Major Breakthrough in Treating Female Sexual Dysfunction

Major Breakthrough in Treating Female Sexual Dysfunction.

Testosterone for the Lady.

Dr Andrew Rynne.

People naturally associate the hormone testosterone, also called androgen, with men. It’s what makes us so nasty, so aggressive, so driven, so bald, so hairy and so sex mad. Isn’t that so? What very few people don’t realise though is that testosterone also plays a vital role in female sexual functioning. To be healthy, a woman needs to have androgen levels of approximately one tenth of that of young men. This they produce in their ovaries and adrenal glands. It plays a part in many things of which sex drive or libido is but one.

It may go against the grain to associate testosterone with femininity. After all, in the main when compared to men, women are gentler, better at empathising, more intuitive and more patient than men with their raging testosterone. So how could they possible need this stuff that enjoys such bad press? Recent studies have shown that post menopausal women not only lack oestrogen and progesterone but testosterone as well.

This low level of male hormone in post-menopausal women can give rise to many undesirable consequences. Indeed it is now suggested that testosterone may be the “missing link” in the management of menopausal symptoms not otherwise responding to standard HRT. To date this in the main consisted of oestrogen and progesterone. Included here are hot flushes, depression, osteoporosis and the sexual dysfunctions of vaginal dryness, dyspareunia, anorgasmia and low or no libido.

So how much testosterone replacement do ladies need? The quick answer is not a lot. At most her optimum levels of androgen will be from one seventh to one tenth of that of men. So, if a man requires on average 50mg of testosterone delivered daily via a gel call Testogel, then a woman’s requirement will be one tenth of this or 5mg of testosterone daily. A handy way to think of this is that if a man uses one tube of Testogel every day then the same tube of gel should last a woman one week. A little “toothpaste” sized smear on the inside of her forearm every day should do the job nicely.

Doctors who “approve” of testosterone replacement therapy for women are still thin on the ground and some of those like to try and make things complicated. Blood tests, for example, to measure the levels of testosterone that a post-menopausal woman might have, are largely a waste of time and money. They contribute not a jot to the diagnosis. Likewise, expensive specially compounded “female” testosterone replacement therapy will do a lot more for the doctor’s bank account than it will for client’s wellbeing. There is nothing wrong with existing pharmaceutically manufactured androgen gels as given to men.

It is in practise quite simple. All you need do is ask yourself some simple questions: Do you have post-menopausal symptoms not relieved with standard HRT? In particular, do you have sexual dysfunctions like vaginal dryness and loss of libido? If the answer to this is “yes” then try some testosterone replacement therapy at a does of about one tenth of that for a man? Did that improve things for you? If yes then continue if no then discontinue. Now, isn’t that nice and simple? Why complicate things?

To find out more about Testosterone treatments available for women please visit www.doctorrynne.com

Testosterone Replacement Therapy – What You Need to Know

Testosterone Replacement Therapy – What You Need to Know.

Dr Andrew Rynne.

The news emerging about Testosterone Replacement Therapy (TRT) keeps getting better all the time. Recent published clinical trials show benefit for this treatment far beyond boosting libido or reducing erectile dysfunction. It is now becoming apparent that TRT has the potential to not only prolong life but to also improve the quality of that prolonged life. In addition to this exciting news, criteria for deciding who might benefit from this treatment have been greatly simplified. And yet, for reasons that I will try and explain later, most doctors remain opposed to this potentially life saving treatment.

It has now been shown unequivocally that by raising testosterone levels in your blood you can:

Ø Reduce insulin requirements in people suffering from type 2 diabetes.

Ø Reduce blood lipid levels and thus the need to take medications for this purpose.

Ø Improve coronary artery disease and its symptoms of angina pectoris.

Ø TRT also reduces visceral fat or “pot belly” so common in older men.

Ø Cognitive function or brain power is improved by keeping testosterone levels up.

Up to a few years ago, it was common practise for those seeking testosterone replacement therapy that they be required to undergo a range of expensive and not altogether reliable hormonal assays. Recently it has emerged that not only were these tests not necessary but also that they added nothing to the decision making process as to whether one might benefit from TRT or not. Today, most enlightened doctors, rely on presenting symptoms and complaints, not on blood tests, when making this decision.

In spite of all these clinically proven advantages for taking TRT must doctors remain opposed to it today. This is due to their harbouring deeply ingrained erroneous notions about raised testosterone levels and the incidence of prostate cancer. Metastatic prostate cancer may be temporarily checked by reducing testosterone levels to zero. This however does not mean that the corollary is true, that raised testosterone increase the incidence of prostate cancer. Clinical studies designed to show this to be the case have all failed to do so. Prostate cancer is a disease of older men with declining testosterone levels and to suggest that raised levels could in any way increase prostate disease is to fly in the face of reason and science.

I believe that as time goes on TRT will eventually become mainstream treatment for some men troubled by their ageing process.  In the meantime, if you would like to know more about this exciting subject, then please visit my website and ask me any questions that you might have. It would be my privilege to try and help you. Thank you for your interest.

Find out more about Testosterone Replacement Therapy at www.doctorrynne.com

My Doctor Will Not Give me Testosterone Replacement. Why?

My Doctor Will Not Give me Testosterone Replacement. Why?
Dr Andrew Rynne.

Doctors around the world still remain sceptical about the value of testosterone replacement therapy (TRT) for certain men. They remain very sceptical against a backdrop of ever mounting good peer review clinical evidence showing that TRT has the capacity to greatly improve older men’s quality of life and indeed maybe even extend their life expectancy.
These doctor’s objections to TRT for older men may spring more from their emotions rather than from their intellect. Here are just some or their erroneous arguments and why I think they are wrong.
(1) The Women’s Health Initiative  Study, published in 2002, showed that HRT was dangerous. This is a felonious argument on several fronts. First of all what this study actually showed was that Progesterone/Oestrogen combination increased the incidence of breast cancer in women by eight cases per annum per ten thousand women so treated.  Secondly, it is nonsense to extrapolate from that which might be true for women in HRT to men taking Testosterone Replacement. At best that’s emotional, not scientific.
(2) Falling levels of testosterone is part of the ageing process and its consequences are natural. Here is another classic for you. Osteoarthritis of the hip is also part of the ageing process and its consequences are natural. But is anyone seriously suggesting that we should not treat osteo of the hip?
(3) Testosterone Replacement Therapy might raise the incidence of prostate cancer. First of all there is not a shred of clinical evidence that this is the case. And secondly, cancer of the prostate is NOT a disease of younger men with high levels of testosterone. It is a disease of older men with low levels of testosterone. If anything then, testosterone might be protective against prostate cancer but I am not making that point here.
(4) Testosterone might fan the flames of an existing, yet to be detected, prostate cancer. This fallacy comes from confused thinking. Because by removing all testosterone you can bring about a temporary remission in prostate cancer, therefore by adding testosterone you might make matters worse. This type of logic, if even logical it is, is called a corollary. Corollaries may work like a dream in religion or philosophy but have no place in science or in clinical medicine.
Doctors waffling on about the “dangers” of TRT are forever preaching to the rest of us about Peer Review and Evidence Based Medicine.  They usually do this from the high moral ground of academia. And yet when it comes to ignoring their own advice, they seem to show very few qualms indeed.
This might be funny if it were not also quite tragic. We now know that TRT has many potential life enhancing and indeed life giving properties. The evidence for its value it treating the metabolic syndrome is emerging every day in new clinical trials. And yet so many of my colleagues are still with the dinosaurs.   

Doctor Andrew Rynne www.doctorrynne.com

Testosterone Replacement Therapy

Testosterone Replacement Therapy. A Fresh Look Perhaps.
Andrew Rynne.
June 2011.

It has to be admitted, the word itself, “testosterone” does not usually evoke positive feelings or responses. In the popular press, the term testosterone is too often associated with reports about boy racers, reckless driving, male aggression, dodgy bodybuilding techniques, commercial dominance, sexual misbehaviour and cheating in competitive sports. All pretty negative stuff.
In the medical press the word “testosterone” does not fare much better. Mention of testosterone replacement therapy (TRT) to your average doctor is likely to elicit vague objections to do with increased cancer risks, it being not natural, it being unnecessary and other generally negative and ill-defined resistance to the suggestion. This may be a pitty.
No, let’s face it; testosterone replacement therapy was never going to be an easy sell. But are things changing? I for one very much hope that they are. I have been at this for almost ten years now, quietly promoting the notion of TRT. To summarily dismiss TRT as unnecessary, unnatural or even dangerous, might be to deny some older men a chance for a better quality of life and a chance for a reduced risk of contracting some of the less savoury side effects associated with the ageing process including premature death.
In the next five minutes, if you will allow me to, I hope to convince you to look afresh at TRT for older and for perhaps not so much older men and to consider recent research findings that cast this treatment in an entirely different and more positive light. Here are the bones of three recent studies that have been published this year alone:
 (1) Low serum testosterone and increased mortality in men with coronary artery disease.
In a large study conducted through the Department of Cardiology, Royal Hallamshire Hospital in Sheffield on 930 consecutive men with proven coronary artery disease recruited between June 2000 and June 2002 and followed up for a mean of 6.9 years the Authors concluded:

In patients with coronary disease Testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of Testosterone replacement are needed to assess the effect of treatment on survival. (1)

(2) Effects of Testosterone Undecanoate (Nebido) on Cardiovascular Risk Factors and Arteriosclerosis in middle aged men with late onset Hypogonadism and Metabolic Syndrome.
This was a randomised double-blind placebo-controlled study on 50 men with mean age of 57 + or – 8 years who received 1,000 mg of Testosterone Undecanoate every 12 weeks or placebo.
  
Conclusion. Testosterone Undecanoate reduced fasting glucose, waist circumference, and improved surrogate markers of atherosclerosis in hypogonadal men with Metabolic Syndrome. Resumption and maintenance of T levels in the normal range of young adults determines a remarkable reduction in cardiovascular risk factors clustered in Metabolic Syndrome without significant haematological and prostate adverse events.

(3) Effects of Testosterone Replacement Therapy on Depressive Symptoms and Sexual Dysfunction in Hypogonadal men with Metabolic Syndrome.
This was a multi-centred, placebo controlled, study directed from the Department of Psychiatry, Leiden University Medical Centre in the Netherlands. In it 184 men suffering from Metabolic Syndrome and Hypogonadism were treated for thirty weeks with either Testosterone  Undecanoate or placebo.  
Conclusions. Testosterone Undecanoate administration may improve depressive symptoms, aging male symptoms and sexual dysfunction
in hypogonadal men with the Metabolic Syndrome. The beneficial effects of testosterone were most evident in men with the lowest baseline total testosterone levels.
                                       *                *             *
       
Traditionally, doctors resistant to the notion that testosterone replacement therapy might be good for one, used to cite the lack of scientific evidence to support their negative views. This is no longer a tactic open to them. Here we have just a sample of some of the clinical studies showing benefit from TRT. Some of them may be small studies but they are peer review, published and conducted in line with strict scientific criteria. They are moreover ongoing. As time goes on you may expect to see further positive evidence for the beneficial effects of TRT.
What are the delivery systems now for testosterone replacement?
Two other points worth considering at this stage are testosterone delivery systems and the clinical criteria now applied when assessing a potential candidate for therapy:
Up to a few short years ago testosterone delivery systems were cumbersome, problematic, erratic and fraught. There were injections that tended to deliver the hormone in bursts that bore no relationship to the levels found in the physiological state. There were implants that were time consuming to insert under the skin and their use carried all the risks common to any minor surgical procedures. They also had a disconcerting tendency to be rejected. And then there were transdermal patches famous for giving rise to local skin reactions and dubious blood hormone levels.
All of these have now largely been replaced by either a transdermal gel – Testogel, Testim, Androderm etc or a long-acting deep intramuscular injection called Nebido and containing 1,000 mg of Testosterone Undecanoate in 4ml oily suspension. This is given every twelve weeks although in practise this is usually increased to be given once every ten weeks. Also, in practise, I find it easiest to prescribe the gel for the first two months before moving on to the intramuscular version, given at 0,6 and then every 10 weeks.
Do I need to run a battery of expensive and unreliable hormonal assays?
The second thing that has changed, or at least that is changing, is the criteria used to decide if a man needs or is likely to benefit from TRT. Heretofore the practise was to order up a battery of hormonal assays including free and total testosterone, sex hormone binding globulin and luteinising hormone to mention only a few. These tests are not just very expensive they are also notoriously unreliable; vary from hour to hour during the day and from laboratory to laboratory on split samples. In a study conducted in 2007 the authors concluded as follows:        
Though laboratory assays can support a diagnosis of androgen deficiency in men, they
should not be used to exclude it. It is suggested that there needs to be greater reliance on the history and clinical features, together with careful evaluation of the symptomatology, and where necessary a therapeutic trial of androgen treatment given. (4)
This has made things a lot easier, not to mention a lot less expensive, for general practitioners considering TRT for certain patients. Today, doctors rely much less on hormone assay when deciding who and who should not be considered for testosterone supplementation. Nowadays I tend to take the pragmatic or empirical approach. If a sixty-three year old man comes to me complaining of mild depression and erectile dysfunction not fixed by Viagra then I would immediately think of TRT.
Or, if a seventy-two year old man attends with Type 2 diabetes and loss of libido, TRT will at the very least cross my mind such that I will  discuss the ins and out of this suggestion with the client. The same holds true for the Metabolic Syndrome. Presented with an overweight, hypertensive, and hyperlipidemic man in his seventies, with a strong family history of coronary artery disease, I would, with very little hesitation, strongly consider TRT as a wise choice for him. In any of these situations, I would consider PSA as the only blood test necessary to do and even at that reluctantly.


As for gauging the clinical indications or efficacy of TRT, in the absence of blood androgen levels, we have the self-assessment tool known as the ADAM test. Here the client, not the doctor, scores himself against a series of graded questions to do mostly with his quality of life. If this score is low then perhaps TRT is worth considering. If after a few weeks on TRT his score remains low then perhaps discontinuation of TRT might be equally meritorious. This is pragmatic medicine. It can be as simple as that.
Does testosterone therapy cause prostate cancer?
There is no evidence that raised testosterone levels causes or increases the risk of prostate cancer. Prostate cancer is a disease of older men with reduces testosterone levels. It is not a disease of younger men with high testosterone levels. So, if anything, testosterone would appear to be protective of the prostate gland against malignancy. I am not making that case here though. 
It has been observed in peer review study that by significantly reducing testosterone levels with the use of finasteride this can reduce the incidence of prostate cancer by some 25%. Does this not therefore strongly suggest that the increase of testosterone levels would have the opposite effect and increase the incidence of prostate cancer?
Yes indeed it does. But such a proposition is no more than a corollary and as with all corollaries it has to be accepted without any supporting evidence. You must accept it as “logical” and leave the field of clinical science and evidence based medicine behind you.
Corollaries work very nicely in religion and philosophy. God is good. If you don’t believe in God then clearly you do not believe in goodness. But do they work in medicine? I hardly think so. It is a tad annoying to see that the very people shuffling on the high moral ground of peer review science and baying for evidence based medicine only, can themselves so readily abandon such lofty principles when it suites them. There is a double standard at play here and it is not equitable. 
Does testosterone therapy not risk accelerating the growth of a pre-existing yet to be detected prostate cancer?   

This might be your Becher’s Brook when it comes to supporting TRT. But that’s all it is, a jump and like most jumps you can get over it. Castration, surgical or pharmaceutical, causes prostate cancer to regress albeit temperately. Therefore, watch the slight of hand here now, increased testosterone levels will or might fan the flames of an existing small and contained prostate cancer. Isn’t that only logical?
Indeed it is only logical. Note the imagery often used – fan the flames. Logical and emotional even. But is it scientific? Is it peer review and evidence based? No it is not. It is another corollary for which there is not one shred of clinical or scientific foundation to support. Indeed, what few studied there have been to date have all failed to demonstrate any correlation between raise testosterone levels and prostate cancer. And yet, when considering a man for TRT we still consider it necessary to apply that monkey-wrench of an instrument called PSA.
Summery. Debate and controversy continue to rage around the subject of testosterone replacement therapy. Clinical trials are ongoing and so far have delivered good news and even hint at an expanding potential range of disease processes related to ageing where TRT may be indicated.
Certainly, in the last ten years, we have moved a long was from thinking of TRT as a mere bedroom fodder, libido booster and adjunct to ED treatments. Evidence is slowly emerging to support the proposition that testosterone has a role to play in the reduction of dementias – senile and Alzheimer’s, the management of type two diabetes, hyperlipidemia, coronary artery disease, metabolic syndrome and osteoporosis.
The academic naysayers and detractors remain alive and well of course although the firmness of the high moral ground upon which they once stood maybe crumbling somewhat.       


(1) Chris J Malkin,1 Peter J Pugh,1 Paul D Morris,1 Sonia Asif,1 T Hugh Jones,2,3
Kevin S Channer1   
(2) Aversa A, Bruzziches R, Francomano D, Rosano G, Isidori AM, Lenzi A, and
men with late onset Hypogonadism and metabolic syndrome: Results from a 24-month, randomized, double-blind, placebo-controlled study. J Sex Med 2010;7:3495–3503.
(3) Giltay EJ, Tishova YA, Mskhalaya GJ, Gooren LJG, Saad F, and Kalinchenko
SY. Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. J Sex Med 2010;7:2572–2582.
(4) The validity of androgen assays
Malcolm Carruthers,1 Tom R. Trinick,2 and Michael J. Wheeler3
1Centre for Men's Health, London, UK
2Department of Chemical Pathology, The Ulster Hospital, Belfast, UK
3Department of Chemical Pathology, St. Thomas' Hospital, London, UK
Correspondence: Malcolm Carruthers, Centre for Men's Health, 20/20 Harley Street, London W1G 9PH, UK. Tel: +44(0)2076368283. Fax: +44(0)2076368292.

Doctor Rynne  www.docrorrynne.com

Understanding Doctors Hostility to Testosterone Replacement Therapy

Understanding Doctors Hostility to Testosterone Replacement Therapy.

 

Dr Andrew Rynne

Traditionally, doctors resistant to the notion that testosterone replacement therapy might be good for one, used to cite the lack of scientific evidence to support their negative views. This is no longer a tactic open to them. Hardly a day goes by now but that there is not some more good news about the value of TRT. Clinical trials are ongoing. As time goes on you may expect to see further positive evidence for the beneficial effects of TRT.

 

What are the delivery systems now for testosterone replacement?

Up to a few short years ago testosterone delivery systems were cumbersome, problematic, erratic and fraught. There were injections that tended to deliver the hormone in bursts that bore no relationship to the levels found in the physiological state. There were implants that were time consuming to insert under the skin and their use carried all the risks common to any minor surgical procedures. They also had a disconcerting tendency to be rejected. And then there were transdermal patches famous for giving rise to local skin reactions and dubious blood hormone levels.

All of these have now largely been replaced by either a transdermal gel – Testogel, Testim, Androderm etc or a long-acting deep intramuscular injection called Nebido and containing 1,000 mg of Testosterone Undecanoate in 4ml oily suspension. This is given every twelve weeks although in practise this is usually increased to be given once every ten weeks. Also, in practise, I find it easiest to prescribe the gel for the first two months before moving on to the intramuscular version, given at 0,6 and then every 10 weeks.

Expensive and unreliable hormonal assays are now a thing of the past.?

 In a study conducted in 2007 the authors concluded as follows:        

Though laboratory assays can support a diagnosis of androgen deficiency in men, they should not be used to exclude it. It is suggested that there needs to be greater reliance on the history and clinical features, together with careful evaluation of the symptomatology, and where necessary a therapeutic trial of androgen treatment given.

It has made things a lot easier, not to mention a lot less expensive, for general practitioners considering TRT for certain patients. Today, doctors rely much less on hormone assay when deciding who and who should not be considered for testosterone supplementation. Nowadays I tend to take the pragmatic or empirical approach. If a sixty-three year old man comes to me complaining of mild depression and erectile dysfunction not fixed by Viagra then I would immediately think of TRT.

Or, if a seventy-two year old man attends with Type 2 diabetes and loss of libido, TRT will at the very least cross my mind such that I will  discuss the ins and out of this suggestion with the client. The same holds true for the Metabolic Syndrome. Presented with an overweight, hypertensive, and hyperlipidemic man in his seventies, with a strong family history of coronary artery disease, I would, with very little hesitation, strongly consider TRT as a wise choice for him. In any of these situations, I would consider PSA as the only blood test necessary to do and even at that reluctantly.

As for gauging the clinical indications or efficacy of TRT, in the absence of blood androgen levels, we have the self-assessment tool known as the ADAM test. Here the client, not the doctor, scores himself against a series of graded questions to do mostly with his quality of life. If this score is low then perhaps TRT is worth considering. If after a few weeks on TRT his score remains low then perhaps discontinuation of TRT might be equally meritorious. This is pragmatic medicine. It can be as simple as that.

Does testosterone therapy cause prostate cancer?

 

There is no evidence that raised testosterone levels causes or increases the risk of prostate cancer. Prostate cancer is a disease of older men with reduces testosterone levels. It is not a disease of younger men with high testosterone levels. So, if anything, testosterone would appear to be protective of the prostate gland against malignancy. I am not making that case here though. 

It has been observed in peer review study that by significantly reducing testosterone levels with the use of finasteride this can reduce the incidence of prostate cancer by some 25%. Does this not therefore strongly suggest that the increase of testosterone levels would have the opposite effect and increase the incidence of prostate cancer?

Yes indeed it does. But such a proposition is no more than a corollary and as with all corollaries it has to be accepted without any supporting evidence. You must accept it as “logical” and leave the field of clinical science and evidence based medicine behind you.

Corollaries work very nicely in religion and philosophy. God is good. If you don’t believe in God then clearly you do not believe in goodness. But do they work in medicine? I hardly think so. It is a tad annoying to see that the very people shuffling on the high moral ground of peer review science and baying for evidence based medicine only, can themselves so readily abandon such lofty principles when it suites them. There is a double standard at play here and it is not equitable. 

Does testosterone therapy not risk accelerating the growth of a pre-existing yet to be detected prostate cancer?   

This might be your Becher’s Brook when it comes to supporting TRT. But that’s all it is, a jump and like most jumps you can get over it. Castration, surgical or pharmaceutical, causes prostate cancer to regress albeit temperately. Therefore, watch the slight of hand here now, increased testosterone levels will or might fan the flames of an existing small and contained prostate cancer. Isn’t that only logical?

Indeed it is only logical. Note the imagery often used – fan the flames. Logical and emotional even. But is it scientific? Is it peer review and evidence based? No it is not. It is another corollary for which there is not one shred of clinical or scientific foundation to support. Indeed, what few studied there have been to date have all failed to demonstrate any correlation between raise testosterone levels and prostate cancer. And yet, when considering a man for TRT we still consider it necessary to apply that monkey-wrench of an instrument called PSA.

Summary.

Debate and controversy continue to rage around the subject of testosterone replacement therapy. Clinical trials are ongoing and so far have delivered good news and even hint at an expanding potential range of disease processes related to ageing where TRT may be indicated.

Certainly, in the last ten years, we have moved a long was from thinking of TRT as a mere bedroom fodder, libido booster and adjunct to ED treatments. Evidence is slowly emerging to support the proposition that testosterone has a role to play in the reduction of dementias – senile and Alzheimer’s, the management of type two diabetes, hyperlipidemia, coronary artery disease, metabolic syndrome and osteoporosis.

The academic naysayers and detractors remain alive and well of course although the firmness of the high moral ground upon which they once stood maybe crumbling somewhat.       

Dr Andrew Rynne www.doctorrynne.com

The Dark Side of Testosterone Replacement Therapy (TRT)

The medical profession remains split on the question of Testosterone Replacement Therapy (TRT) and its value for older men. Those who are opposed to it in principle, as it were, will argue that TRT is dangerous and unnecessary and that low levels of circulating testosterone in older men is natural and should not be interfered with. That at least is what they will say in public. In private, anti TRT doctors will express serious reservations about increasing older men's libido and reduction their erectile dysfunction.
In fact, it is this very misconception --- that TRT is to do solely with older men's sexuality that may be subliminally militating against the broader uptake of this otherwise useful therapy. I say that this is a misconception because in my experience of treating older using TRT, increased libido or sex drive and reduction of erectile dysfunction are far from the predominant effects of testosterone replacement. This does occur of course but it is subtle and not at all pronounced.
Doctors who are opposed in principle to HRT for older men seem to ignore, or be unaware, of other potential benefits to this treatment that have nothing to do with a man's sexuality. Recent studies have shown that nasty, age related conditions like Alzheimer's, dementia, type 2 diabetes, osteoporosis, cardiovascular disease and the Metabolic Syndrome may all be positively effected by testosterone therapy.
For example, a recent article published in the Journal of Andrology (Vol. 30 No 5 Sep/Oct 2009) makes for very interesting reading indeed. This is the work of four highly respected scientists: Abdulmaged Traish, Farid Saad, Robert Feeley and Andre Guay. In a broad met analysis of all the work carried out into testosterone replacement therapy over the last ten years, these investigators concluded: "Androgen Deficiency (low testosterone) might be the underlying cause for a variety of common clinical conditions such as diabetes, ED, the Metabolic Syndrome and cardiovascular disease."

If this subject interests you, I recommend you read this paper it its entirety. It is available here at this article.
If you have any questions at all that you think I might be able to help you with, I am available through me website here at http://www.doctorrynne.com. 

Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction but most particularly Erectile Dysfunction and Premature Ejaculation.

Testosterone Replacement Therapy and Erectile Dysfunction

Testosterone Replacement Therapy and Erectile Dysfunction.

Testosterone replacement therapy has changed quite significantly in the last ten years. Ten years ago, before a man was considered suitable for TRT, he was required to undergo a battery of hormonal assays. These included exotic named tests like free and bonded testosterone, sex hormone binding globulin, serum prolactin and luteinizing hormone.
All that has now changed. These tests were not only very expensive they were also unhelpful. Blood levels of testosterone, free or bonded, are notoriously unreliable and difficult to interpret. Recently I have abandoned their use altogether and replaced them with a more pragmatic approach of measuring benefit, if any, before and after testosterone treatment begins. The easiest way to do this is by using a self-assessment questionnaire called the ADAM test.
The ADAM test is a very simple one page questionnaire that anyone can use to score their own symptoms (if any) of Testosterone Deficiency Syndrome. No needles, no blood, no expensive laboratories, no uncertainty and no delays. It is simplicity itself. Score symptoms before treatment commences and one month later. If there is no improvement then perhaps TRT is not for you.
Another recently introduced improvement in the management of androgen deficiency was the introduction of a sustained release intramuscular injection called Nebido. Administered by a doctor every ten weeks this preparation is a big improvement on previous gels, implants, patches and erratic injections. I usually recommend gel for the first month to see if the ADAM score improves and then move on to Nebido if the client is impressed.
Finally, here is a useful tip for you. If you suffer from erectile dysfunction that does not respond adequately to Viagra 100 mg then ask your doctor to consider placing you on a trial of TRT. Often the addition of this hormone allows Viagra, Cialis or Levitra to click in and allow you to enjoy intercourse as you have always done before.
Doctor Rynne

Visit my website at: http://www.doctorrynne.com