As of April 11, 2021, due to a new federal law called the 21st Century Cures Act that requires electronic health information to be made available to patients without delay.You will have access to your test results prior to your physician/provider has had a chance to review. We provide patients with secure, 24/7 access to their health records through our patient portal. And they go on this spiritual journey to learn everything they can about perimenopause and hormones. I don't know anything about thyroid hormones. And just like there is a specialist all over your face, there are specialists and much fewer for this part of the genitals because we haven't valued or cared about this part of the body for women. And so vaginal hormones help with this tissue. And so we see a lot of patients who have, they think they're abnormal when really big labia are hormonally healthy labia. Hyperprolactinemia is an uncommon condition172, 173 but it is a well-established cause of secondary (central) testosterone deficiency and can lead to infertility, decreased libido, sexual dysfunction, and gynecomastia. Hypergonadotropic hypogonadism, which is not a contraindication to begin testosterone therapy, can result from a number of conditions, including congenital abnormalities (KS being the most common), iatrogenic causes (e.g., bilateral orchiectomy, testicular radiation, chemotherapy), testicular trauma, infection, or autoimmune damage. Screening questionnaires are not an appropriate tool to identify candidates for testosterone therapy. Thus, pituitary dysfunction can develop after radiation therapy for sellar, parasellar, and extrasellar neoplasms (e.g., craniopharyngiomas, meningiomas, germinomas, chordomas, hemangio-pericytomas, pituicytomas, gliomas), head and neck tumors, and following total body irradiation for systemic malignancies. A survey of 120 patients who were treated for infertility at the University of Illinois-Chicago found that the incidence of testosterone deficiency was 45% in men with non-obstructive azoospermia, 42.9% in men with oligospermia, and 16.7% in men with obstructive azoospermia.159 Testosterone therapy in women has a much narrower evidence-based indication, with the strongest support in postmenopausal women with hypoactive sexual desire disorder (Davis et al., Journal of Sexual Medicine, 2019; Parish et al., Climacteric, 2021). The AUA guideline is often cited because it uses a total testosterone below 300 ng/dL as a reasonable diagnostic cutoff for testosterone deficiency. For women, the goal is to avoid supraphysiologic exposure and maintain levels within the normal female range if therapy is used at all (Travison et al., Journal of Clinical Endocrinology & Metabolism, 2017; Davis et al., Journal of Sexual Medicine, 2019). There’s growing interest in testosterone’s benefits for women with low levels. Urologists are also skilled in treating sexual problems such as erectile dysfunction or low sperm count. A urologist is helpful if the cause of low testosterone is in the testicles. These glands help control how much testosterone is made. Each doctor brings different knowledge and skills, and working as a team can help find the best treatment plan. Understanding their roles can help patients get the right care. Several types of doctors can be involved in diagnosing and treating low testosterone. When these symptoms start, many people wonder who to see for help. This also helps guide decisions about which type of doctor might be best for diagnosis and treatment. It is important to understand that testosterone does more than affect sex drive. This condition can happen for different reasons, including problems with the testicles, pituitary gland, or other health conditions. Low testosterone is one of several possible causes of anemia in men. Using vaginal hormones prevent urinary tract infections by more than half. Dr. Rubin gives you the evidence-backed treatment that can cut UTIs by more than half. Whether you’re navigating prostate issues, seeking answers about incontinence or ED, or facing a cancer diagnosis, we’re here with leading-edge care that’s specialized and compassionate. Congenital testosterone deficiency is often characterized by underdeveloped or undeterminable genitalia. These include damage to the hypothalamus, pituitary gland or testicles that can inhibit hormone secretion and testosterone production. Natural testosterone production declines with age, but a testosterone deficiency — also known as hypogonadism — can be the result of disease or other factors. Currently published studies have not demonstrated an increased risk of biochemical cancer recurrence in post-RP patients who are on testosterone therapy, nor does it define the optimal timing for commencement of testosterone therapy. Given the reproductive profile of the study population, the spermatogenesis results might not be generalizable to patients with testosterone deficiency.332A study of 66 males who presented with infertility while on exogenous testosterone therapy revealed several interesting findings.333 The authors used a total motile sperm count (TMSC) of 5 million as the benchmark for spermatogenesis recovery. Patients with testosterone deficiency who maintain testosterone levels in the normal range while on testosterone therapy should have their PSA levels tested, utilizing a shared decision-making approach, in accordance with the AUA's Early Detection of Prostate Cancer Guideline. Specifically, the odds ratio for developing ED in men with total testosterone 6 used a single question to define ED and also showed an increase in ED risk as total testosterone levels decreased. In a small study of young men with acute respiratory infections, mean total testosterone levels declined by 10%, with some cohorts experiencing reductions of up to 30%.25
