Men’s Health

For many men, low testosterone—also known as Low-T is a medical problem that often goes undiagnosed and untreated for years. Testosterone replacement therapy is the only scientifically proven method for treating the many symptoms associated with this hormone deficiency. Dr. Patel utilizes bioidentical hormones—also known as bioidentical hormone replacement therapy (BHRT)—to help men regain the physical vigor and emotional wellbeing that comes with normal testosterone levels.

For other men, erectile dysfunction (ED) seriously reduces their sexual pleasure and significantly harms their relationships and self-esteem. Dr. Patel practices functional medicine to discover the root cause of each man’s ED and individually tailor treatment to produce the best results possible. For some patients this involves a prescription such as Viagra, while other men require alternative erection treatment to address their sexual problems and start living life to the fullest again.


Testosterone Basics

What is testosterone?
Testosterone is a sex hormone produced by both men and women and is essential for good health and overall wellbeing. In men, this hormone is produced in the testes.
What is a hypogonadism?
Also known as Low-T, hypogonadism is the medical condition where a man’s body does not produce enough testosterone on its own. This hormone deficiency usually results from a problem in the testes or pituitary gland.
What are common symptoms of Low-T in men?
An inadequate amount of this vital hormone can cause numerous physical and psychological problems for men. Common symptoms of testosterone deficiency include:
What is “male menopause”?
Also known as andropause, male menopause is a term used to describe the gradual and natural decline in testosterone levels as men age. Many men start to really notice this decline in middle age. (At about the same time women go through menopause.)
How common is low testosterone?
Research estimates that about 2.5 million men in the United States between the ages of 40 and 69 suffer from hypogonadism. Put another way, low testosterone impacts between 20-40% of men over the age of 40 in this country.
Is testosterone replacement therapy (TRT) new?
No. Different types of TRT have been successfully used for over 70 years to treat the physical, psychological, and sexual consequences of Low-T in men.
What is the goal of TRT?
The goal is to bring your testosterone level into to a normal healthy range. Most men experience a significance improvement in their physical health, emotional wellbeing, and overall quality of life once hormone balance is restored.
What improvements are commonly seen with TRT?
Within a relatively short period time, most men start to experience:
  • Increased sexual desire and improved sexual performance
  • Increased physical energy (including exercise capacity)
  • Better general mood and sense of overall wellbeing
  • Decreased anxiety and depression
  • More mental energy and clarity
  • Better sleep resulting in less fatigue and irritability
  • Stronger bone density (or slower bone loss)
  • More muscular strength and lean body mass
When is testosterone therapy needed?
When a man’s natural testosterone levels are clinically low on a consistent basis and he is experiencing negative symptoms that seriously impact his overall quality of life.
Is TRT the only way to treat hypogonadism in such cases?
Yes. If your body is not producing enough natural testosterone, resulting in significant physical and/or psychological problems, TRT is the only safe and proven way to restore hormonal balance.
How soon after I start TRT will I start to feel and look better?
That varies with each individual and the type of treatment, but most men start to notice improvements to their health, appearance and wellbeing within 3 to 6 weeks after starting hormone treatment.
Is TRT approved for safety by the U.S. Food and Drug Administration (FDA)?
Yes. It is an approved medical treatment for men experiencing significant negative symptoms resulting from clinically low testosterone levels.
Can I take testosterone as an oral medication?
No. Oral forms of testosterone are not approved by the FDA and can cause serious health problems, particularly with your liver.
Does Dr. Patel need to monitor my testosterone use on an ongoing basis?
Yes, ongoing medical supervision is essential. Initial blood tests are needed to determine whether TRT is an appropriate treatment for you. Regular follow-up lab work is also needed for men receiving TRT to ensure optimal effectiveness and safety. Dr. Patel will review your test results with you during your office visits and make any necessary changes to your medication protocol.

Danger Of Low Testosterone

Do low testosterone levels pose a health risk for men?
Probably. A large body of research strongly suggests that low levels of testosterone can have important long-term negative health impacts.
Does a low testosterone level (Low-T) itself cause diseases?
Currently there is no scientific evidence that Low-T directly causes any serious illness. But a large amount of research demonstrates a strong connection between Low-T and many health problems.
What serious diseases are associated with Low-T?
Major health problems associated with low testosterone levels include:
  • Diabetes
  • Heart disease
  • High blood pressure
  • Stroke
  • Disease of the arteries
Is low testosterone associated with higher rates of obesity (and vice-versa)?
Yes. Large research studies, such as the European Male Aging Study, have established a strong link between clinically low levels of testosterone and increased rates of male obesity. (With all the major health problems that accompany it.)
Are men with normal levels of testosterone less likely to develop type 2 diabetes than men with Low-T?
Yes. Research studies indicate men with normal testosterone levels are about 40% less likely to develop diabetes.
Is Low-T associated with greater risk for depression in men?
Yes. A large body of scientific research demonstrates a strong link between low levels of testosterone in men and higher rates of depression.
Is testosterone replacement therapy (TRT) safe for men at-risk for heart disease?
Yes. Assuming such patients are closely monitored by an experienced physician like Dr. Patel, research indicates TRT is not only safe but may actually help prevent heart problems in the future.

Treatment Benefits and Risks (for men)

Is a proper testosterone level important for men in maintaining overall health?
Yes. Testosterone is a vital hormone, providing a wide variety of health benefits and helping to ensure physical and psychological wellbeing.
Can testosterone replacement therapy (TRT) help prevent heart disease?
Yes. For men with clinically low testosterone and no history of heart attack or stroke, research strongly indicates that TRT can help prevent serious cardiac problems in the future.
Can TRT help reduce the many health risks associated with obesity (metabolic syndrome)?
Yes. Normal testosterone levels can help men lose weight, reduce body fat and increase muscle mass. These changes can significantly improve overall health and quality of life while reducing the potential impact of serious medical conditions.
What obesity-related health problems can TRT help correct?
By helping men to lose weight and improve the muscle-fat ratio in their bodies, TRT can reduce the risk of dangerous problems associated with high blood pressure, type 2 diabetes, and high cholesterol levels.
Can testosterone therapy also improve overall psychological wellbeing?
Yes. Many scientific studies report that adequate testosterone levels help alleviate depression, anxiety, irritability and other common emotional problems in men.
Can TRT help with sexual problems such as lack of desire and erectile dysfunction?
Yes. Because testosterone is a sex hormone, having proper levels in the body can dramatically improve the sex lives of men currently suffering from Low-T. (Testosterone usually impacts low sex drive more than erectile dysfunction.)
Can older men on TRT enjoy all these health and lifestyle benefits as much as middle-aged men?
Yes. Older men suffering from Low-T can experience significant improvements in many aspects of their physical and emotional wellbeing. This includes increased libido (sexual desire) and improved sexual performance.
Do men on testosterone therapy need regular lab testing to monitor their blood levels?
Yes. Men undergoing TRT need lab tests on a scheduled basis to make sure their testosterone, PSA, and other key health indicators remain within safe ranges.
Is too much testosterone as dangerous to my health as too little testosterone?
Yes. Testosterone levels that are either significantly too high or too low can cause a variety of health problems, some of them potentially serious.
Will Dr. Patel prescribe hormone therapy to any man who requests it?
No. He only treats men with clinically low testosterone levels who exhibit symptoms of hypogonadism (low testosterone disorder). For men with naturally normal levels, the health risks of prescribing additional testosterone outweigh any potential health benefits.
Will TRT increase my chance of heart disease?
No. The most important risk factors for heart disease are related to obesity. TRT can help you lose weight and increase your energy to exercise more, thereby reducing your risk of heart disease.
Is TRT dangerous for my liver?
No. The various forms of non-oral testosterone that Dr. Patel prescribes do not pass through the liver before being absorbed by the body.
Will testosterone replacement therapy make me more aggressive?
No. Increased aggression is only a risk for men use oral anabolic steroids—which Dr. Patel never prescribes—or those who intentionally increase their testosterone level well above the normal range.
Does TRT increase my risk of prostrate cancer?
It depends. There is not an increased risk for prostate problems (including cancer) for men who are properly monitored by an experienced physician like Dr. Patel and have their blood levels tested on a scheduled basis. This treatment plan ensures their testosterone and PSA remain at safe levels.
What is the prostate cancer risk for men who take testosterone products without proper medical supervision and lab testing?
Testosterone and PSA levels in these men can rise to abnormal and dangerous levels. This significantly increases their risk for prostate problems, including possibly cancer.
Is TRT safe for men with a history of prostate cancer?
In some cases. This is an issue to discuss in detail with Dr. Patel, who will help you weigh the health benefits and risks of TRT given your complete medical history and current life circumstances.

Older Men

What is late-onset hypogonadism (LOH)?
It is a gradual age-related decline in testosterone levels that occurs in many men.
What age can LOH begin?
Testosterone levels usually begin to naturally decline after about age 40. For some men, this process can start earlier or later in their life.
What is the most common symptom of LOH?
The most common sign of lower testosterone in older men is decreased sex drive. Fortunately, this condition—which can cause significant stress in a man’s personal life—is treatable with proper medical attention.
What about erectile dysfunction?
Although low testosterone levels can contribute to ED in some cases, it is not usually the primary cause of the problem. (Please see the “Erectile Dysfunction” drop-down section for more information on this condition and the services we offer to treat it.)
Are there other symptoms commonly associated with LOH?
Yes. Older men can suffer from a wide variety of health-related problems linked to low testosterone. These include:
  • Low energy level
  • Anxiety, depression and irritability
  • Insomnia and other sleeping problems
  • Memory loss and unclear thinking
  • Excessive fatigue from exercise
  • Hair loss
  • Urinary problems
How many men suffer from LOH in the United States?
Although there is no universally accepted definition for LOH—that is, exactly how low a man’s testosterone level must drop to be diagnosed—it is estimated that roughly 2.5 million men in the U.S. between the ages of 40 and 69 have clinically low testosterone levels.
Have all of these men been diagnosed with the disorder?
No. Unfortunately, many older men (and their doctors) are not aware that numerous health and personal problems in their daily lives might be linked to low testosterone.
In addition to lower quality of life, can LOH contribute to serious medical problems?
Yes. Research indicates that low testosterone in middle-aged and older men is associated with increased risk for several serious health conditions, including diabetes and heart disease.
Can testosterone replacement therapy successfully treat LOH?
Yes. Testosterone therapy is an effective treatment for symptoms associated with hypogonadism in men over age 40. Benefits often include increased libido (sex drive).
Is testosterone therapy safe for men above age 65?
Yes, provided they are monitored on an ongoing basis by Dr. Patel. Under proper medical supervision, hormone replacement therapy does not increase the risk of serious conditions such as prostate cancer, urinary disorders, and heart disease.
Can men above age 65 benefit from treatment as much as younger men?
Yes. Medical research indicates that older men can benefit from testosterone therapy just as much as men in middle age.

Erectile Dysfunction

What is erectile dysfunction (ED)?
Erectile dysfunction (also know as impotence) occurs when a man is unable to get an erection during sexual activity or is unable to maintain an erection long enough to finish having sex.
How common is erectile dysfunction in the Unites States?
ED is the most common sex-related problem men discuss with their physician. It is estimated that about 30 million men in the U.S. currently suffer with this condition.
Can ED occur at any age?
Yes, but it becomes more common as men age. This is particularly true for men as they enter middle age and beyond.
So is erectile dysfunction just a natural part of the aging process?
No. Every man has many physical and psychological life factors that interact to determine his overall risk for ED. Age is but one of these factors—and impacts some men more than others.
What medical conditions can contribute to reoccurring erectile dysfunction?
A wide variety of health issues can increase your chances of experiencing ED on a regular basis. Please tell Dr. Patel if any of these apply to you:
  • Heart disease
  • High cholesterol
  • Diabetes
  • Clogged arteries (atherosclerosis)
  • High blood pressure
  • Parkinson's disease
  • Multiple sclerosis
  • Insomnia or other sleep disorders
  • Treatments for an enlarged prostate or prostate cancer
  • Surgeries or injuries involving the spinal cord or pelvic area
Are these the only risk factors for ED?
No. A number of personal characteristics and behaviors can also impact sexual functioning. These include:
Can emotional issues contribute to sexual problems as well?
Absolutely. Erectile dysfunction often has a psychological as well as a physical component. Men experiencing emotional issues such as depression, anxiety, irritation, and excess stress, especially on an ongoing basis, commonly have difficulties with sexual functioning.
Do sexual problems themselves often have emotional consequences?
Yes. Common psychological problems that can result from ED include anxiety, low self-esteem, and depression. It can also cause considerable emotional stress between a man and his sexual partner.
What physical conditions related to the penis can cause ED?
Certain medical diseases, injuries, surgeries, and treatments (especially cancer treatments) can negatively impact the sexual functioning of the penis. Biological problems that can hinder erections include:
  • Restricted blood flow into the penis
  • Inability to trap blood in the penis
  • Scar tissue inside the penis (Peyronie's disease)
  • Nerve signals not reaching the penis
  • Vascular or nerve damage to the penis
Can certain commonly prescribed medications contribute to ED?
Yes. These include pain medications, antidepressants, appetite suppressants, high blood pressure medicines, antihistamines, ulcer medications, tranquilizers or sedatives, and prostate medicines. Please tell Dr. Patel if you are taking of these medications.
So erectile dysfunction can have multiple causes in a particular case?
Yes. As the Mayo Clinic states: “Male arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels.” This complexity is why Dr. Patel always uses a holistic approach when treating ED.
What oral medications are available to treat ED?
There are currently four prescription medications available to treat ED, each with a different chemical formulation. One pill often works better than another for a particular man. The four medications are:
  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)
How do these oral medications work?
They all increase the amount of naturally occurring nitric oxide in the body. This relaxes the muscles in the penis and increases blood flow during sexual stimulation, allowing a man to get an erection.
What side effects are associated with these medications?
Possible side effects include headache, upset stomach, backache, vision or hearing changes, nasal congestion, and flushing. The most serious possible side effect is priapism—which involves having an erection that lasts four hours or longer. This condition requires immediate medical attention.
Who should not take these medicines?
Men who are already taking nitrates to treat chest pain or other heart conditions. Combining nitrates with ED drugs can cause a dangerous drop in blood pressure. The same is true for alpha-blockers used to treat prostate enlargement. Tell Dr. Patel about all the medications you are currently taking.
Do prescribed oral ED medications work for all men?
No. It is estimated that these oral medications work in about 70% of cases. But every man’s biological response and personal circumstances are different. As a result, drugs like Viagra or Cialis are not always the solution.
Are there other treatments available for men not helped by oral medications?
Yes. There are a variety of other treatment options. These include:
  • Penile Injections
  • Intraurethral medication
  • Vacuum Erection Devices
  • Penile Implants
What are penile injections?
Using a very fine needle, the drug Alprostadil is injected into the side of the penis. These injections are very effective for many men unable to get an erection from using oral medications. Dr. Patel will discuss whether this might be a treatment option in your case—and if so, will provide instruction on how to self-administer the injections.
How is intraurethral medication used to treat ED?
Using a special applicator, a tiny pellet of the drug Alprostadil is inserted into the urethra of the penis. (The urethra is the tube that carries urine out of the body.) When effective, men usually obtain an erection within 10 minutes, which usually lasts between 30 and 60 minutes. Dr. Patel will discuss whether intraurethral medication is an appropriate option for you—and if so, will provide instruction on how to self-administer the pellets.
What are vacuum erection devices?
Available by prescription, these devices produce an erection by pulling blood into the penis. The device consists of a hollow plastic tube that fits over the penis and a hand-powered or battery-powered pump which draws air out of the tube, creating a vacuum effect that causes an erection. In most cases the erection lasts long enough for a couple to have sex.
Can testosterone replacement therapy help with erectile dysfunction?
It might help when a man has clinically low testosterone levels. But testosterone therapy is not a proven method in and of itself to treat ED. In most cases the hormone is responsible for increasing the libido (sex drive), not improving sexual performance.
Does Dr. Patel perform surgery to correct erectile dysfunction?
No, he does perform procedures such as penile implants. That requires a urologic surgeon. But Dr. Patel can advise you when surgery might be a wise option to explore.