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What is low T? Does Manopause exist?

It seems you can’t go anywhere these days without seeing an advertisement on the TV, Radio, or billboard for Low T or Testosterone.
Testosterone is a hormone produced by the Testes and plays an important role in men’s health as it helps maintain:
1. Muscle mass
2. Bone formation
3. Red blood cell production
4. Normal libido
5. Sperm production
As we age testosterone levels tend to decrease. There are 3 blood tests to check Testosterone Levels. There is some controversy how to
interpret these tests.
1. Total Testosterone
2. Free testosterone
3. SHBG (Sex Hormone Binding Gobulin)
It is best to check levels in the morning as they tend to be highest at this time of the day. It may be useful to check other blood hormone levels including thyroid function, LH, FSH, and Prolactin levels as part of an evaluation. Occasionally obesity can decrease SHBG and cause a falsely low testosterone.
Testosterone Replacement is approved for individuals with low testosterone ( usually below 300ng/dl) associated with:
1. Decreased Libido
2. Erectile Dysfunction
3. Lack or decrease in energy
4. Osteoporosis or bone loss
5. Depression
6. Hair loss
7. Sleep disturbance
8. Decrease in strength
There are several types of FDA approved Testosterone replacement including creams, injections, pellets, and buccal. In addition many anti aging clinics use compound pharmacies to produce unique testosterone blends.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Understanding Menopause and Hot Flashes

Flickr/Ryk Neethling

Flickr/Ryk Neethling

Menopause is defined as one year without a period. However, menopausal symptoms can begin to develop 5 to 15 years before the onset of menopause. This is called perimenopause. During this time your estrogen levels begin to decrease. This lack of estrogen creates a constellation of signs and symptoms including hot flashes, vaginal dryness, mood swings, libido changes, sleep disturbances and more.

One of the most troubling symptoms of menopause or perimenopause is hot flashes. Hot flashes are a sudden sensation of intense heat, which causes the face, neck, or upper body to become flushed and sweaty. A hot flash can last 30 seconds to 5 minutes. A hot flash during the night often requires that you change your night clothes as they are all wet.

How do we treat these debilitating symptoms? There are 3 options: Do nothing and live with them, treat them with prescription medications, or treat them with herbal preparations.

Pharmacologic or prescription medicine for the management of hot flashes consists of hormonal and non-hormonal options. The hormonal option is estrogen and it can be taken as a pill, a patch or a cream. This is successful in relieving 99% of hot flashes. It is the most effective treatment. Its major disadvantage is that it may cause blood clots, or increase your risk of certain cancers, including breast cancer. It is generally a safe option for the first 5 years following menopause.

The most common non-hormonal treatment for control of hot flashes is antidepressants. These medications can decrease the number of hot flashes by approximately 80% and they are well tolerated. Their major side effect is loss of libido. These are other prescription medications such as blood pressure pills, migraine medications, and antihistamines, which have small success rates.

For patients who prefer a natural alternative, there are multiple herbal preparations, which can decrease hot flashes. The Chinese herbs like Black Cohosh and Dong Quai have been studied the most. While the data is conflicting, there still is a large body of evidence, which suggest that these herbs may improve hot flashes. Isoflavones and soy are plant-derived substances called phytoestrogens. These herbs appear to “mimic” estrogen and appear to reduce hot flashes. There are multiple studies showing improvement of hot flashes and other menopausal symptoms while taking soy isoflavones. Other herbal products, which seem to help include yams and red clover.

The ultimate decision on the correct treatment varies from woman to woman. It is important that you discuss the side effects, the risks and the benefits of each class of treatment and decide the best treatment for you. There are many health professionals and knowledgeable people who can help guide you through this process.

For more daily health enhancing tips please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition

-Dr. Robert Feldman M.D. – Obstetrics and Gynecology

Let’s Talk Sex: What About Lubrication?

Flickr/Tela Chhe

Flickr/Tela Chhe

Female lubrication can be a problematic and troubling issue. It varies from person to person and from encounter to encounter. Sometimes, lack of lubrication is related to “not being in the mood” or not receiving adequate stimulation prior to intercourse. Other times it is related to having too much activity in too short of a time – the vagina tires out and cannot make enough moisture. And some other times it comes with normal body changes as we age, such as menopause.

These are very different causes for lack of lubrication and thus require very different solutions. The real problem is, deciding which problem you have and then is it the same problem every time?

Women take longer to get excited than men. A woman requires stimulation – both emotional and physical. If a woman tries to have sex without adequate stimulation she will not lubricate. Sometimes employing a lubricant or gel and adding that to foreplay will increase sensitivity, lubrication and receptivity.

If a woman has too much sex in too short of time period, the vagina can fatigue and not produce adequate lubrication. This is a normal physiological response and it generally reacts well to the use of a cream, gel or lubricant. Some women taking birth control pills have problems with vaginal dryness and finds gel helpful during intercourse. Some women going through menopause finds lubrication and arousal a difficult task as well.

There are many different gels available in the marketplace. Some employ menthol, some nicotinic acid, amino acids, etc. Some will increase blood flow to the genitalia and this should help with dryness and responsiveness.

Remember, vaginal lubrication is both physical and emotional. Spend time touching, kissing, cuddling, talking and getting “in the mood” before becoming intimate.

-Dr. Robert Feldman M.D. – Obstetrics and Gynecologist

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A Touch of Intimacy Goes a Long Way

Image courtesy of tmarsee530 via Flickr

Image courtesy of tmarsee530 via Flickr

Everyone is talking about intimacy in their relationships – and if they’re not, they should be.  Intimacy, which can be defined as how comfortable we feel when we interact with someone either sexually or emotionally, serves as a great barometer for the overall health of our relationships.  Couples who experience high levels of intimacy, either sexual or emotional, report higher levels of satisfaction in their relationships.  And in turn, people who are in intimate relationships report being happier and having greater life satisfaction.  Intimacy can be hard to attain – women are supposed to be in search of it and men are supposed to be afraid of it.  Regardless of whether these stereotypes are true, there is a clear benefit to being in an intimate relationship and any effort you make to increase intimacy in your relationship will pay off dividends.

Now, a recent study seems to suggest that the simple act of touching is associated with greater intimacy in relationships.  The past several years has seen an increase in research showing the positive effects that touch can have on our physical and psychological health.  A group of researchers at the University of Zurich had dating couples keep diaries of the frequency and the effects of touching.  Their results showed that couples that touched more often – either through holding hands, giving a massage or enjoying a warm hug – reported feeling happier and experiencing more intimacy than couples who didn’t.  Of course, it is possible that couples who feel more intimate with each other engaged in more touching, but regardless of the association, the benefits of touching were quite clear.  We all know that relationships can be a struggle at times.  Good relationships don’t just happen, and we should all make the effort to find ways to attain and maintain intimacy and happiness with our partners.  The results from this study provide us with a simple ingredient that may contribute to a satisfying relationship.  Go ahead and touch as often as possible and see if it serves to bring you and your partner closer together.

For more daily health enhancing tips and living, please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition

-Dr. Rafael Rivas-Vasquez PsyD – Physchologist

Fountain of Youth

Image courtesy of tiinaI91 via Flickr

Image courtesy of tiinaI91 via Flickr

All of us want to be stronger… and think clearer… and have better sex. And while there is a whole medical system built around helping us to achieve those goals, one of the first places to start is very basic and quite often overlooked – sleep!

True peaceful slumber, not half asleep in front of the TV in the bedroom, not dosing in the chair while watching the evening news, and however refreshing little cat naps at the desk may be, not even that. Our bodies are built to refresh and regenerate during deep stages of sleep, it allows our brain cells to reboot if you will and recharge, form memories, and clear the stage for intellectual activities in the day ahead. Our old cells and shed and broken down and new healthy cells generated during sleep, helping our skin to look better and our organs to function better. Our kidneys are flushed through and muscles refreshed. Getting an adequate amount of deep sleep also improves mood and strengthens sexual desire and function. It is the true fountain of youth!!! And of course the most elusive in the modern world.

Our lives get in the way of good sleep. We are overwhelmed by the demands on our time from work and life stresses and are bludgeoned by electronic stimulation from televisions, tablets, computers, smart phones and the latest gadgets. It is increasingly more difficult to separate yourself from our electronic toys to allow your brain to focus on preparing for sleep. But research shows that you need at least 60-90 minutes free of screen time for you to do just that. Additionally sleep experts recommend no exposure to screens in the bedroom at all. That means that phones/televisions/laptops – all have to be left outside. The bedroom should be a sanctum for rest and relaxation, and of course the occasional romp under the sheets. Reading a calm book, taking a hot bath, and drinking a hot beverage like milk or tea is a very easy way to start preparing for deep refreshing slumber. Give it a try.

For more daily health enhancing tips and living, please stay plugged into to this blog and follow us on Twitter @Miami_Nutrition

-Dr. Olga Kromo M.D – Rheumatologist

Let’s Talk Sex

Image courtesy of you mee via Flickr

Image courtesy of you mee via Flickr

For women, sex is very complicated. It takes a variety of emotional and physical stimulation to create excitement and then climax. You have to be in the mood and then have a partner who you want to be with. You can have the best sex in your life tonight – then next week do everything the same – and it is a bust. Why?

Men think about sex and they are to the races. For women it takes longer to get excited. Women need emotional stimulation. It helps if they receive back rubs, hugs, cuddles, and then gradually increase physical contact.

Here are five tips you can do and share with your partner that will help get you in the mood:

•           Have a romantic/personal dinner

•           Take a walk along a moonlit beach

•           Dress up and go dancing

•           Watch a steamy movie

•           Take a bath with your partner

Give it a try and share your experiences with us!

-Dr. Robert Feldman M.D. – Obstetrics and Gynecologist

Follow us on Twitter for more! @Miami_Nutrition

Foods That Boost Your Sex Drive

Image courtesy of UrbaneWomenMag

Image courtesy of UrbaneWomenMag

Our diet can affect many aspects of our health, including our sex drive, which is a part of our health and wellness that should not be ignored. Here are some foods that can help boost your libido, you may be surprised but they are worth a try: 

Black raspberries – This phytochemical-rich food enhances both libido and sexual endurance.

Broccoli – High in Vitamin which aids in blood circulation to organs and has also been associated with an improved female libido.

Figs – They’re considered excellent stimulants of fertility and enhance the secretion of pheromone.

Watermelon – Watermelon contains a phytonutrient called citrulline, which the body converts to arginine, an amino acid that boosts nitric oxide levels in the body, which relax blood vessels in the same way a medicine like Viagra does

Eggs – Eggs are high in protein, which is a source of stamina, and they’re also low in calories,” Glassman says. In addition, they’re a good source for an amino acid L-arginine, which has been shown effective in treating types of heart ailments and erectile dysfunction.

Would you open to trying these foods to boost your libido? Do you think they work? Let us know!