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At Renown Dermatology, Laser & Skin Care, our experienced providers offer a wide range of services, coupled with advanced medical technology.   Skincare services include dermatology and competitively-priced treatments and procedures. Our professional and compassionate staff focuses on promoting lifelong health and wellness in a relaxing, modern atmosphere.

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Seeing a snake while exploring northern Nevada’s trails is somewhat rare and the chance of a snakebite is even less common. However, it’s important to make sure you’re ready for snakes and know what to do in case of a snakebite. Hiking the rugged, stunning and varied landscapes of northern Nevada is a huge draw for many who live here. But it’s important to stay alert and be prepared while you’re out exploring the natural habitats of wildlife, especially if you encounter a snake or get a snakebite. As you prep for your next outdoor adventure, remember these three tips to stay safe in Nevada’s wilderness. 1. Leave snakes alone In general, if you don’t mess with snakes, they won’t mess with you. Seeing a snake is fairly uncommon because of their body camouflage and secretive nature, which are their first defenses in evading predators. According to the Nevada Department of Wildlife (NDOW), most snakebites happen when a person tries to capture or kill the snake. Nevada is home to 52 species of snakes and reptiles, according to NDOW. Only six can be dangerous to people and pets: Western Rattlesnake (this is the most common type of venomous snake in northern Nevada, especially around Yerington and Fallon) Sidewinder Mohave Rattlesnake Speckled Rattlesnake Western Diamondback Gila Monster (these live in southern Nevada’s Mojave Desert) Venomous snakes, like the rattlesnakes, have a wide head and thick body. Non-venomous snakes are usually more slender and have a narrow head. If you see a snake on the trail and you aren’t sure if it’s venomous or not, it’s best to be safe and leave it alone by moving away slowly. 2. Wear the right gear and take care where you walk NDOW and the U.S. Department of Agriculture suggest doing the following to decrease your chances of a snakebite: Wear over-the-ankle boots, thick socks and loose-fitting long pants. Stick to trails and stay out of the bushes or tall grass. Don’t step where you can’t see. If going over a fallen tree or large rock, step on it. Don’t jump over it. A snake might be lying on the other side. Always check stumps or logs for snakes if you’re going to sit on it. If you see one or hear a rattle, move away from the area slowly. Don’t run or make any sudden movements. Don’t handle or move a recently-killed snake as it can still inject venom. And for your dog, the best way to prevent a snake bite is to keep it on a leash. 3. Know what to do (and not do) if you get a snakebite Renown Health primary care physician Aaron A. Bertalmio, MD, reminds us the odds of getting a snakebite are very low. Roughly 7,000 to 8,000 people get bitten annually and only 5 percent die according to the U.S. Food and Drug Administration. But in the event of a snakebite, here’s what to do: Get medical help as soon as possible Stay calm to help keep your heart-rate low Remove constrictive clothing or jewelry Clean the wound with soap and water if available Cover the snakebite with dry, sterile cloth or adhesive bandage if available Keep the bite snakebite area level and below your heart if possible WHAT NOT TO DO IF YOU GET A SNAKEBITE: Apply a tourniquet (a tool used to stop arm or leg blood flow) Ice the bitten area Suck out the venom You’re now prepped and ready on what you need to know about Nevada’s slithery friends so you can stay safe and enjoy the outdoors!

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Something wasn’t right. Even though it was the holiday season, on December 23, 2018, Mondo Corona didn’t feel good…not to mention his sudden earache. Although Christmas was a happy celebration with his family. He still felt tired. Was it the flu? And that darn earache wouldn’t go away. On that cool winter day, Mondo could not imagine he was near death. Or that he would become a heart attack survivor. Know Your Heart A few days later, on December 27, he wasn’t feeling any better. He decided to go to the emergency room at Renown Regional Medical Center. That’s when a simple blood test revealed shocking results. “I thought about death a lot. I was calling people to ask them to help take care of my family if I wasn’t going to be here anymore,” he emotionally confesses. Although Mondo loves his job as a railroad engineer, it involves on-call shifts and an erratic sleep schedule. At that time his exercise and eating habits weren’t the best either. Yet he never imagined he would have a massive, often lethal, type of heart attack called ‘the widowmaker.’ In fact, his family had been concerned about his health for awhile. “He worked so much and he didn’t take care of himself and he didn’t exercise – he was burning the candle at both ends,” shares his wife, Alison. His daughter Justice, an avid exerciser, was always encouraging him to join her at the gym, but could never quite convince him. Mondo remembers the time before he became a heart attack survivor. “I didn’t have any exercise whatsoever in my life. At that point my eating habits were just terrible,” he shares. He went to the emergency room due to his earache, but nothing was found until one of the doctors ordered some tests. Specifically blood work showed high troponin levels. Troponin is a blood protein often released in large amounts when the heart muscle has damage, sometimes by a heart attack. Heart Attack Survivor “My surgeon came in and told us that it was going to be a triple bypass – that three of the four…major arteries were clogged 100 percent,” Mondo explains. Amazingly his heart was pumping on only 10 percent blood flow. Heart surgeon, Joseph Brandl, MD, told him he survived a widowmaker heart attack. This type of heart attack happens when there is a 100 percent blockage in the critical left anterior descending artery (LAD) of the heart. Frequently the symptoms can often be mistaken for the flu. According to the Centers for Disease Control and Prevention (CDC), every 40 seconds a person in the U.S. has a heart attack. And 1 in 5 heart attacks are “silent” – meaning you can be a heart attack survivor, but not know it. For Mondo’s children, seeing their strong father struggle after heart surgery was difficult. Justice tearfully shares, “It was really hard seeing him so vulnerable. He really needed anybody’s and everybody’s help at that point.” A Heart Attack Survivor Program After leaving the hospital on January 5, 2019, he was extremely weak. On February 12, Mondo began Renown Health’s Intensive Cardiac Rehabilitation (ICR) Program called the Healthy Heart Program. This program, requiring a doctor referral, includes 12 weeks of supervised exercise along with nutrition education and stress management skills. In spite of heart disease being the leading cause of death in the U.S. – more than all cancers combined, the risk can be lessened with daily lifestyle habits. Mondo credits the ICR program with motivating him and getting his focus back on his health. He saw the team members setting an example and also caring about his health. He describes one of his favorite recipes, “In ICR Sara showed us how to make this incredible fruit salad, with jicama, watermelon, grapes, oranges, red onion, and ginger!” Of course, the recovery process was not overnight. “It did take a long time to really realize that he was going to be back to normal, that he was going to be okay and that he was going to be that strong provider for me and my children,” Alison reflects. “Mondo’s had an amazing outcome and he’s not limited in his activities at all and should hopefully have a life that’s not limited at all from heart disease as we’re monitoring everything and everything’s looking good,” reports his heart doctor Jayson Morgan, MD. Mondo describes his care experience being a heart attack survivor as life-changing. “The care teams at both Renown and ICR were incredible. There wasn’t a single person we came across who didn’t immediately become a part of the family. They truly cared for us, all of us, including the extended family that came to visit. They were informative and supportive. I felt like I created lasting bonds with so many of them, especially the gang in ICR. What amazing people.” Lynice Anderson, Director of Intensive Cardiac Rehab, Healthy Heart Program, shares,” Mondo is one of the most genuine, thoughtful and humble people I have ever met. His love for his family is palpable. His impact on me personally and our team is forever.” She acknowledges family support is key to his success, “Mondo’s family is his rock and they are his. I have never met a family that was so ‘all in’ in the support of their loved one. His new heart healthy lifestyle is modeled through his family every day.” Fighting The Good Fight Of course, Mondo may look familiar to you. That’s because he is featured in Renown Health’s “Fight The Good Fight” brand campaign. For this reason, you may have seen him in advertising working out on a treadmill, shirtless, with his open heart surgery scar in full view. When asked how he feels about showing his scar he confidently says, “I don’t mind showing it to people. I don’t. I earned that scar.” He is a proud heart attack survivor. Today, he’s grateful to be alive and takes his health commitment seriously. “Things have a different feel now. The skies and lakes are bluer and the trees greener. My family is so much more a part of my day. We go on so many more outdoor adventures, trying to incorporate a little exercise into our fun. We watch what we eat more and are trying to teach our children and loved ones about healthy choices. And I think with a few we’ve even been successful!” he observes. “Don’t take life for granted.” “Unconditional love. I get nothing but support from my family without them I wouldn’t be where I’m at. What happened to me definitely makes me a fighter for sure. I’m fighting for my life – the good fight – I think life is good,” he adds.

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It seemed like a normal Wednesday, except Kimi Woolsey was feeling really stressed. On Sept. 4, 2019 she was rushing to get ready for an appointment when suddenly, she could not feel her legs. Kimi immediately knew something was wrong and called out to her fiancé, Paul, for help. After seeing a bright light in her right eye, she felt a severe, sharp pain in her head traveling down into her leg. Paul quickly called 911, the EMT’s arrived and her stroke survival journey began. At first the medical team thought she had a complicated migraine, but one of them suspected a stroke. On the way to the hospital Kimi felt numbness and her face drooping, then instantly, no pain. For a moment she thought she was dying, going from pain to numbness and realizing she couldn’t move or speak. Kimi didn’t know she was having another massive stroke in transit. Each year nearly 800,000 people in the U.S. suffer a stroke, or “brain attack” – that’s one every 40 seconds. Of those, about 75% occur in people over age 65. However, at only 45 years old, Kimi is proof that a stroke can happen at any age. Stroke Survival Begins for Kimi Upon arriving at the emergency department of Renown Regional Medical Center the Certified Comprehensive Stroke Center team went into action. Kimi received a brain MRI, then was wheeled into surgery for a thrombectomy (clot removal). She was in the intensive care unit for 11 days. She remembers someone telling her, “Generally people don’t survive this magnitude of stroke.” And a doctor saying, “You are here for a reason.” Kimi’s comeback journey began with the comprehensive care team at Renown Rehabilitation Hospital. “Literally I had the best day of my life that first day there…I was so happy because I couldn’t imagine being in a safer place with people that literally live for you,” she recalls. During her 41 days there, her biggest milestone was being able to get out of bed and walk. For Kimi the support she felt at the rehab hospital was key to her progress, ”I still feel loved and appreciated and they’re rooting for me still and I can feel it.” Although she left the rehab hospital on Oct. 18, 2019, she is still working on improving the left side of her body. Currently Kimi works with therapists in outpatient physical rehabilitation sessions, continuing to see improvement in both her hand and leg. Her advice to those currently in a rehab hospital setting is, “Stay as long as you can to get the most out of it and push, push, push.” Kimi’s Stroke Survival as a Warrior “Having a stroke is not for the faint of heart,” says Kimi. She experienced despair and felt discouraged. Many days she would ask herself, “Why am I here?” Today she proudly calls herself a stroke warrior and refuses to be a victim of her stroke. Alongside her tenacious spirit, Kimi actively helps others on their stroke survival journey. Before her stroke she never dreamed of starting a non-profit foundation. Now, each day you’ll find her texting inspiration to others, offering advice and connecting with other struggling stroke survivors on her Facebook page, Stroke Warrior Recovery Coach. Her goal is to become the person she needed to talk to after her stroke; she currently coaches several stroke survivors. “Stroke survivors need to know that they aren’t alone. Mental support and encouragement are so important for each person’s stroke journey,” Kimi said. Along with the physical changes, Kimi feels the stroke magnified her empathy. “I was always in a hurry in my life. People didn’t go fast enough for me – on the road, at the grocery store, in a line. Now I have more patience with myself and others." Kimi realizes most people cannot wrap their brain around the concept of a stroke. In fact, the brain fog, physical challenges and frustration are hard to explain… unless you’ve experienced them. “You need to find your tribe,” she explains. “I have a passion for helping people through this process.” Most of all, she encourages people to keep going and never stop. After her stroke, Kimi has a greater appreciation for her family, health and life. She is one of the patients featured in the current “Fight The Good Fight” trauma and physical rehab advertising campaign. “I wake up every day and fight,” she asserts. “Each day you have to fight for your recovery and fight for yourself.”

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A Friendship Gone Viral  When a friendship is strong enough, it can survive just about anything – even a pandemic! Sterling Silver Club members and longtime friends, Marlene and Kim, are living and thriving proof of that.  Career & Community Cohorts  With successful careers in the Reno area and a common passion for community involvement, it’s no surprise the women knew of each other even before their friendship developed. The first time they actually worked together was in 2001 at TMWA (Truckee Meadows Water Authority), where Marlene’s company was brought on board to steer communications and Kim was heading up the then-new utility’s customer relations department. TMWA was where these colleagues became cohorts who have since become the best of friends.  Now retired, Kim’s favorite job these days is being a doting “Noni” to her two granddaughters who live nearby and who she keeps up with by staying active. Kim enjoys practicing yoga and loves to spend time walking and hiking in the great outdoors – with two enthusiastic dogs that are always ready to join her.  Marlene is still working and running her nearly 40-year-old public engagement and outreach company, GoodStanding. Her “fun and interesting” projects help to build community engagement for her clients and often focus on water resource management and conservation.  The Rotary Club of Reno, known as the “downtown club,” is also an important part of both women’s lives. Marlene was just the third woman to join the historically male organization in 1991 and made it her mission to recruit and sponsor female members – like Kim. Today, women make up nearly half of the membership and Marlene and Kim are both heavily involved in the club and its initiatives, including its scholarship program and community beautification projects along Riverside Drive.  A Friendly Q & A  To learn more about the friends and maintaining friendships in these socially distanced times, we asked them some questions.   What drew you to each other as friends?  Kim: Marlene’s honesty, integrity and ethics. Marlene always does what is best for her clients, no matter what.  Marlene: Kim and I communicate very well. It’s hard to explain, but sometimes we are both way ahead of our words. How would you describe each other in a single word? Marlene: Focused. Don’t put anything in front of Kim that you don’t want done, and done expertly. Also, helper. She thrives on helping people and working through their problems.  Kim: Creative! Marlene came up with many unique ideas to promote and publicize TMWA. And her house the most cozy spaces to sit and visit.  Do you have a favorite “That’s so her” moment to share? Kim: Burning Man! Marlene had friends with a camp at Burning Man and she invited me to join them for three days a number of years ago. We rode our bikes, admired the art and did our best to sleep through the techno music that played through the night. It was an amazing time.  Marlene: Kim’s involvement in Rotary’s Achievement Beyond Obstacles (a support and scholarship program for deserving local high school students). She has a heart for kids facing challenges, she is a great leader and she loves to help and make a difference.  How has COVID-19 affected your friendship, how have things changed and how have things stayed the same? Kim: We don’t see each other in person quite as much. However, Marlene has made sure that many of our girlfriends are able to stay in touch.  Marlene: I don’t take for granted we are going to see each other, so we plan it. I am the instigator of walks, socially distanced get-togethers in our green space and Zoom meetings. This new normal has also given me permission to stay home and work. Now, it’s OK to do some gardening or take a walk in the middle of the day. I suppose that’s one pleasant side effect of COVID-19.  Why did you become members of the Sterling Silver Club and why would you encourage others to join?  Kim: So many friends and family members had nothing but good things to say about Renown that I decided to switch providers. I also really liked what Renown was doing with the Healthy Nevada Project. So, when I saw the Sterling Silver Club, it seemed to me to be just another extension of all the good things Renown has to offer!  Marlene: This Club sounded interesting because it would allow me to focus more on my health with like-minded people in my age group. And, I’m with Kim, Healthy Nevada Project is very intriguing for how it could potentially improve health care for all of us.  What is the secret to a lasting friendship?  Kim: Have patience. Don’t take things personally. Be flexible. And just enjoy one another’s company. Marlene: Respect and grace, equally. We are not perfect and we are all different. So give your friends respect always, grace when they flub up and support when they need help.  Thanks to Kim and Marlene for being such generous collaborators and ambassadors of the Sterling Silver Club.  Friend Fun Fact:  Kim helped Marlene find her new house a few years ago – and more recently, a new dog! Marlene and “Levi” have been inseparable ever since.

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If Sterling Silver Club member Ann had an official motto, it would be, “I love to learn new things.” Ann has been a Reno resident for about 25 years after making her way to the Silver State from Arizona and before that, her birth state of Indiana. All along the way, she’s been growing, exploring and learning. Meet Ann From her days as a Girl Scout to her cherished roles as mother and grandmother and her time spent working for the federal government, Ann has enjoyed the adventures she’s had, the people she’s met and the learning opportunities that continue to be an important part of her life’s journey. “Learning never has to end,” Ann says wisely. Today, Ann lives a life full of learning — and giving. She is a member of the Osher Lifelong Learning Institute (OLLI) at UNR, which offers classes and events for people who are 50 and older. She has also been a foster grandparent for Seniors in Service and has tutored troubled teens at the Jan Evans Juvenile Detention Center and helped out at Title 1 schools. Volunteer Extraordinaire Her volunteer résumé continues with work for the Reno Police Department’s SAVE program through Retired Senior Volunteer Program (RSVP) for Sanford Center for Aging and time spent with VISTA for AmeriCorps, helping victims of domestic violence and refugees. And with her recent appearance in Ky’s Kab, a segment of Aging & Awesome — the popular 55+ show airing Saturdays at 7 p.m. on local CBS affiliate, KTVN Channel 2 — she’s a bit of a celebrity to boot! Through all of her experiences, Ann has learned something about herself and others. She looks forward to the new memories and friendships her latest membership to the Sterling Silver Club will bring. “I love being a member of the Sterling Silver Club because it’s another opportunity for me to grow, have fun, learn and socialize,” she says. And everyone at Renown is thrilled to help her do those things — and live a happy, healthy life. Please join us in welcoming Ann, one of our first members of the Sterling Silver Club. Today we have more than 2,800 members and we’re happy to be featuring members and getting to know you all along the way!

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Need fresh hiking trails? These hiking trails offer new views, a different route or the motivation you need to get outside. Of course, whatever you’re looking for this summer, these trails were made for sunshine in Reno-Tahoe. Easy Hiking Trails Oxbow Nature Study Area Nature Trail Location: 3100 Dickerson Road, at the Truckee River. Parking: There is a parking lot onsite. Time Out and Back: 30 minutes Items to Bring: Water, sunscreen and a hat. Although this loop is just under one mile, it’s the perfect escape in the heart of Reno. And this riverside trail is accessible for all skill levels. Bird watcher? Certainly, keep an eye out for black-crowned night herons, red-shouldered hawks, mule deer, beavers and more wildlife in the area. Tahoe-Pyramid Bikeway – Sections 2 to 4 Location: West Reno to Sparks Parking: Woodland Drive, Crissie Caughlin Park, Idlewild Park, 1st Street, Rock Park and Spice Island Drive. Time Out and Back: 2-4 hours (each section, out and back) Items to Bring: Water, sunscreen and a hat. From west Reno to Sparks, this paved portion of the trail stretches more than 8 miles. And it is easy to find as it runs along the Truckee River. As one of the easiest hiking trails in the region, it includes numerous parking access points and you can walk as long or short as you desire. In particular, one great route is from Rock Park on S. Rock Boulevard to Cottonwood Park on Spice Island Drive in Sparks. It’s an easy walk for all hiking levels. Notably many evening hikers explore this area to view the bats living under the McCarran Bridge. Additionally, an array of birds and river views can also be found along this enjoyable path. For maps for sections of this path, visit Tahoe-Pyramid Bikeway’s website. Cave Rock Hiking Trail Location: South Lake Tahoe; turn right on Cave Rock Drive from Highway 50, just prior to the tunnel. Parking: Park on Cave Rock Drive. Time Out and Back: 30 minutes Items to Bring: Water and sunscreen. Not only does this short trail have breathtaking views of Lake Tahoe, but it is also meaningful. Chiefly the rock was created more than three million years ago. Equally important, it is still considered sacred to the Washoe Native Americans. Also, leashed dogs are welcome on the trail. Moderate Hiking Trails Steamboat Ditch Trail Location: To get to the trailhead, take Mayberry Drive in west Reno. Then turn south on Plateau Road and right onto Woodchuck Circle. Parking: There is a dirt area for limited parking. Time Out and Back: 3-5 hours Items to Bring: Water, layers, sunscreen and a hat. Of all the hiking trails listed, this one offers some of the best views of downtown Reno and the surrounding hillsides. Built by Chinese laborers in the late 1870s, the Steamboat Ditch is the longest ditch in the Truckee Meadows region. In fact, the water serves as a vital source for ranchers and farmers south of Reno. First, start behind the Patagonia in northwest Reno at the Tom Cooke Trail or park off of Woodchuck Circle. Next head west to find the “Hole in the Wall.” Surprisingly this is a tunnel engineered through the hill, so the ditch could supply water to the Truckee Meadows. This hike is a little over 8 miles with the halfway point just under 4½ miles. With this in mind, if you’re thinking of hiking with your four-legged friend, remember to bring your leash because rattlesnakes can be spotted. Usually there’s also little shade, so plan accordingly by bringing a hat and dressing in layers. Thomas Creek Trail Location: Head out on Mt. Rose Highway going west to Timberline Road. Then drive 1.3 miles past the end of the pavement, stay on Timberline and you will see the trail head on your left shortly after you cross the bridge. Parking: There is a paved parking area on Timberline Drive. Time Out to Back: 2-6 hours Items to Bring: Water, layers, food and a phone with GPS or map. Definitely put he Thomas Creek Trail on your hiking trails list. Located off of Mt. Rose Highway, it is a very scenic hike winding along Thomas Creek into a Jeffrey pine forest. You may choose to hike to what appears to be the end of the trail (where it meets the road) or continue further up for 1/8 of a mile into the Mt. Rose Wilderness. Hiking up the trail to the creek crossing, and then taking the dirt road back down is a great way to see the entire canyon. While this hiking trail is closer to 5 miles, it can be shortened by turning around at any point. Another option is to look for signs to turn off the Thomas Creek Trail at the junction for Dry Pond Loop. Dry Pond is a 4½-mile, out and back hiking trail from the Timberline parking lot. Ultimately you may see a pond or hilltop meadow, depending on the season and weather. Overall it is possible to go anywhere from 2 to 6 miles (or more), based on what you choose to hike. The gain along the creek is minimal, with an 800-foot gain at the top part of the trail. In particular, watch for mountain bikers, as this is also a very popular biking trail. Hunter Creek Trail Location: Go west on Mayberry Drive to Plateau Road. Then turn left and go up the hill to Woodchuck Drive. Lastly, turn right and follow Woodchuck to the hiking trail head. Parking: Paved parking on Woodchuck Drive with a bathroom and benches. Time Out and Back: 2-5 hours Items to Bring: Water, layers, a snack, sturdy shoes and sunscreen. The Hunter Creek trail is about a 7-mile day hike with a little over 1,000 feet of overall gain leading to a waterfall. Ultimately it’s totally worth the trip! This hiking trail winds up Hunter Canyon through sagebrush, Jeffrey pines and interesting rock formations. The waterfall is a great place to sit on shaded logs and enjoy lunch. This trek is very rocky and narrow at times, so good trail shoes are recommended. Furry friends should also be leashed, as rattlesnakes and wildlife are common along the trail. Difficult Hiking Trails Hidden Valley Loop Location: Hidden Valley Regional Park; drive east on Pembroke Drive and turn left on Parkway Drive. The park is at the end of the road. Parking: Park on the east side of the park, closest to the hills. Time Out and Back: 3-6 hours Items to Bring: Water, sunscreen, shoes with good traction and a lunch or snack. Overall this 6-mile loop has about 1,800 feet of gain and is located east of Hidden Valley. We recommend starting the hike from Hidden Valley Regional Park. First, head southeast on a dirt road and then turn east onto a very steep trail that winds over red dirt for about a half mile. In fact, this is the steepest part and it’s a leg burner. Once you get past the climb, the trail gradient decreases. Then you wind along the south side of a big bowl lined with pinyon pine and juniper trees. The hiking trail continues up to the ridge line where there are incredible views of the Truckee Meadows and Mt. Rose. You can hike back down from this point, but it is best to continue on the trail along the ridge line to where it isn’t as steep with incredible views. Frequently you may see wild horses while hiking in this area. Mount Tallac Location: Southwestern side of Lake Tahoe, between Emerald Bay and Camp Richardson. Turn south on Mt. Tallac Road from Highway 89. Parking: Follow Mt. Tallac Road to the parking lot. Time Out and Back: 6 hours Items to Bring: Water, layers, lunch or snacks, sunglasses, hat, sturdy shoes and sunscreen. Definitely a big hike with an even bigger reward — an incredible view of the Desolation Wilderness and Lake Tahoe. This hiking trail is 10.5 miles out and back with a 3,500-foot elevation gain. If you’d like to explore the area without the 6-hour commitment, hike 1.7 miles out to Floating Island Lake or 2.3 miles out to Cathedral Lake. Day use permits are required and you can fill one out for free at the trailhead.

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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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