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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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Much like general physical and mental health, sexual health is an essential aspect of your overall well-being. Therefore, educating yourself on your sexual health is an important piece regarding your overall wellness. Secure & Private Virtual Visits Did you know that many sexually transmitted disease appointments can happen virtually, in the privacy of your own home? Our providers can perform a screening examination for sexually transmitted illness (without symptoms) when it’s convenient for you. This is a great option if the topic makes you uncomfortable during an in-person visit, or if you can’t find time to visit your primary care provider or local urgent care. After the telehealth appointment, your provider will determine the  next steps for you. Remember, in-person visits are always an option as well.   Here’s how you can take charge of your sexual health:  Get Comfortable with Getting Tested  Surprisingly, some people with STDs don't show symptoms, meaning they may not even know they have an STD unless they get tested. Even if an STD shows no symptoms, the result of non-treatment can be serious. Bret Michael Bellard, MD, with Renown Medical Group, shares that it’s important for people to get tested for STDs because if left untreated, they can cause the following health problems: Loss of fertility Pregnancy complications Other health issues  When to Visit Your Primary Care Provider  Who should get tested and how often? “The recommendations are that everyone from ages 13 to 64 should get tested at least once for HIV. All sexually active adults should also be tested for other STDs once a year, and all pregnant women should be tested at the start of their pregnancy,” says Dr. Bellard. Some STDs, like syphilis, can be passed from mother to baby, so it's important for women to get tested as soon as they know they’re pregnant.  Dr. Bellard recommends going to your primary care provider for testing. “They can also give advice on prevention and other health topics.” If you don’t have a primary care provider, this is a great reason to get established with one. Women with an established OB/GYN can have STD testing done simultaneously with their annual pelvic exam. The providers in Renown's network care for patients of all ages and specialize in family medicine, internal medicine, pediatrics and OB/GYN.   Practice Safe Sex  STDs are preventable. Practicing safe sex and getting tested routinely are your best defenses against all types of STDs.  For many, the conversation about sexually transmitted diseases is awkward and many avoid it. To lower your risk of contracting an STD, don’t wait until you’re “in the moment” to have the conversation with your partner about the last time you were both last tested. If you haven’t gotten tested in-between new partners, use latex condoms every time you have sex until you are both confirmed negative of STDs. Condoms are not 100% effective at preventing disease or pregnancy. However, they are extremely effective if used properly.   To establish Primary Care, visit renown.org/virtualvisits or call 775-982-5000

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“You’re gonna be a dad!” Whether you’ve been waiting years to hear those words or still think you’re too much of a kid to have a kid, the reality of impending fatherhood can be terrifying for any first-time, soon-to-be-dad. But not to worry, Best Medicine has some timely tips to help calm those bundle-of-joy fears and help you rock your new role as a brand-new, baby daddy.   Winter is Where Babies Come From Fact: More babies are born in September than any other month, with spill over (and spit-up) into October. Subtract ten months for the typical 40-week, bun-in-the-oven baking time and early winter stands out as the top baby-making part of the year. Is it the cozy nights before a fire as people avoid the snowman-friendly temperatures outside? Possibly. There could be any number of reasons, both seasonal and otherwise, for what will eventually arrive in the fall and immediately steal your heart — and untold hours of your sleep. Though moms carry most of the baby burden traditionally (and literally for three trimesters), that’s no excuse for the soon-to-be-dad not to step up to the plate and take a swing at being the best partner and father on the planet. Below is a list of tips and resources to help you do just that. So read on, daddy-o.  Tip #1: Don’t Freak Out Ok, you’re probably going to freak out even if we tell you not to. But once you calm down, consider this: human beings have been having babies for millions of years, and many of those soon-to-be-dads had it much tougher than we do today. And guess what? The human race is still going strong. Those first moms and dads did a good job — and you will too, with a little help. Tip #2: Take a Class Knowledge is power. In this case, it's diaper-changing, swaddle-wrapping, 2 a.m.-feeding power. And for you and your partner, taking a parenting class or two should be a no-brainer. You'll both learn what to expect and prepare for as you support each other and bond with your baby even before he or she arrives.   Tip #3: Learn From Other Dads If the thought of sitting in a room full of full-bellied women and their partners makes you uncomfortable, you may opt to stick with bros for your lesson plan. Dad-only classes and soon-to-be-dad support groups — taught and led by seasoned fathers with tales to tell and words of wisdom to share — are available online and in cities and communities around the country. Dad-focused sites also offer advice for new and still-learning proud papas. Here are a few options to check out:  Boot Camp for New Dads City Dads Group Wilderdad.com Fatherly.com Fathers.com  Tip #4: Babies are Required Reading Haven't read a good book lately? Well, if you're expecting a baby, now is the time to flip through a few pages that could make your life a whole lot easier in a few months. There's no such thing as being too-well-read when it comes to your fast-approaching, adorable little poop machine. The least you can do is read a book or two, or seven.  We're Pregnant! The First Time Dad's Pregnancy Handbook From Dude to Dad: The Diaper Dude Guide to Pregnancy We're Pregnant! The First Time Dad's Pregnancy Handbook  What to Expect When Your Wife Is Expanding Be Prepared: A Practical Handbook for New Dads  The New Dad's Survival Guide: Man-to-Man Advice for First-Time Fathers What to Expect When You're Expecting  Tip #5: Be a Prepared Soon-To-Be-Dad Tips 1 through 4 are meant to help alleviate some of your jittery, new-dad anxiety. And we hope they do just that. But if you really want to hold that "Best Dad Ever" coffee mug starting on day one, there are also some practical things you can do to prepare. Check these items off your list now to make life with baby more baby-, mommy- and daddy-friendly from the get-go.  Buy a baby/child car seat. Three out of four car seats are installed incorrectly. Protect your children by ensuring they are riding in a properly secured and age-appropriate car seat. Renown Children’s Hospital Car Seat Station is staffed by certified technicians who provide child vehicle safety restraint education, inspection and installation. Set up the baby's nursery early, including furniture  Stock up on diapers and baby supplies  Cook and freeze 2 weeks of food for nights when no one wants to cook  Research family healthcare  Agree upon a shared diaper-changing/feeding schedule  Ask about paternity leave from work  Get bills and finances up-to-date or pre-pay to avoid late charges   Give the home a thorough cleaning before the baby arrives

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If you and your partner are looking for a more permanent birth control method, you might consider a vasectomy. Although vasectomies are common, knowledge about them isn’t quite as common or talked about. If you are considering a vasectomy, talking with your primary care doctor is a great way to learn more and start the process. We consulted with Dr. Aurosis Reddy a primary care doctor with Renown Health – South Carson, about key topics to discuss with your doctor when considering a vasectomy. What is a vasectomy? A vasectomy – also called male sterilization – is a form of male birth control that blocks sperm from reaching semen, according to the American Urological Association (AUA). How effective and safe are vasectomies? Vasectomies are one of the most effective methods of birth control with a long-term success rate of over 99%. A vasectomy has been a safe and successful birth control method for many years. More than 500,000 men elect to have vasectomies every year in the U.S., and the number is rising. A vasectomy is also generally a low-risk procedure with a low complication rate ranging between 1-2%. What does the recovery period look like? A vasectomy is typically a quick procedure that takes under thirty minutes and can be performed in an outpatient setting under local anesthesia. Recovery from a vasectomy is also considered relatively easy. After a vasectomy, most can: Resume everyday activities within two to three days Resume normal exercise in one week Start engaging in sexual activity again in one week Your doctor can provide more details on what your individualized recovery process will look like.

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Concussions are an unfortunate occurrence in youth sports and other physical activities. Learning the signs now will help you respond if you suspect that someone near you has suffered a concussion. A concussion is a mild type of traumatic brain injury (TBI) that can occur after any injury to the head/neck area. It’s important to seek the appropriate level of care if they occur. Brandon Hockenberry, MD with Renown Sports Medicine shares tips on concussion signs to look for and what to do next. Look for these Dangerous Signs First Call 911 or visit an ER right away if you notice one of the following in the person who suffered a blow to the head or body: One pupil is larger than the other Severe or worsening headaches Drowsiness or inability to wake up, including any period of unconsciousness Slurred speech, weakness, numbness or decreased coordination Multiple episodes of vomiting Convulsions, shaking or twitching Monitor for Concussion Signs and Symptoms If someone suffers a bump, blow or other jolt, it’s important to look out for changing symptoms. Symptoms can continue to evolve for up to 24 hours after the injury. Seek care from your primary care provider, an urgent care or a sports medicine provider if you notice any of the following: Cannot recall events prior to or after the incident Appears confused or disoriented Clumsy movements Slow reaction, including movements and speech Changes to normal behavior or mood You should also question the person about how they are feeling. If they report any of the following symptoms, seek care: Headache or feelings of pressure in their head Nausea or vomiting Dizziness or balance issues Problems with eyesight, such as blurriness or double vision Increase sensitivity to light or sound Sluggishness, or feelings described as “hazy” or “foggy” Struggles with remembering or concentration Just “not feeling right”

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Tendonitis occurs when a tendon in your body is inflamed or irritated. This painful condition can impact your day-to-day activities, but can be managed and prevented. Luis Palacio, MD, shared some insights into how to manage tendonitis. Overuse and Repetitive Motion Tendons are complex tissues in our body that connect muscles to bones, allowing us to move. Unfortunately, sometimes these tendons become inflamed, worn down or injured, a condition called tendonitis. Symptoms of tendonitis include pain or dull ache, tenderness and mild swelling at the site. While tendonitis can be caused by a sudden injury, it is more commonly seen in frequent motions, including: Repetitive motions in exercise, work or other physical activities. Awkward positions in a movement, including poor posture. Forced movements that strain your body. Sudden increase in frequency of movement or level of difficulty, including little to no recover time between new activity. Shoes without proper support or hard surfaces, such as concrete floors. Evaluation is Key If you suspect that you have tendonitis and it does not resolve on its own after a few days, you should get it evaluated by a primary care or sports medicine doctor. They can make recommendations to aid your recovery and refer you to the right sub-specialist if needed. With some intentional actions, you can help reduce the risk of tendonitis with the following suggestions: Add variety: Mixing up the type of exercise you do will help prevent repetitive motions that can result in overuse. Stretch and condition: Make sure the keep up with proper stretching and muscle strengthening to support your physical activities. Do it right: Make sure that the way you are completing exercise or work-related physical activities is correct. Seek out a professional for lessons or guidance if you are unsure.

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Injuries happen to everyone. They are caused by participating in sports, recreational activities like hiking, and even by accidentally stepping off a curb wrong. If you experience a sprain or strain, the first few days are often the most painful. Renown Sports Medicine physicians Luis Palacio, MD and Brandon Hockenberry, MD walked us through what to do after an injury.  Listen to Your Body See a medical professional right away if: You know or suspect that a bone is broken You are having difficulties putting full weight on a joint of the leg Pain or swelling is severe There is a sign of an infection, such as redness and warmth in the joint  The First 24-72 Hours Joint sprains tend to swell more than muscle strains. You can use ice as needed for comfort and to relieve any pain, but do not use ice for more than 15-20 minutes at a time. Ice and NSAIDs (such as ibuprofen) can help prevent excessive swelling and mask the pain, but they do not speed recovery. Some research shows that overuse of ice actually delays recovery.    During the first 24-72 hours, your injury will go through an inflammation phase. Inflammation is your body’s natural way to dispose of dead tissue cells, build new healthy structures, and hopefully heal even stronger than before.

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Heat and ice are two of the most common treatments used to relieve pain and reduce swelling in injuries. However, each one is better suited for certain types of injuries Dr. Luis Palacio, MD explores the differences between the two.  When it comes to treating aches and pains, the debate between heat and ice has been ongoing for quite some time. Both have their benefits making it crucial to understand which option is better suited for your specific needs.   Determining which method is better depends on various factors such as the type of injury or pain you are experiencing. For instance, if you have recently sprained your ankle or pulled a muscle during exercise, applying ice within the first 48 hours can help minimize swelling and alleviate discomfort.   It's worth noting that some individuals find alternating between heat and ice therapy beneficial as well. This approach combines the benefits of both methods by using heat to increase blood flow followed by ice to reduce inflammation.  Cold Therapy  Cold therapy can help to reduce inflammation after an injury, heat can have the opposite effect. Therefore, heat therapy should be reserved for those who have chronic pain issues and are not dealing with an acute injury. Cold therapy is often recommended immediately after an injury or during the initial stages of inflammation.  Cold therapy such as ice packs are especially effective in treating: Sprains  Strains Any injury that involves swelling Heat Therapy  Heat therapy is known for its ability to relax muscles, increase blood flow and soothe pain. It is often used for chronic conditions or injuries that are not inflamed. Applying heat can help alleviate stiffness, promote healing and provide a comforting sensation. This increased circulation can bring more nutrients and oxygen to the area, helping it to heal faster.  Heat therapy such as heating packs are especially effective in treating:  Stiffness with associated pain   Injuries that are not inflamed  Muscle pain

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