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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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Jason Farnsworth, Evan Fox and Jennifer Jenni are three of Renown’s more than 500 employees who currently serve, or who have served, in our miliary. Their deep-rooted passion for helping our community extends to the Nevada National Guard (NANG), an organization that shares many values with Renown. We sat down with Jason, Evan and Jenni to ask their perspective on what propels them to serve people in our home state and learn more about how Renown's partnership with the Nevada National Guard has supported their personal and professional growth. Meet Jason Farnsworth, the Face Behind Renown’s Partnership with the National Guard Jason Farnsworth is the Director of Respiratory Care Services at Renown and the Chief Master Sergeant, Medical Superintendent of the Nevada National Guard. He has been with the Guard and Renown for 23 years. Jason joined the Guard over 20 years ago to help pay for his college education. After using up his paid vacation time from Renown for Guard events like deployments or training in his initial years as a Guard member, Jason approached Renown senior leadership with the idea of paid military leave. “In full support of employees who choose to serve, Renown stepped up to give a resounding, ‘yes,’ as they have time and time again for our military community,” Jason said. From that day forward, policies were implemented at Renown to further support individuals who serve our country with paid military leave. As a result, Jason submitted an Employer Support of the Guard and Reserve (ESGR) Secretary of Defense Freedom Award nomination and Renown Health won the highest-level department of defense employer recognition in the nation. Since then, Jason has received four associate degrees, one bachelor’s degree and a master’s degree with the government’s support and has been promoted several times to his current roles at Renown and the Guard. “As I progressed at Renown, I was able to progress in the National Guard. They've complimented one another on leadership skills and clinical competencies.” How Evan Fox Finds Synergy in His Roles at Renown and the National Guard After five years as a cardiac intensive care unit (ICU) nurse at Renown Regional Medical Center and two years as a First Lieutenant Critical Care Nurse in the Guard, Evan Fox has implemented care plans for many community members and put his expertise to good use. The countless trauma hours he has completed at Renown have directly translated to the field as a Guard member. He states that “his roles are synergistic, and his innumerable hours of critical care are worth their weight in gold because of the transferability between the two positions.” Evan’s Roles Provide Service to Our Community, and Beyond Evan feels passionately that his experience with the Guard is unique because you live in the area that you serve, whereas with other military branches you are often stationed elsewhere. Recently, he’s cared for many people involved in firefighting missions in our surrounding areas. As a member of the medical group of the Nevada National Guard, Evan is prepared to provide critical care at any given moment in the event of deployment due to a natural or man-made disaster. He can provide critical care in our region and across the nation. How Jennifer’s Leadership Journey Continues to Grow Jennifer Jenni is the nurse manager of the cardiac ICU and intermediate care unit at Renown Regional Medical Center. She has been with Renown for 13 years and initially started at Renown South Meadows Medical Center in the general surgical unit. She felt compelled to take advantage of Renown’s development programs as she worked her way up to supervisor and now as a manager. She is also a registered nurse and captain in the Nevada National Guard as well as a member of an enhanced resource force team, equipped to provide aid anywhere in the nation in the event of a disaster. With Jennifer, People Always Come First Her dedication to serving people has always been a part of who she is, even before she became a leader. From an early age, Jennifer felt strongly that she wanted to be involved in the military in some way stating that “the Guard is very much a service to the people, whether it's our community or nationwide.” While her clinical leadership qualities and skills have translated well to her role as a captain, holding two leadership titles is no easy feat – especially when it comes to the continued training her roles require. However, because of the support Renown provides its military community, Jennifer was able to confidently attend officer training in Alabama last year. Jennifer was fully supported by her Renown team when she was away and took advantage of her paid military leave benefit. More Than Just a Partnership, but a Family Jason, Evan and Jennifer are among the many employees who choose to serve both here at Renown and in the Guard. You might see National Guard members who are also Renown employees in areas like the cardiac ICU, trauma ICU, emergency department or medics who work on hospital floors. “Not only is my family out at the National Guard, but they are also here at Renown. It’s amazing to see how many people spend their lives giving back,” Jason said.

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Most babies weigh just one pound and are roughly the size of an eggplant when they reach 24 weeks of development inside the womb. It is a crucial stage when internal organs begin functioning, and the babies' respiratory and central nervous systems are still developing.     So, in November 2021 when Kallie Johnson experienced a premature rupture of amniotic fluid around this point in her pregnancy, her care team in Winnemucca decided to transport her via Care Flight to Renown Regional Medical Center. The team at Renown Children’s Hospital immediately began discussing the risks of delivering at 24 weeks with the Johnson family.  Moving Forward with Hope Knowing the stakes, Kallie remembers never feeling rushed to decide about delivering her baby preterm. “I felt educated and supported by my care team at Renown throughout our entire stay, starting with the education they provided about what it meant to deliver my baby early,” Kallie said. “The team really helped me make the best decision for myself and my family.”    Together, Renown employees and the Johnson family moved forward with a healthy set of nerves and a powerful feeling of hope.  Weighing in at one pound 11 ounces, Sloan entered the world on Nov. 19, 2021, via emergency Cesarean section. Her birth was classified as a micro preemie because she was born before week 26 of pregnancy and so small that she fit inside the palm of her father Sterling’s hand. A full-term pregnancy is classified as reaching 39 weeks.   A Fighting Chance  Called a fighter by many Renown Children’s Hospital care team members, Sloan spent over five months in the neonatal intensive care unit (NICU). She was placed on a ventilator, fed through a feeding tube and monitored 24/7, overcoming daily challenges with the Renown team and her family.  As a result of being born prematurely, Sloan developed a grade one brain bleed and a congenital heart defect called patent ductus arteriosus, a persistent opening between two major blood vessels, causing too much blood to flow to the lungs and heart.   To meet the oxygen needs of her tiny lungs, Sloan was intubated and developed a severe oral aversion and high-arched palate as a result. The effects would lead to difficult developmental and physical challenges that she still conquers today. Yet, with the help of her care team – including physical, occupational and speech therapists, dieticians and doctors – Sloan continues to make progress every day.

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