade kidney infection. If I had let it go another day the doctor said I would have been forced to hole up in a hospital with an iv strapped on. If I had let it go another 2 days it could have easily led to a more intense sepsis, blood infection, and even have led to amputation!
Luckily, I escaped with 2 weeks of antibiotics and at least 2 days of bed rest. I slowly nursed myself back to health and was feeling like my normal chipper self after a good week.
Don’t mess around with your health people! I’m so lucky I got to the doctor in time to stop the kidney infection from progressing any further. Please pay attention to the signs and signals your body is sending you to let you know something is off!
Never wanting to go through the experience again, I sat down with one of the best Urologists in the city – Dr. David Shusterman ofNYUrology.com. He gave me some great advice for me and girls like me who may not be up to date on all the deets on UTI’s and how to prevent them from turning into something much much worse.
The key of course is prevention. Anyone who’s had a UTI can tell you it’s no pretty walk in the park so forget the kidney infection part.. let’s just skip UTI’s altogether.
Here are Dr. Shusterman’s top 3 tips to avoid and prevent a UTI
Drink plenty of liquids, especially water.
Wipe from front to back. UTI’s are caused from bacteria and one of the main ways you get rid of bacteria in your system is through going #2. Try to avoid getting that bacteria back in your system by wiping from the front to back and do it efficiently!
Go to the bathroom, after having sex. Sex is one of the main ways women contract UTI’s. The friction of sex allows all sorts of material (including stuff from the back end) to move around to the urethra.
Oh and that myth you’ve heard about drinking cranberry juice to help prevent and cure UTI’s? Well, you can stop drinking the juice for your urinary cure-all. It’s actually a myth according to Dr. Shusterman – All just one brilliant marketing scheme for Ocean Spray Cranberry Juice. In fact, cranberry juice could actually make some of your symptoms worse. I feel so taken advantage of!
Most importantly, if you start feeling the symptoms of a UTI don’t delay.. get to your doctor. The sooner you get on antibiotics the less chance you have of the infection spreading to other areas.
I highly recommend Dr. Shusterman, his office is at 800 2nd Ave.
Cheers to good health!
About Dr. Shusterman:
Dr. Shusterman is the managing partner and head urologist at Advanced New York Urology. He is experienced in robotic and minimally invasive surgery. He is an attending at Lenox Hill Hospital and New York Hospital in Queens. He has special interest in Urologic-Oncology, prostate cancer, robotic and minimally invasive surgery, and general urology.
Dr. Shusterman is well trained at Robotic Prostatectomy and other minimally invasive robotic surgeries. His clinical interest involves urologic oncology with special emphasis on the care of patients with prostate, bladder and other urological cancers. He performs open, laparoscopic and robotic surgeries. He performs state of the art kidney sparing surgery by freezing or removing the cancer cells and sparing the rest of the kidney. He is also very skilled in diagnosing prostate cancer by using PSA and modern ultrasound guided biopsy techniques.
It is our goal to make sure you feel your best and stay that way. You can count on our many years of experience, our highly trained team of wellness professionals, and exquisite professional service.
Patients Honor Dr. David Shusterman For Compassion
Dr. David Shusterman of New York, New York is ranked among the top physicians in the nation based on patient reviews.
NEW YORK, March 27, 2013 /PRNewswire-USNewswire/ -- Patients' Choice has announced that Dr. David Shusterman was one of a select few physicians honored with the prestigious 2012 Compassionate Doctor Certification.
Only those physicians with near perfect overall and bedside manner scores, as voted by their patients, are selected for the Compassionate Doctor recognition. Of the nation's 870,000 active physicians, only 3% were accorded this honor in 2012.
The Compassionate Doctor certification is part of the Patients' Choice recognition program, where patients rate and vote for their favorite doctors.
Dr. David Shusterman commented on the recognition: "This is quite an honor for me. I am very pleased to have been selected and grateful to my patients who went out of their way to rate me and give me positive reviews."
About David Shusterman: a short profile by and about the honoree:
Dr. David Shusterman is a board certified urologist. He specializes in state of the art compassionate urological treatment. He provides in office anesthesia for procedures that in the past would be painful but now are pain-free. In addition to having the latest equipment for diagnosis, he is on the leading edge of research and innovation in robotic and minimally invasive urology. He has offices inManhattan and Forest Hills, New York. He has been awarded numerous awards including Patients Choice and Top Urologist awards for 5 years in a row. Visit his website NYUrology.com for more information.
For more information on this Compassionate Doctor, please visit Dr. David Shusterman's profile on Vitals.com.
Following the publication of Dr. David Shusterman 's selection for the Patients' Choice Award, American Registry seconded the honor and added Dr. Shusterman to The Registry™ of Business Excellence. An exclusive recognition plaque has been designed to commemorate the honor.
For more information on Dr. David Shusterman , located in New York , New York call 800-818-1720, or visit NYUrology.com.
In February, after days of experiencing debilitating back pain, Angela Trostle figured she had pulled a muscle from working out.
But when her fever spiked and she couldn’t get out of bed, her doctor nearly sent her to the hospital.
“I couldn’t move,” recalls the 29-year-old publicist. “My body was shutting down — I had extreme chills, I was shaking and shivering, and I sweat through three sets of sheets.”
The lower Manhattan resident had an undiagnosed urinary tract infection (UTI), which turned into a kidney infection — a condition she blames on back-to-back meetings with no time for bathroom breaks.
“I definitely hold it in a little bit more than I should,” concedes Trostle, whose urologist prescribed an aggressive two-week treatment of the antibiotic Cipro. “I’d never want to go through that again, especially with the kidneys involved — I’ve never had pain like that.”
Turns out, she’s not alone. When the Mets announced last week that they were pulling pitcher Matt Harvey from a scheduled spring training start, Amazin’s fans held their breath, wondering what was wrong. But when news broke that the 27-year-old had suffered a painful blood clot stemming from complications from a UTI, fans pounced on their “golden” boy, dubbing him the “MVPee.”
Angela Trostle’s undiagnosed UTI turned into a kidney infection.
Still, many New Yorkers can sympathize. One of them is Matthew, a 32-year-old Met fan with an active dating life who emulates Harvey, right down to his below-the-belt infection.
For the past four years, the Chelsea resident (who, for privacy’s sake, prefers not to give his last name) has suffered from recurring UTIs triggered by bacterial infections. He was upset that the Met pitcher’s medical condition garnered so much derision.
“If Matt Harvey had diabetes, he’d have sympathy,” says Matthew, a fund-raiser for a nonprofit. “[But] when a guy, a professional athlete, has a UTI, people are unsympathetic.
“But, hey, that’s life — that’s my life.”
Matthew says that, over the years, he’s shelled out thousands of dollars on co-pays, exams and medications — and still feels shame admitting his woes to a doctor.
“It’s tied to your confidence and masculinity,” he says. “The tests that need to be done can be really embarrassing and emasculating.”
Dr. James Wysock, a urologist at NYU, says that some UTIs in men and women are caused by failure to empty the bladder. “When someone’s urine is held for too long, bladder muscles stretch out,” he says. “When it’s relieved, it could bleed. That can lead to blood clots.”
But that’s only part of the story, doctors say: Some blame the condition on undiagnosed STDs.
“In men, [UTIs] include the kidneys, ureters, bladder, urethra, prostate and urethritis — inflammation of the urethra — and [it’s] usually triggered by an STD,” says Dr. David Shusterman, founder of Midtown’s New York Urology. “These young guys have sex with a bunch of girls, they come in with misdiagnosed UTI, and it turns out it’s not. A nice way of calling an STD is a UTI.”
Over the past few years, Shusterman says he’s seen male patients with a more laissez-faire attitude toward unprotected sex, which makes them ripe for infections. He says there’s been a 20 percent increase in his male patients under age 30 having a UTI, and blames about 75 percent of his cases on risky behavior and a cavalier attitude toward condoms.
Although Shusterman is skeptical that holding in urine can cause a UTI, the doctor says it’s best to go to the bathroom early and often.
Meanwhile, Matthew hopes his pain is behind him. Last month he had surgery to burn off a concentrated inflammation of his bladder, and he says the symptoms have abated. Gone, too, are the days of improvised remedies.
“[At work], I would put a hot compress on my junk, inside my underwear,” he sheepishly says of his efforts to stem the constant urge to go. (He even resorted to nuking his hot compress in the office microwave.)
“At a certain point, you do anything to find relief.”