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You probably know testosterone (T) plays an important role in how boys physically develop into men. But is that all you know? What happens when a man's T levels are off? Are there symptoms men should look for? And what are the treatment options? Dr. Bobby Kahlon, MD, Renown Medical Group provides answers in a Testosterone Q&A.   What does testosterone do for men?  "Testosterone is known as the 'manly hormone' for a reason," says Dr. Kahlon. "Though women also naturally produce small amounts of it, men produce testosterone at much higher concentration levels. And it affects men in more physical and obvious ways. How much hair a man has on his chest, how deep his voice is, or how muscular he is are all attributable in some way to testosterone. It's also responsible in large part for sex drive and bone strength and affects how men think, learn and experience their surroundings."  Testosterone in men:   Powers virilization (male physical characteristics) and sexual function Builds muscle mass and strength  Supports bone density  Improves cognition  T Trivia: Discover Magazine reveals that “manly” testosterone and other sex hormones evolved long before we did — 500 million years ago — from the ultimate “female” hormone, estrogen. Can you have too much or too little testosterone?  Though high testosterone isn't a concern for most men, low testosterone or low T occurs more frequently and develops for two primary reasons.  Dr. Kuhadiya explains, "Subnormal testosterone concentrations occur either due to pituitary or testicular failure and the causes for each need to be discussed with your physician."  Pituitary failure: Approximately one-third of men with obesity, type 2 diabetes, or metabolic syndrome (which includes increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) have low free — or "bioavailable" — testosterone. These health conditions can cause the pituitary gland to "fail" to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which are essential for triggering testosterone and sperm production. And that can cause low testosterone (hypogonadism). Testicular failure: Though less common than pituitary failure, testicular failure may also be responsible for low T. It's caused by diseases or illnesses affecting the testicles, injury or trauma to the testicles, or certain medicines and treatments such as chemotherapy or opioid pain medication. Providing your complete medical history to your doctor is always the first step toward a proper diagnosis.  What are the symptoms of low T?  The following indicators could be a sign that you have low T, say the doctors.  Lack of motivation and determination, including mild depression  Loss of physical endurance and muscle strength  Loss of or diminished early morning erections  Reduced libido (sex drive)   Erectile dysfunction (ED — difficulty achieving or maintaining an erection)   Gynecomastia (male breasts)  Small testes  T and Time: T levels in men naturally begin to decline by about 1% a year starting at age 30.  How do you test for low T?  "There are different methods for testing testosterone levels," says Dr. Kuhadiya. "Each approach uses a blood sample to evaluate total testosterone, which includes free and attached testosterone that combines with proteins albumin and sex hormone-binding globulin (SHBG). For the most accurate results, testing is based on samples collected in the morning after fasting, and from tests on two different days."  What treatment options are available?  "Well, your best natural option may be YOU," says Dr. Kahlon. "Men with pituitary failure are often able to treat their low T by losing weight to increase levels of the hormone. And even if you don't lose weight, exercise can help boost your testosterone. Unfortunately, if you have testicular failure, weight loss and exercise may not have the same effect."  So, are there other options? "You may want to consider Testosterone Replacement Therapy (TRT)," says Dr. Kuhadiya. "TRT is only available to men who are hypogonadal — with a clinical diagnosis of low T. Injection, gel, skin patch and nasal spray are available TRT options. The best option is the one that works best for the patient. Convenience, insurance coverage and cost are all factors to consider." Dr. Kahlon's TRT preference? Daily gel treatments, which are applied directly to the skin. On the other hand, Dr. Kuhadiya recommends intramuscular injections, which take place once a week or every two weeks.  But both doctors agree on this: physicians and their patients need to weigh the benefits and risks of TRT before proceeding with treatment — especially if your low T condition may require lifelong treatment. "In my clinical practice, I have seen some very good long-term results with an improved quality of life," says Dr. Kuhadiya. "However, in certain situations, TRT may increase the risk of heart disease and is not recommended for men with a history of prostate cancer." Dr. Kahlon adds, "Patients receiving any type of hormone therapy need to be closely monitored throughout the treatment process for any changes in their health."   How do you feel about steroids and T boosters?  "I don't recommend them, certainly not for hypogonadism," advises Dr. Kahlon. "There is no evidence to support anabolic-androgenic steroids or testosterone boosters as a safe or effective treatment for low T in men."  "In fact, there continues to be emerging evidence they may lead to side effects that could potentially harm the liver and the pituitary and endocrine functions of the body," warns Dr. Kuhadiya. "And that damage may be irreversible."

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October is Breast Cancer Awareness Month. Join us in honoring our Chemotherapy & Infusion Services team at Renown Health!  Living life with a chronic condition is never easy – and the road to recovery can take many different turns. When it comes to a daunting diagnosis like cancer or a lifelong illness like multiple sclerosis or rheumatoid arthritis, chemotherapy, transfusions and IV medications are often significant parts of the puzzle. We’re proud to introduce our experts that provide that crucial puzzle piece.  The Chemotherapy & Infusion Services department at Renown Health is where compassionate care meets cutting-edge expertise. Proudly boasting a 100% patient satisfaction rate for 2023, this team – which encompasses nurses, physicians, pharmacists, dietitians, social workers, scheduling and insurance staff and financial counselors – embodies a profound dedication to healing while simultaneously empowering patients to face their diagnosis with resilience and hope.  Going Above and Beyond  The expertise within the Infusion Services team is unmatched in the region, offering education and treatment for a wide variety of illnesses, including:  Cancer Multiple sclerosis (MS) Anemia Osteoporosis Osteomyelitis Rheumatoid arthritis Genetic disorders Polycythemia vera  According to this team, it truly takes a village to deliver this expert care to all their patients.  “It's really impressive how many key players are involved in caring for our patients!” said Kaitlin Hildebrand, Supervisor of Infusion Services. “The process starts with our amazing Medical Oncology team or community providers referring patients to us. Our nurses are the absolute best advocates for our patients and are amazing at what they do; over half of us are Certified Oncology Nurses. We couldn’t do what we do without our CNAs or our pharmacy team as well; they are such valuable resources for us.”  “It is remarkable to think of the details that take place to ensure care for our patients,” added Amanda Thomas, Chemotherapy RN Specialist. “First, our incredible intake team schedules and obtains authorization, and the patient access representatives check in our patients. From there, our CNAs greet our patients, take their vital signs, ensure they have the proper nutrition and make sure they feel welcomed and comfortable with the process. Then, our chemotherapy specialist RN – which is my role – reviews treatments and coordinates with providers, personalizing care for each patient. In the background, the pharmacy specialists perform safety checks and medication preparation. And of course, our sincerely caring team of nurses assess, care and treat the patient while ensuring they feel educated, led by the charge nurse who supports the team doing safety verifications for all chemotherapies.”  Managing a diagnosis is more than medication – the hope and healing this team provides their patients is a huge aspect of each patient’s journey.  “We work together to take care of this amazing population of patients,” said Stacy Demitropoulos, Infusion Services RN. “We go above and beyond. It is more than just giving patients their medications. It is about human connection, helping them navigate this journey in their health and so much more! We help to troubleshoot problems they may be having and help give them resources.”  “I view going through someone’s cancer journey with them as a privilege,” added Ashley Gravelle, Infusion Services RN. “I try to just meet them where they are. Sometimes we are the only people patients are truly able to express themselves to, whether that be complaining about symptoms, talking about death and dying or being lighthearted about something really serious. I will be whatever the patient needs me to be that day.”  While the work of infusion therapy is fast-paced and requires close attention to time and detail, these teammates are never alone. They work closely together to ensure every patient gets the individualized care they need and deserve.  “Infusion Therapy is busy and extremely time-oriented,” said Audrey Arthur, Infusion Services RN.   “Between handling chemotherapy, immunotherapy, blood products, injections, antibiotics and central lines, there is always a task that needs to be handled. There is an expectation to provide detailed care as swiftly as possible so that these patients can go back home to their families. Additionally, you must keep treatment moving forward so the next person waiting in the lobby can receive their treatment in an appropriate and timely manner.”  “Life in the infusion center is fast-paced but rewarding,” added Nick Leid, Infusion Pharmacist. “The protocols that have been put in place by our clinical specialists allow us to provide patient care for dozens of patients every day while remaining safe and accurate. On the pharmacy side of the infusion center, we ensure that protocols are being adhered to: Making sure doses are calculated correctly, labs are appropriate for treatment, pre-medications for nausea and other symptoms are ordered correctly and that the products delivered to the patient are made correctly.”  “A day in the life of an infusion nurse is a busy one,” added Ashley Gravelle. “We care for usually 9-10 patients each on a given day, and the treatment ranges from chemotherapy and antibiotics to various biologics, TP, injections, lab draws and port/central line care. You have to be an excellent multitasker and be able to switch gears very quickly. It is impossible to do this work without our whole team. When one of us needs help, someone is always there to jump in. We work as a well- oiled machine.”  Together, the infusion services team exemplifies the power of compassionate care, dedication and expertise, lighting the way for healthier tomorrows.

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