Tag Archives: Menopause

Straight, No Chaser: Low Testosterone

Endocrine/Metabolic, General Health and Wellness, Genital/Urinary, , , , , , ,

low-testosterone-treatment

Are you someone who had never heard of Low-T until recent commercials starting telling you that you weren’t normal? Let’s review what all the fuss is about.
As most people know, testosterone is the most important male sex hormone that in many ways and for many defines “manhood,” contributing to the following:

  • Changes of puberty, including deepening of your voice
  • Production of pubic, facial and body hair
  • Production of sperm
  • Facilitation of sex drive
  • Maintenance of bone health, which assists growth

Low-T-In-Men-Tucson

In case you were wondering, this is what “male menopause” looks like.
Certain parts of the brain (hypothalamus and pituitary gland) signal how much testosterone needs to be produced. Most production occurs in the testes.
The symptoms of low testosterone are predictable. Symptoms include a reduction in sex drive, erections and sperm count. Men may also see an enlargement of their breasts. Additional symptoms (over the long-term) may include smaller testes, less energy, mood changes, loss of muscle size and strength, and weakened bones.

low-testosterone

The aging process normally reduces sex drive, sperm count and frequency of erections. Aging also reduces testosterone such that clinically low testosterone levels invariably occur by age 70. The presence of these two independent facts can make it confusing to know if these symptoms are simply part of the aging process or might be attributable to a disease in the areas that either produce or regulate testosterone. In other words, although a natural age-related reduction in testosterone level is normal, it may or may not be the cause of lower sex drive.

testostgraph_men

Low testosterone in the absence of aging really is thought to be more of a sign of disease than a disease unto itself. The primary goal is to ensure than none of the more serious causes of low testosterone are present. Some of the more serious causes and considerations leading to low testosterone include injury, infection or cancer to the testes, radiation therapy or chemotherapy, hormonal disorders such as pituitary gland tumors or diseases, liver and kidney disease, diabetes, HIV/AIDS, obesity, certain genetic disorders and use of opiates (pain-killers).
Based on the cause and your health status, you may be prescribed testosterone replacement therapy. Testosterone replacement may occur via periodic injections, skin patches/gels, skin pellets or tablets that stick to the gums.
Testosterone replacement is not like taking a pill for an erection. These are hormones and come with long-term risks, the most notable being prostate cancer. Therefore, those males with prostate or breast cancer aren’t candidates for testosterone replacement therapy. Other side effects of testosterone replacement therapy include acne, breast enlargement, fluid buildup in the legs, ankles and feet, increased red blood cell count, prostate enlargement and sleep apnea.
Here are groups with significant enough risks from testosterone replacement therapy that they require monitoring if treated this way:

  • African-American men
  • Men over 40 years of age who have close relatives with prostate cancer
  • All men over 50 years of age

So what should you do with this information?

  • Understand that certain age-related changes occur naturally and don’t represent disease.
  • Understand that the premature presence of these symptoms could represent disease and need to be evaluated.
  • Understand that a desire to avoid the symptoms associated with low testosterone is best done with routine health measures (diet and exercise) that help the body function and maintain healthy levels of testosterone naturally.
  • Understand that a decision to seek treatment for these symptoms isn’t as simple as getting a pill or a patch. Hormonal treatment has real and serious associated side effects and risks and should only be done with the consultation and consent of your physician and endocrinologist (hormone specialist).

hrt

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Male Menopause (aka Andropause)

Endocrine/Metabolic, General Health and Wellness, Genital/Urinary, , , , , , ,

Andropause

Manopause?  Male Menopause? Yes, andropause is a thing (at least according to many medical authorities). Most of us are roughly familiar with menopause. You may or may not be surprised to discover that men suffer through similar age-related changes called andropause.
With both sexes, changes are related to diminishing sex hormones. In the example of women, it’s estrogen and progesterone. With men, it’s testosterone. One big difference between the male and female experiences is lower testosterone levels don’t prevent men from still being able to have kids. Men can have kids into their 90s.

andropauselowt

So the logical question to ask would be is this just the same as low testosterone? Well, not exactly. It’s the confluence of several problems men face with aging, including low testosterone, obesity, diabetes and depression (in those with these conditions). In particular, obesity, high blood pressure and diabetes seem to be particular risk factors. The fortunate news is this complex doesn’t occur universally and can be delayed with certain actions.
So what are you to do? For starters, know the symptoms and know when to ask for help. Here are symptoms commonly associated with andropause.

  1. Depression
  2. Difficulty sleeping
  3. Increased body fat, particularly in the midsection
  4. Irritability
  5. Less desire for physical activity
  6. Less energy
  7. Less erections or less strong erections
  8. Less mental sharpness and quickness
  9. Loss of armpit or genital hair
  10. Loss of confidence
  11. Loss of interest in regular activities
  12. Loss of libido
  13. Night sweats
  14. Reduced muscle mass
  15. Social withdrawal
  16. Swollen breasts

homer-2011-10-22-at-12.10.22-PM3

It’s important to get evaluated for these issues because even if these aren’t attributable to andropause, other causes can be even more serious. Examples of conditions that can cause these same symptoms include depression, drug and alcohol abuse, infections, heart disease, poor nutrition, stress and thyroid disease.
When you begin to develop these symptoms, you may discover that diet, exercise and weight control are important in relieving symptoms and slowing the progression of symptoms. Your physician likely will advise the same. In many cases, treating low testosterone is another important component of management. The next few Straight, No Chaser posts will discuss these additional considerations.

andropause-affects-men-382x382

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Twenty Questions on Menopause (Plus One)

Obstetrics and Gynecology, , , , , , ,

Menopause concept.

Menopause (aka “the change of life”) seems to be one of those things that everyone knows about but many don’t understand well. Let’s approach the topic by reviewing a series of frequently asked questions.

1. Why does it occur?
Menopause is the completion of menstruation. It can occur naturally due to the exhaustion of a woman’s supply of eggs or for other reasons such as having a hysterectomy combined with removal of the ovaries that store these eggs.
2. When does it occur?
The average age of menopause is 51. Symptoms may start much earlier, but it’s usually after age 45.
3. How do I know that menopause has started?
The first thing you may notice at the beginning of menopause is irregular periods. Other changes may include alterations in the flow or duration of periods. To actually know that the process has begun, you should discuss your symptoms with your gynecologist.
4. What’s going on with my hormones during menopause?
Many of the symptoms of menopause are related to changing levels of estrogen and progesterone, two prominent female hormones made in the ovaries.
5. What is perimenopause?
Perimenopause is the timeframe between when menopausal symptoms begin and your last menstrual period. You can still have periods and get pregnant during this time.

meno-symptoms-img1

6. What are the common symptoms of menopause?

  • A change in periods (shorter or longer, lighter or heavier, with more or less time between)
  • A change in your sleep patterns, with trouble sleeping
  • Hot flashes and/or night sweats
  • Mood swings
  • Less hair on the head and more on the face
  • Trouble focusing
  • Vaginal dryness

7. What is a hot flash?
A hot flash is a sudden warming sensation in your body, usually in the upper portions. This can result in flushing of your upper skin with redness and sweating, followed by shivering. Hot flashes tend to last between 30 seconds and 10 minutes.
8. How do I best deal with hot flashes associated with menopause?
Here are some tips to help you address those hot flashes and night sweats.

  • Drink cold fluids when symptoms begin.
  • Don’t smoke.
  • Dress in layers so that if symptoms begin, you may comfortably take off some clothing.
  • Dress and sleep in fabrics that allow your skin to “breathe.”
  • Lower the room temperature, especially when you sleep

9. I’ve heard that hot flashes aren’t as bad if I’ve had a hysterectomy. Is that true?
In some cases, yes. Overall, that correlates with age. If you have a hysterectomy without affecting the ovaries, then the ovaries are still able to make estrogen and progesterone (two important female hormones), and hot flashes may not occur or be as prominent early on. Once the ovaries stop making these hormones, symptoms may occur.
10. Why do I have problems with my bladder?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequent can lead to imperfect control, resulting in leaking and urinary tract infections.

© Copyright 2010 CorbisCorporation

11. Does sex change after menopause?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequently can lead to pain and other types of discomfort during intercourse. It is not uncommon to see a decreased level of interest after menopause. However, in some the feelings of freedom from possible pregnancy and other considerations lead many to feel sexually freer.
12. What causes early menopause?
Early (premature) menopause may be due to several factors, such as chemotherapy or pelvic radiation treatments for cancer, surgeries of the ovaries or uterus, genetics, chromosomal defects and certain autoimmune diseases (e.g., thyroid disease and rheumatoid arthritis–two conditions in which the body’s immune system may attack the ovaries).
13. Can I get pregnant after menopause?
By definition, no. Menopause represents the end of your menstrual periods, and as such you aren’t releasing any eggs that could be fertilized once this has happened. However, you can get pregnant during the perimenopausal period.
14. How is menopause medically managed?
Menopause is an occurrence, not a disease. However, some symptoms of menopause require treatment. More importantly (usually) considerations of and risks for breast cancer, heart disease and osteoporosis must be addressed. Your physician can be expected to have these conversations with you.
15. Can I still have periods after menopause?
By definition, no. “After menopause” is after you’ve had your last menstrual period. During the transition (i.e., the perimenopausal period), you may have a long gap between periods (i.e., irregular periods), but once menopause has occurred, you’re finished with menstruation.

menopausemoods

16. Why do I seem to be more moody?
It is not clear that mood changes are directly related to menopause. Many other circumstances occurring simultaneously may be contributing to these feelings. Such considerations include stress, anxiety related to family changes (e.g., becoming an “empty nester” or having ill parents), depression or diminished physical fitness, all of which may independently cause emotional distress and mood changes.
17. Why do I develop problems with my bones?
Estrogen controls bone loss. The loss of estrogen occurring around the time of menopause contributes to women losing more bone than is being replaced. As this process progresses, bones become weaker or more likely to break.
18. Why do I develop problems with my heart?
This is likely multifactorial. Heart disease simply increases with age. So does obesity and high blood pressure, both of which are risk factors for heart attacks. Estrogen loss may also contribute.
19.  How can I best stay healthy after menopause?
Read the next Straight, No Chaser post, which specifically answers this question.
20. When is it safe to say I’ve reached menopause?
It’s safe to say a woman has reached menopause when she has not had a period for one year.

andropause_

21. Why don’t men go through this?
Men actually do have a version of menopause called andropause. Stay tuned!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Twenty Questions on Menopause (Plus One)

Obstetrics and Gynecology, , , , , ,

Menopause concept.

Menopause (aka “the change of life”) seems to be one of those things that everyone knows about but many don’t understand well. Let’s approach the topic by reviewing a series of frequently asked questions.

1. Why does it occur?
Menopause is the completion of menstruation. It can occur naturally due to the exhaustion of a woman’s supply of eggs or for other reasons such as having a hysterectomy combined with removal of the ovaries that store these eggs.
2. When does it occur?
The average age of menopause is 51. Symptoms may start much earlier, but it’s usually after age 45.
3. How do I know that menopause has started?
The first thing you may notice at the beginning of menopause is irregular periods. Other changes may include alterations in the flow or duration of periods. To actually know that the process has begun, you should discuss your symptoms with your gynecologist.
4. What’s going on with my hormones during menopause?
Many of the symptoms of menopause are related to changing levels of estrogen and progesterone, two prominent female hormones made in the ovaries.
5. What is perimenopause?
Perimenopause is the timeframe between when menopausal symptoms begin and your last menstrual period. You can still have periods and get pregnant during this time.

meno-symptoms-img1

6. What are the common symptoms of menopause?

  • A change in periods (shorter or longer, lighter or heavier, with more or less time between)
  • A change in your sleep patterns, with trouble sleeping
  • Hot flashes and/or night sweats
  • Mood swings
  • Less hair on the head and more on the face
  • Trouble focusing
  • Vaginal dryness

7. What is a hot flash?
A hot flash is a sudden warming sensation in your body, usually in the upper portions. This can result in flushing of your upper skin with redness and sweating, followed by shivering. Hot flashes tend to last between 30 seconds and 10 minutes.
8. How do I best deal with hot flashes associated with menopause?
Here are some tips to help you address those hot flashes and night sweats.

  • Drink cold fluids when symptoms begin.
  • Don’t smoke.
  • Dress in layers so that if symptoms begin, you may comfortably take off some clothing.
  • Dress and sleep in fabrics that allow your skin to “breathe.”
  • Lower the room temperature, especially when you sleep

9. I’ve heard that hot flashes aren’t as bad if I’ve had a hysterectomy. Is that true?
In some cases, yes. Overall, that correlates with age. If you have a hysterectomy without affecting the ovaries, then the ovaries are still able to make estrogen and progesterone (two important female hormones), and hot flashes may not occur or be as prominent early on. Once the ovaries stop making these hormones, symptoms may occur.
10. Why do I have problems with my bladder?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequent can lead to imperfect control, resulting in leaking and urinary tract infections.

© Copyright 2010 CorbisCorporation

11. Does sex change after menopause?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequently can lead to pain and other types of discomfort during intercourse. It is not uncommon to see a decreased level of interest after menopause. However, in some the feelings of freedom from possible pregnancy and other considerations lead many to feel sexually freer.
12. What causes early menopause?
Early (premature) menopause may be due to several factors, such as chemotherapy or pelvic radiation treatments for cancer, surgeries of the ovaries or uterus, genetics, chromosomal defects and certain autoimmune diseases (e.g., thyroid disease and rheumatoid arthritis–two conditions in which the body’s immune system may attack the ovaries).
13. Can I get pregnant after menopause?
By definition, no. Menopause represents the end of your menstrual periods, and as such you aren’t releasing any eggs that could be fertilized once this has happened. However, you can get pregnant during the perimenopausal period.
14. How is menopause medically managed?
Menopause is an occurrence, not a disease. However, some symptoms of menopause require treatment. More importantly (usually) considerations of and risks for breast cancer, heart disease and osteoporosis must be addressed. Your physician can be expected to have these conversations with you.
15. Can I still have periods after menopause?
By definition, no. “After menopause” is after you’ve had your last menstrual period. During the transition (i.e., the perimenopausal period), you may have a long gap between periods (i.e., irregular periods), but once menopause has occurred, you’re finished with menstruation.

menopausemoods

16. Why do I seem to be more moody?
It is not clear that mood changes are directly related to menopause. Many other circumstances occurring simultaneously may be contributing to these feelings. Such considerations include stress, anxiety related to family changes (e.g., becoming an “empty nester” or having ill parents), depression or diminished physical fitness, all of which may independently cause emotional distress and mood changes.
17. Why do I develop problems with my bones?
Estrogen controls bone loss. The loss of estrogen occurring around the time of menopause contributes to women losing more bone than is being replaced. As this process progresses, bones become weaker or more likely to break.
18. Why do I develop problems with my heart?
This is likely multifactorial. Heart disease simply increases with age. So does obesity and high blood pressure, both of which are risk factors for heart attacks. Estrogen loss may also contribute.
19.  How can I best stay healthy after menopause?
Read the next Straight, No Chaser post, which specifically answers this question.
20. When is it safe to say I’ve reached menopause?
It’s safe to say a woman has reached menopause when she has not had a period for one year.

andropause_

21. Why don’t men go through this?
Men actually do have a version of menopause called andropause. It is discussed in this Straight, No Chaser.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: Low Testosterone

Endocrine/Metabolic, General Health and Wellness, Genital/Urinary, , , , , ,

low-testosterone-treatment

Are you someone who had never heard of Low-T until recent commercials starting telling you that you weren’t normal? Let’s review what all the fuss is about.
As most people know, testosterone is the most important male sex hormone that in many ways and for many defines “manhood,” contributing to the following:

  • Changes of puberty, including deepening of your voice
  • Production of pubic, facial and body hair
  • Production of sperm
  • Facilitation of sex drive
  • Maintenance of bone health, which assists growth

Low-T-In-Men-Tucson

In case you were wondering, this is what “male menopause” looks like.
Certain parts of the brain (hypothalamus and pituitary gland) signal how much testosterone needs to be produced. Most production occurs in the testes.
The symptoms of low testosterone are predictable. Symptoms include a reduction in sex drive, erections and sperm count. Men may also see an enlargement of their breasts. Additional symptoms (over the long-term) may include smaller testes, less energy, mood changes, loss of muscle size and strength, and weakened bones.

low-testosterone

The aging process normally reduces sex drive, sperm count and frequency of erections. Aging also reduces testosterone such that clinically low testosterone levels invariably occur by age 70. The presence of these two independent facts can make it confusing to know if these symptoms are simply part of the aging process or might be attributable to a disease in the areas that either produce or regulate testosterone. In other words, although a natural age-related reduction in testosterone level is normal, it may or may not be the cause of lower sex drive.

testostgraph_men

Low testosterone in the absence of aging really is thought to be more of a sign of disease than a disease unto itself. The primary goal is to ensure than none of the more serious causes of low testosterone are present. Some of the more serious causes and considerations leading to low testosterone include injury, infection or cancer to the testes, radiation therapy or chemotherapy, hormonal disorders such as pituitary gland tumors or diseases, liver and kidney disease, diabetes, HIV/AIDS, obesity, certain genetic disorders and use of opiates (pain-killers).
Based on the cause and your health status, you may be prescribed testosterone replacement therapy. Testosterone replacement may occur via periodic injections, skin patches/gels, skin pellets or tablets that stick to the gums.
Testosterone replacement is not like taking a pill for an erection. These are hormones and come with long-term risks, the most notable being prostate cancer. Therefore, those males with prostate or breast cancer aren’t candidates for testosterone replacement therapy. Other side effects of testosterone replacement therapy include acne, breast enlargement, fluid buildup in the legs, ankles and feet, increased red blood cell count, prostate enlargement and sleep apnea.
Here are groups with significant enough risks from testosterone replacement therapy that they require monitoring if treated this way:

  • African-American men
  • Men over 40 years of age who have close relatives with prostate cancer
  • All men over 50 years of age

So what should you do with this information?

  • Understand that certain age-related changes occur naturally and don’t represent disease.
  • Understand that the premature presence of these symptoms could represent disease and need to be evaluated.
  • Understand that a desire to avoid the symptoms associated with low testosterone is best done with routine health measures (diet and exercise) that help the body function and maintain healthy levels of testosterone naturally.
  • Understand that a decision to seek treatment for these symptoms isn’t as simple as getting a pill or a patch. Hormonal treatment has real and serious associated side effects and risks and should only be done with the consultation and consent of your physician and endocrinologist (hormone specialist).

hrt

Feel free to contact your SMA expert consultant for any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Male Menopause (aka Andropause)

Endocrine/Metabolic, General Health and Wellness, Genital/Urinary, , , , , ,

homer-2011-10-22-at-12.10.22-PM3

Manopause?  Male Menopause? Yes, andropause is a thing (at least according to many medical authorities). Most of us are roughly familiar with menopause. You may or may not be surprised to discover that men suffer through similar age-related changes called andropause.
With both sexes, changes are related to diminishing sex hormones. In the example of women, it’s estrogen and progesterone. With men, it’s testosterone. One big difference between the male and female experiences is lower testosterone levels don’t prevent men from still being able to have kids. Men can have kids into their 90s.
So the logical question to ask would be is this just the same as low testosterone? Well, not exactly. It’s the confluence of several problems men face with aging, including low testosterone, obesity, diabetes and depression (in those with these conditions). In particular, obesity, high blood pressure and diabetes seem to be particular risk factors. The fortunate news is this complex doesn’t occur universally and can be delayed with certain actions.
So what are you to do? For starters, know the symptoms and know when to ask for help. Here are symptoms commonly associated with andropause.

  1. Depression
  2. Difficulty sleeping
  3. Increased body fat, particularly in the midsection
  4. Irritability
  5. Less desire for physical activity
  6. Less energy
  7. Less erections or less strong erections
  8. Less mental sharpness and quickness
  9. Loss of armpit or genital hair
  10. Loss of confidence
  11. Loss of interest in regular activities
  12. Loss of libido
  13. Night sweats
  14. Reduced muscle mass
  15. Social withdrawal
  16. Swollen breasts

It’s important to get evaluated for these issues because even if these aren’t attributable to andropause, other causes can be even more serious. Examples of conditions that can cause these same symptoms include depression, drug and alcohol abuse, infections, heart disease, poor nutrition, stress and thyroid disease.
When you begin to develop these symptoms, you may discover that diet, exercise and weight control are important in relieving symptoms and slowing the progression of symptoms. Your physician likely will advise the same. In many cases, treating low testosterone is another important component of management. The next few Straight, No Chaser posts will discuss these additional considerations.
Feel free to ask your SMA expert consultant any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Male Menopause (aka Andropause)

Genital/Urinary, , , , , ,

homer-2011-10-22-at-12.10.22-PM3

Manopause?  Male Menopause? Yes, andropause is a thing (at least according to many medical authorities).
In a previous post, we discussed menopause. You may or may not be surprised to discover that men suffer through similar age-related changes called andropause.
With both sexes, changes are related to diminishing sex hormones. In the example of women, it’s estrogen and progesterone. With men, it’s testosterone. One big difference between the male and female experiences is lower testosterone levels don’t prevent men from still being able to have kids. Men can have kids into their 90s.
So the logical question to ask would be is this just the same as low testosterone? Well, not exactly. It’s the confluence of several problems men face with aging, including low testosterone, obesity, diabetes and depression (in those with these conditions). In particular, obesity, high blood pressure and diabetes seem to be particular risk factors. The fortunate news is this complex doesn’t occur universally and can be delayed with certain actions.
So what are you to do? For starters, know the symptoms and know when to ask for help. Here are symptoms commonly associated with andropause.

  1. Depression
  2. Difficulty sleeping
  3. Increased body fat, particularly in the midsection
  4. Irritability
  5. Less desire for physical activity
  6. Less energy
  7. Less erections or less strong erections
  8. Less mental sharpness and quickness
  9. Loss of armpit or genital hair
  10. Loss of confidence
  11. Loss of interest in regular activities
  12. Loss of libido
  13. Night sweats
  14. Reduced muscle mass
  15. Social withdrawal
  16. Swollen breasts

It’s important to get evaluated for these issues because even if these aren’t attributable to andropause, other causes can be serious. Examples of conditions that can cause these same symptoms include depression, drug and alcohol abuse, infections, heart disease, poor nutrition, stress and thyroid disease.
When you begin to develop these symptoms, you may discover that diet, exercise and weight control are important in relieving symptoms and slowing the progression of symptoms. Your physician likely will advise the same. In many cases, treating low testosterone is another important component of management.
Feel free to ask your SMA expert consultant any questions you have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Twenty-One Questions on Menopause

Obstetrics and Gynecology, , , , , ,

meno-symptoms-img1

Menopause (aka “the change of life”) seems to be one of those things that everyone knows about but many don’t understand well. Let’s approach the topic by reviewing a series of frequently asked questions.

1. Why does it occur?
Menopause is the completion of menstruation. It can occur naturally due to the exhaustion of a woman’s supply of eggs or for other reasons such as having a hysterectomy combined with removal of the ovaries that store these eggs.
2. When does it occur?
The average age of menopause is 51. Symptoms may start much earlier, but it’s usually after age 45.
3. How do I know that menopause has started?
The first thing you may notice at the beginning of menopause is irregular periods. Other changes may include alterations in the flow or duration of periods. To actually know that the process has begun, you should discuss your symptoms with your gynecologist.
4. What’s going on with my hormones during menopause?
Many of the symptoms of menopause are related to changing levels of estrogen and progesterone, two prominent female hormones made in the ovaries.
5. What is perimenopause?
Perimenopause is the timeframe between when menopausal symptoms begin and your last menstrual period. You can still have periods and get pregnant during this time.
6. What are the common symptoms of menopause?

  • A change in periods (shorter or longer, lighter or heavier, with more or less time between)
  • A change in your sleep patterns, with trouble sleeping
  • Hot flashes and/or night sweats
  • Mood swings
  • Less hair on the head and more on the face
  • Trouble focusing
  • Vaginal dryness

7. What is a hot flash?
A hot flash is a sudden warming sensation in your body, usually in the upper portions. This can result in flushing of your upper skin with redness and sweating, followed by shivering. Hot flashes tend to last between 30 seconds and 10 minutes.
8. How do I best deal with hot flashes associated with menopause?
Here are some tips to help you address those hot flashes and night sweats.

  • Drink cold fluids when symptoms begin.
  • Don’t smoke.
  • Dress in layers so that if symptoms begin, you may comfortably take off some clothing.
  • Dress and sleep in fabrics that allow your skin to “breathe.”
  • Lower the room temperature, especially when you sleep

9. I’ve heard that hot flashes aren’t as bad if I’ve had a hysterectomy. Is that true?
In some cases, yes. Overall, that correlates with age. If you have a hysterectomy without affecting the ovaries, then the ovaries are still able to make estrogen and progesterone (two important female hormones), and hot flashes may not occur or be as prominent early on. Once the ovaries stop making these hormones, symptoms may occur.
10. Why do I have problems with my bladder?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequent can lead to imperfect control, resulting in leaking and urinary tract infections.
11. Does sex change after menopause?
Changes in your hormone levels (i.e., estrogen) cause thinning and dryness of your genital area. This subsequently can lead to pain and other types of discomfort during intercourse. It is not uncommon to see a decreased level of interest after menopause. However, in some the feelings of freedom from possible pregnancy and other considerations lead many to feel sexually freer.
12. What causes early menopause?
Early (premature) menopause may be due to several factors, such as chemotherapy or pelvic radiation treatments for cancer, surgeries of the ovaries or uterus, genetics, chromosomal defects and certain autoimmune diseases (e.g., thyroid disease and rheumatoid arthritis–two conditions in which the body’s immune system may attack the ovaries).
13. Can I get pregnant after menopause?
By definition, no. Menopause represents the end of your menstrual periods, and as such you aren’t releasing any eggs that could be fertilized once this has happened. However, you can get pregnant during the perimenopausal period.
14. How is menopause medically managed?
Menopause is an occurrence, not a disease. However, some symptoms of menopause require treatment. More importantly (usually) considerations of and risks for breast cancer, heart disease and osteoporosis must be addressed. Your physician can be expected to have these conversations with you.
15. Can I still have periods after menopause?
By definition, no. “After menopause” is after you’ve had your last menstrual period. During the transition (i.e., the perimenopausal period), you may have a long gap between periods (i.e., irregular periods), but once menopause has occurred, you’re finished with menstruation.
16. Why do I seem to be more moody?
It is not clear that mood changes are directly related to menopause. Many other circumstances occurring simultaneously may be contributing to these feelings. Such considerations include stress, anxiety related to family changes (e.g., becoming an “empty nester” or having ill parents), depression or diminished physical fitness, all of which may independently cause emotional distress and mood changes.
17. Why do I develop problems with my bones?
Estrogen controls bone loss. The loss of estrogen occurring around the time of menopause contributes to women losing more bone than is being replaced. As this process progresses, bones become weaker or more likely to break.
18. Why do I develop problems with my heart?
This is likely multifactorial. Heart disease simply increases with age. So does obesity and high blood pressure, both of which are risk factors for heart attacks. Estrogen loss may also contribute.
19.  How can I best stay healthy after menopause?
Read the next Straight, No Chaser post, which specifically answers this question.
20. When is it safe to say I’ve reached menopause?
It’s safe to say a woman has reached menopause when she has not had a period for one year.
21. Why don’t men go through this?
Men actually do have a version of menopause called andropause. It is discussed in this Straight, No Chaser.
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Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1

Hematology & Oncology/Blood Disorders/Cancer, Health Prevention, , , , , , ,

breastcaassessment

When I started this point, my first thought was “Why reinvent the wheel? There is a massive amount of information available on the web about breast cancer.” However, as I looked through it all, I was equally amazed at how technical and filled with medical jargon much of it is. I guess that’s why Straight, No Chaser comes in handy! With that in mind, today I’m going to address specific simple steps you should be taking to assess yourself for breast cancer.
1. Reduce your risk factors

  • Discuss with your physician balancing the need for birth control with the use of oral contraceptives
  • When you are pregnant, breast feed
  • Exercise and reduce your obesity
  • Limit alcohol intake
  • If you’re post-menopausal, discuss with your physician balancing the need for hormone use with your breast cancer risks

2. Get screened

  • Learn your body better than anyone else; learn to do breast exams at and after age 20
  • Have a clinical breast exam at least every three years starting at age 20, and every year starting at age 40
  • Have a mammogram every year starting at age 40 unless your physician places you on a different schedule

3. Know the signs of concern and prompts to see your health care provider

  • Lump, hard knot or change in consistency inside the breast or underarm area
  • Persistent pain, swelling, warmth, redness or discoloration of the breast
  • Change in the size or shape of the breast
  • Dimpling, puckering or pulling in of the skin, nipple or other parts of the breast
  • Itchy, scaly sore or rash on the nipple
  • Nipple discharge that starts suddenly

I welcome your questions and comments.
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Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors

Hematology & Oncology/Blood Disorders/Cancer, Health Prevention, , , , , , , , , , , ,

breastcancerincidence

Even as a physician, I am left to think about the horror of being a woman with a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, it must be emphasized early and often: risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.
Breast cancer is the second most common cancer contracted by American women (after skin cancer), and it is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly, and approximately 40,000 women will die from complications of breast cancer annually (that’s over 100 deaths every day).
In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized.  This is largely thought to be due to declining rates of post-menopausal hormone use in response to results from major research projects. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.
Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor, and there are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with; if you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.
There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams and seeking early care for suspicious findings.  Now, there are other risk factors you can minimize. Oral contraceptive use, postmenopausal hormonal therapy, choosing not to breast feed, alcohol use and obesity are all risk factors for breast cancer that are under your control.
The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.
I welcome your questions and comments.
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Straight, No Chaser: (El)even More Myths Regarding Breast Cancer

Hematology & Oncology/Blood Disorders/Cancer, Health Prevention, , , , , , ,

Breast-Cancer-Myths2

Continuing from the earlier post with additional myths, well because you have so many questions!  In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.  

6. “Breast cancer is preventable.”

  • Unfortunately, this is not true.  All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. The risk of breast cancer isn’t affected by obesity.

  • Not true. The risk is particularly increased in post-menopausal women with weight gain.

8. African-American women have an increased risk due to hair straighteners and relaxers.

  • This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

  • Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

  • The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

11. “Tight clothes and underwire bras will make me get breast cancer.”

  • Not true. Neither has any connection to breast cancer.

12. “I was told small breasts give me less of a chance of having cancer!”

  • Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”

  • The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

  • No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

  • Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

  • Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

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Straight, No Chaser: Five Myths Surrounding Breast Cancer

Hematology & Oncology/Blood Disorders/Cancer, Health Prevention, , , , , , , , , , , , ,

bustingthemyths

Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.
1. “If a family member of mine has breast cancer, that means I’ll get it too.”

  • It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

  • There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

3. “Men don’t get breast cancer.”

  • Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

  • No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

  • Actually it’s 1 in 8 during a woman’s lifetime. The important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

Check back this afternoon for even more breast cancer facts and myths busted.
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Straight No Chaser: Myth Busters Edition – Migraine Headaches Fact vs. Fiction

Medical Treatment, Health Prevention, , , , , , , , , , , , , , ,

headache

There are 30 million migraine sufferers in the U.S. alone.  Women are thrice as likely to have them, but both sexes have to address the issues raised by them.  Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked.  And yes, regarding the lead picture, I refuse to say she’s lion.

Myth #1: I can’t help if I get migraines.  They’re hereditary, right?

There are a few things about being predisposed to having migraines I want you to know.

  • If you have one parent with migraines, there’s a 50% chance you’ll have them.
  • If both your parents have migraines, there’s a 75% chance you also will.
  • 4 of 5 migraine sufferers have a relative with migraines.

These facts represent a predisposition.  In order to have migraines, you must have triggers that will set off the migraine.  That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.

Myth #2: This is a woman’s disease.  They stress out more and are more emotional.  That’s why they get headaches.

It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone.  In fact, the incidence of migraines between the sexes is pretty equal until puberty.  Migraines are increased during pre-menstruation, when hormone levels are high.  Menopause may ease migraines.    All of this said, men still get migraines as well because of the presence of other triggers.  It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men.  Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.

Myth #3: My migraines won’t get any easier as I get older.

Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40.  Because of hormonal fluctuations during perimenopause, this reduction may not be seen.

  • Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.

Myth #4: Once I’m diagnosed with migraines, only narcotics will help.

First of all, trigger identification and prevention is vital.  Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.

  • Think triggers first and last.  The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications.  Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines.  Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
  • A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user.  If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine.  If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.

Patients must become their own experts on how and when you use different medications.

  • I hope you and your primary care physician have discussed and have you focusing on your abortive medications.  These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
  • Painkillers have consequences.  As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent.  Rebound headaches are a major component of these symptoms.  That’s a vicious cycle that doesn’t have a happy ending.  It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.

Myth #5: Migraines really don’t cause problems beyond the headaches, right?

Wrong.  If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes.  Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition.  If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%).  The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.

As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power.  Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments.  Take good care.