Episode 98: Men, Hormones, and Sexual Desire (Part Two) with Dr. Harvey Bartnof

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Dr. Patti talks with Dr. Harvey Bartnof, renowned age management medical specialist, about issues related to men, hormones, and libido. The major hormone for men is testosterone. At what age does testosterone decline? What are the symptoms of hormonal decline? How does testosterone replacement help? Who is a candidate for this? Are there risks? Learn about the amazing benefits of testosterone. I'll give you a hint: it can help significantly with erectile dysfunction! Beyond even this...learn why testosterone is being considered one of the most important hormones for male health and longevity today. What other hormones are important? Find out more about the extensive resources on Dr. Bartnof's website. And, learn why an age management program might improve your relationship life as well as your health and sex life!

Transcript

Dr. Patti Taylor: Welcome to the Expanded Lovemaking show. I’m your host Dr. Patti Taylor of expandedlovemaking.com, and I teach you how to make exquisite love. This is part two of a two-part series. Today we’re talking about men and their hormones and sexual desire. Men’s hormones; I’m excited. If there’s one thing I’ve always been thankful for personally it’s testosterone. I think there’s a lot of controversy over how much is enough or too much. And I think that’s the whole subject of men’s hormones. I think it’s way underserved. So I’m told that today we get to spend some extraordinary time with a leading expert on just this topic and I’m so pleased to welcome back our guest for today, Dr. Harvey Bartnof. So welcome back to the show.

Dr. Harvey Bartnof: Thank you Patti. Thanks for having me.

Dr. Patti Taylor: Oh it’s such a pleasure. So Dr. Harvey Bartnof is a licensed physician whose been in practice since 1978. We had been talking on show one about women, sexual desire and hormones, so I hope you’ve checked out that show. Just a little bit about Dr. Bartnof for those of you who are just jumping on board now; he started the California Longevity and Vitality Medical Institute in San Francisco, California in 2004 where he’s practicing today, and he has extensive academic credentials and had his own radio show on age management and is just an amazing brilliant leader in the field. So lets get going, talk about men. Where should we start with men? What would be a good starting place?

Dr. Harvey Bartnof: Well men are subject to hormone declines, just like women can have hormone declines. And when men get hormone declines, they can get some declines in their quality of life. And some men it can be quite subtle, other men it can be more traumatic, but they can get decline in energy, maybe not quite the energy they had ten, twenty years prior, and they can get decline in libido, they can get decline in erectile function, so erections are not working as well. Of course they can get mood changes, maybe a little depression, maybe a little irritability. They can get body shape changes, expanding waistline with body fat, and it’s not good and these things are fixable and repairable so men can have a good quality of life.

Dr. Patti Taylor: Okay, now what age would this all start happening?

Dr. Harvey Bartnof: In studies that are published in the medical journals, men will start to have decline in their testosterone on average about age 30, about one percent or so per year, but it’s quite variable. Some men will get a faster decline and some men will get a slower decline.

Dr. Patti Taylor: Now is this what is typically known as andropause?

Dr. Harvey Bartnof: That would be a typical term that’s used. In the medical literature the term hypogonadism is used, hypogonadism, that’s very low testosterone with symptoms. andropause refers to the flip side of menopause if you will, so menopause is decline in female hormones, usually with symptoms, not always. But andropause refers to decline in testosterone with symptoms in general.

Dr. Patti Taylor: Okay, great. Or male menopause, right?

Dr. Harvey Bartnof: Or male menopause.

Dr. Patti Taylor: Right.

Dr. Harvey Bartnof: Sometimes called manopause.

Dr. Patti Taylor: Right, right. So it’s maybe almost with a, you know… Is it something that men don’t want to admit? Sort of like they’ve got to keep that sort of façade to the world?

Dr. Harvey Bartnof: Absolutely. You know, men who have their own issues about machoism and “I’m not going to have a problem with testosterone decline” and “I’m okay”, and that’s, you know, that’s part of the macho image I think it’s quite prevalent in most cultures, but once men are able to break through that and get test and treated and it can turn around their life, and half our practice is men, they do extremely well.

Dr. Patti Taylor: Right, so oh yeah, “Women have menopause, I’m not going to do that. That’s the woman’s thing”, right?

Dr. Harvey Bartnof: Exactly.

Dr. Patti Taylor: Until they realize, “Uh, you know, well, would you like to have more testosterone?”

Dr. Harvey Bartnof: Exactly, exactly. Well for men it’s their erections. You know, the erections and the libido will get the men. If they notice they’re not having erections any more, it’s not working quite right, that’ll get their attention. Of course there are all the ads on TV about the various products like Viagra, Cialis, Levitra and so forth. But I have a number of men who’ll come in where they’re maybe getting a response with one of those, maybe not, and really what they need is just testosterone replacement and they don’t necessarily need any of those any more.

Dr. Patti Taylor: Okay, so lets talk about that for a minute, ‘cause, you know, how, alright I… I had a show recently and I think the figure was anywhere from thirty to seventy percent of men have some kind of erectile dysfunction issue, which is a pretty broad statistic I realize…

Dr. Harvey Bartnof: Yes.

Dr. Patti Taylor: But then it’s like half the men in the country right?

Dr. Harvey Bartnof: Yeah. Mm hmm.

Dr. Patti Taylor: I figure. So out of that what percentage would you say were testosterone related issues?

Dr. Harvey Bartnof: Well it’s going to be significantly related to the age of the man. So the older a man is the more likely he is to have decline in testosterone or low testosterone. I mean the basic numbers are about ten percent of men in their 40’s will have a low testosterone and very few of them are ever treated. Approximately a third to forty percent or so of men in their 50’s will have a low testosterone. And from there, men in their 60’s, it’s over half. And then in their 70’s it’s much more than that, so…

Dr. Patti Taylor: Wow, to be getting big plants starting to manufacture this stuff by the, you know, like trailer trucks all over the country, huh?

Dr. Harvey Bartnof: Well it’s out there and available, but then you have to have enough of a interest to be able to pursue this and to be able to find somebody who is a confident professional to know how to evaluate for this and to treat for it, it does require monitoring. And yes, I mean it’s very, very common and there are a number of medical journals that have show that by far very few men are ever treated. It’s improving, but worldwide this is a huge problem.

Dr. Patti Taylor: Okay. So now lets talk about why people, why men, okay, are not getting treated.

Dr. Harvey Bartnof: Men are not getting treated, number one, I would say that there’s not enough information about this out there. So testosterone itself, there’s no company that’s going to be able to make a lot of money on it because regular testosterone is not, it’s not a big blockbuster drug because it’s not a new drug, so the pharmaceutical industry cannot make a lot of money on it, so therefore it’s not going to be advertised very much, so that’s number one. And it falls below the radar screen, I would say. Number two, there are other health issues that come to the forefront more. Number three, it gets a bad rap I think because of the celebrity athletes who are abusing it and doping with it, so it gets a bad rap that way and has a little bit of a negative connotation there. And so, and then you add in male ego, and so it’s just a real challenge in terms of getting men in to be evaluated so they can improve their quality of life.

Dr. Patti Taylor: Boy, if I were a guy I’d be like running to my doctor. I understand, now correct me if I’m wrong, that there’s a huge amount of controversy over exactly what is the right amount of testosterone that a man really needs. In other words, I don’t have the numbers right, but if the blood level said 300 and the man was, you know, 50, don’t quote me on the numbers, but the man might need 300, he might need 500, he might…you know what I’m saying, that there’s no agreed upon exactly what someone really needs, so you might need way more than that or, you know what I’m saying?

Dr. Harvey Bartnof: Yes, and that’s a good point. The professional societies, the professional guidelines are out there in terms of what the definitions are based upon blood levels actually, and then once someone has a particular diagnosis of andropause or low testosterone, there are guidelines as to what the level should be, what the target level should be. In general those target levels are going to be in the upper half of the reference range. The reference range is when they’ll sample, lets say, a thousand men and come up with the standard range of what’s the low end and what’s the high end, so… But a number of men will just do better if they have a level that’s higher range compared to when it was lower, and there’s a lot of very interesting active research on that. It turns out that the optimal level lets say for libido might not necessarily be the same as the optimal level to maintain bone density. So men who have low testosterone for example are at increased risk of osteoporosis, just like women who have low estrogen are at risk of osteoporosis. So the amount of testosterone they might need in order to maintain bone may be different than what they need to have optimal libido and to have optimal erection function.

Dr. Patti Taylor: Okay, so that’s very interesting. So even our standards for, you know, what is optimal is not really an agreed upon by a standard for all, it’s not a one size fits all optimum number.

Dr. Harvey Bartnof: That’s true. And different professional societies will have different guidelines. Some of the European guidelines will differ significantly from some of the American guidelines in terms of professional societies. So it’s individualized, you have to look at the individual patient and what their current symptoms are, look at the overall pattern because there are other changes that will come about. In men that have low testosterone, they’re at increased risk of diabetes and pre-diabetes, which is, I’m sure your listeners know, is increasing significantly in our culture. Low testosterone is more common in men who have too much weight, just they’re overweight or obese. It’s more common in men who have excess body fat on their midsection, and this of course becomes much more common as men get into middle age, and it’s thought to be, oh, man is just aging. It’s not necessarily the case of it’s due to testosterone decline, that’s not healthy.

Dr. Patti Taylor: Okay, well I want to come back to this. So please stay with us. This is Dr. Patti Taylor and I’m here with Dr. Bartnof. You can find more about him at his website, longevitymd.net, l-o-n-g-e-v-i-t-y, m-d, dot net. We’ll be right back.

Dr. Patti Taylor: We’re back and we’re talking to Dr. Harvey Bartnof about men, hormones and sexual desire, and we’ve been talking about testosterone where I want to stay talking for a little bit longer. Before we go onto some of the other risks of testosterone, like I said in the opening of the show, I love testosterone. Maybe I’ll tell you why in a little bit, but… I want to just ask you, I think men, don’t men have a fear of taking too much, that it might inflame their prostate cancer or something like that? Isn’t that another common…?

Dr. Harvey Bartnof: That’s a good question. There has been this concern that testosterone replacement might somehow cause prostate cancer, and I would say we’re now learning that that turns out to be a myth. There’s a Harvard Urologist, Dr. Abraham Morgentaler, whose written extensively about the risks of testosterone replacement and prostate cancer, actually we have several of his references on our homepage of our website, longevitymd.net, where people can read more about it. But it turns out that there’s no evidence that testosterone replacement causes prostate cancer, and that’s a very important concept. Even a lot of doctors may think that because that’s what was taught in the past, but it turns out to be a myth. Now if a man does have a preexisting cancer of the prostate and their testosterone is low and you replace it, that might cause the cancer to grow faster, so therefore before a man is started on testosterone you want to do a screen. We would need to do that to make sure there’s not any prostate cancer. But prostate cancer is still relatively uncommon; only one in six men will develop prostate cancer and only one in thirty will die of prostate cancer.

Dr. Patti Taylor: So what are the elevated PSA levels? What would, would that just…

Dr. Harvey Bartnof: Right, so PSA is a prostate antigen protein that we can measure in the blood. It’s a very specific protein that comes from the prostate gland. But it turns out that most men with a high PSA, it’s not due to prostate cancer. Actually the Stanford Research Group has now published in the Medical Journal that the most common cause of a high PSA is not prostate cancer but prostate enlargement, which is a totally different problem or different issue than prostate cancer. Some men will have prostate inflammation, prostatitis or prostate infection, also called prostatitis. But the most common cause of a high PSA is not going to be a prostate cancer, it’s going to be prostate enlargement or prostate inflammation or infection. So, now it does require evaluation. If a man comes in and presents and has a high PSA it does require an evaluation to make sure that they don’t have a prostate cancer, but by far, by far the vast majority will not have a prostate cancer.

Dr. Patti Taylor: Okay, so I’m really glad you’ve cleared this up for our listeners ‘cause I’m thinking a lot of our listeners have that question on their minds.

Dr. Harvey Bartnof: Sure.

Dr. Patti Taylor: I want to go back to mood and testosterone for a little bit. What might be some of the changes in mood that a man might experience once he’s gotten his testosterone to the appropriate level? Lets say a guy comes in and he’s like, you know, “Wow, I heard your show and I want to just get all I can”, and then he does.

Dr. Harvey Bartnof: Well symptoms of low testosterone, or decline testosterone, are published and are well established. In general, men – and it’s not one size fits all, not all men will have all of these symptoms, some will have none, some will have all of them – but in general, men need enough testosterone to have a normal mood, so there tends to be maybe a little bit more of a depressed mood. Men who have low testosterone tend to be more anxious. So it’s unusual, in general men in their 20’s who have a good testosterone level, they’re not anxious in general. But when men get into middle age beyond things that would otherwise not have sort of bothered them may now bother them. Also irritability. Sort of the old concept of grumpy old men. If you think of the character on the old Dennis the Menace, Mr. Wilson, he’s a typical pattern of a man with andropause, grumpy, grumpy, and he’s got this big belly due to too much belly fat that’s a significant degree due to a decline in testosterone, that lifestyle of course is important there as well. You replace the testosterone men just feel better. They have a better sense of well being. In general their libido’s going to increase. They don’t feel as anxious. They don’t feel irritable. And they just feel better and they get along in their interactions with others and relationships are better and even their thinking often can improve, their motivation can improve, their productivity can improve. Theirs is of course, again, a balance of all hormones, it’s not just testosterone, we evaluate for 13 different hormones. But testosterone there’s not question is an important on for men.

Dr. Patti Taylor: Right. So that’s really good to know because I mean I think there’s also the joke, “Well he’s got too much testosterone”, right, and then you always think of this crazed guy with hair that’s just sort of flying out all over the place and stalking the telephone pole, you know what I mean.

Dr. Harvey Bartnof: Yeah, so the concept of roid rage. Roid rage is out there, and so, and again, this comes about from men who may be doping illegally, and so that’s common. I mean in the gyms and people, men can buy testosterone on the black market, on the internet or go to Mexico and so forth and they don’t know the right dose…

Dr. Patti Taylor: Yeah.

Dr. Harvey Bartnof: And a lot of body builders may be doping and they’re doing too much. And like so many of the other hormones, it needs to be just right, optimal, not too high, not too low. I like to use the concept of the old Goldie Locks principle, remember Goldie Locks and the Three Bears?

Dr. Patti Taylor: My favorite word, the Goldie Locks, everything just right.

Dr. Harvey Bartnof: Just right. Not too high, not too low. So when men are doping with testosterone, particularly the body builders who are doping on their own, their levels go way too high and they may get some mood change that may go into occasional roid rage. But we don’t do that in age management medicine. We just keep it within the optimal range and it does require monitoring.

Dr. Patti Taylor: Thank you for that. Would it be a sort of a reasonable generalization to say that if you’re taking Viagrra or one of their counterparts, that you’re a candidate for at least inquiring into your testosterone level?

Dr. Harvey Bartnof: Absolutely. I’ve seen that in a number of cases, even beyond that. You know, there’s a, there are treatments advertised out there about injections in the penis for men who are having erection problems when they’re quote, “not responding to Viagra, Levitra, Cialis”. I actually have a gentleman in my practice who came in who’s doing the injections regularly to, so he can have his normal erections for intercourse with his wife. So he came in, his testosterone levels were not great. We replaced his testosterone, course got all his other hormones in balance, a complete program of age management medicine, and he not only doesn’t need Viagra or Cialis, he certainly doesn’t need injections anymore and his erections are very firm, he and his wife are very happy and it’s just replacing what nature originally had there whose levels have come down. So that’s not the case in all men, but that’s the typical example that I see.

Dr. Patti Taylor: Yeah, and I believe you. And so you were telling me before that there are some other health benefits to testosterone, and you just started to go into them about the diabetes. But my understanding is the testosterone is sort of a Pandora’s box, that they’re finding out if used properly that the testosterone is quite more than people thought. I know we don’t have a lot time, but do you think you could just sort of, just sort of maybe briefly pave it out a few of the things they’re discovering about testosterone?

Dr. Harvey Bartnof: Sure. It’s an excellent question and this is something else that’s a newer paradigm, a newer way of understanding about testosterone and this actually a very, very important concept for men and their families, in that men with low testosterone don’t live as long. I mean it suggests as simple as that, there are now three large studies published in the medical journals in the last three years or so that men with low testosterone don’t live as long. The largest study was over eleven thousand men in Europe in the epic studies, so it’s not just a matter of men being able to have good energy and good libido and good erections and good workouts and not the grumpy and not the irritable, it’s “Do you want to meet your grandchildren, yes or no?” And so the take home message is that testosterone is a total body hormone. Testosterone is a total body hormone because you need it for heart function, you need it for bone function, you need it for blood vessel function, you need it for brain function. There are published studies that men with low testosterone are more likely to contract Alzheimer’s ten, twenty years later. I mentioned earlier men with low testosterone clearly have low bone density. And if they have low bone density and they take an accidental fall and break a hip bone or spine bone, that’s a major medical problem. In men who die younger because of low testosterone, they die of a heart attack. They don’t die because of lack of erections. They die of a heart attack. So testosterone is an important hormone for heart function and blood vessel function. There’s a clear association in men who have lower testosterone are more likely to have pre-diabetes and diabetes, which of course unfortunately is an epidemic throughout the world and is increasing in the United States. Even the Diabetes Association has had a public service campaign that men with diabetes should have their testosterone checked, because if they get it checked and it’s low and usually it’s not optimal, when we replace the testosterone their blood sugar is able to be better controlled. And when you better control their blood sugar they have fewer complications of diabetes, which is going to include erection problems and kidney problems and heart attacks and so forth. So the other notion is that certain aspects of the cholesterol panel are off when men have low testosterone, and you replace the testosterone and those aspects of the cholesterol panel improve. Now how many people go to their doctor, then they find they have high cholesterol and immediately be given a prescription for Lipitor or one of the other staten drugs. So the point is that these hormones are important for co-factors for many diseases, and testosterone is right up there at the top and these hormones need to be in an optimal range in order to offset risks for many diseases.

Dr. Patti Taylor: Wow! Well I’ll tell you, the phone is going to be ringing off the hook for everyone who does testosterone management after people hear this show. That is a pretty impressive list. Well thank you very much. We’re going to take a break. This is Dr. Patti Taylor and I am here with Dr. Harvey Bartnof, and you can read more about what he’s been talking about at his website, longevitymd.net, which does have some amazing articles on it, as well as interviews. So we will be right back.

Dr. Patti Taylor: We’re back. I have a question for you; in addition to all the health benefits, do you think testosterone makes men pay more attention to their partners, the wives, their girlfriends?

Dr. Harvey Bartnof: That’s a good question, I would say when men have more interest about sex they’re going to pay more attention to their sex partner, yes. That really kind of comes to mind here. When men have their hormones balanced similar with their levels RH 21, 25 they’re going to pay more attention to their sex partner, they may want to have more sex. But they’re going to tend to want to be more intimate, I would say, and they’re going to be less irritable and they’re going to have a better mood, so interactions, I would say, are going to improve on that level.

Dr. Patti Taylor: ‘Cause that’s what I was thinking too. That’s why I love testosterone, you know. Show me a guy whose got good testosterone levels and I’ll show you the nicest man in the world.

Dr. Harvey Bartnof: There you are. There you are. And, you know, that brings up a good point in that when hormone levels decline at an unequal rate in partners, that can create stress in terms of their love life and their sex life. And it doesn’t always happen where the woman’s hormones are going to decline first. Sometimes the men’s hormones may decline. You may have a couple in their 50’s and the woman may be still interested and the man may not be because his hormone levels are low. So they need to be in a good balance and then… But the point is of a natural decline is not equal in both partners and that can create problems in terms of their love life.

Dr. Patti Taylor: Right. So that’s a loving thing to do to get your hormones checked if you don’t feel optimal.

Dr. Harvey Bartnof: Exactly.

Dr. Patti Taylor: Before you just go out and take the blame for yourself or your partner, you know, get these things checked out.

Dr. Harvey Bartnof: Exactly.

Dr. Patti Taylor: Well before we end the show I know that you, you know, you do this sort of very routine checking, but I thought you might just sort of treat us and tell us a little about what you do in your clinic.

Dr. Harvey Bartnof: Sure. At our institute we have very comprehensive evaluations for all patients. Actually it’s a all day consultation where we literally go through every bodily system, every abnormal symptom and plot a course over the next ten, twenty, thirty plus years, so that people not only can feel well in the short term, but really plot a course to delay diseases and offset risk of diseases, because there are many of us baby boomers who are going to be living well into our 80’s and 90’s plus, but people don’t want to be in a wheelchair or be in a nursing home if they don’t need to be. People want to have good energy and good thinking and good libido, and with a complete program of age management medicine those things are potentially achievable, and so the age management medicine program is not just for hormones, but it’s a program of lifestyle, of course the right nutrition, the right exercise, the right vitamins, supplements, nutraceuticals, stress management, avoiding toxicities and all these things together are going to add up so that people can have an excellent quality of life. And the other important concept for men is that testosterone is just one hormone that we evaluate. There are thirteen different hormones that we evaluate for, and just to mention that a lot of men with hormone replacement, if it’s not being monitored correctly it can convert into other hormones which can be a negative, and so those need to be monitored for to be sure that they’re not changing the testosterone into other hormones which can be a negative for them.

Dr. Patti Taylor: Well I’m glad you said that ‘cause I was just about to say that I know we’ve really focused on testosterone today at the expense of all other twelve hormones because of my bias, but there are other hormones and I, you know, so…But it does sound, you do have to look at all, the whole picture…

Dr. Harvey Bartnof: Right.

Dr. Patti Taylor: And I’m glad you do that. So before we go I was just wondering if you could just paint out a case history of maybe one guy that came into your program and what happened to him.

Dr. Harvey Bartnof: Sure. Lets see, a typical case, a gentleman came in, about 45, libido decline, erections were more of a problem, he wasn’t approaching his wife very much, his workouts were much more difficult. He went and saw his primary care doctor and was put on an antidepressant, which didn’t help his libido very much and certainly didn’t help his erections, so we evaluated him, his testosterone level was low, he had actually a number of hormone levels were low, DHEA, his thyroid was not optimal, he had a number of problems, and we replaced his hormones and were able to get him on a complete program of age management medicine, his erections improved, his workouts improved, he, his wife called up and said, “Thank you so much for giving me my husband back.” He also, you know, he was quite depressed when his testosterone level was low and so he just did extremely well. I’ll also mention, we did a bone density scan on him and he had osteopenia, which is a mild bone density loss, and after a year and a half of testosterone placement his bone density was back up into the normal range, so he didn’t need any of the drugs that are advertised on TV for bone density, he just needed to have his testosterone replaced.

Dr. Patti Taylor: Well that’s very impressive. That’s very impressive. I know we mentioned this on the other show, but Suzanne Somers, in her new book Breakthrough I think, talks about a lot of these age management type of innovations that are going on that are so exciting.

Dr. Harvey Bartnof: Yes, yes.

Dr. Patti Taylor: And it sounds like you’re doing a lot of that kind of thing with the work you’re doing…

Dr. Harvey Bartnof: Yes.

Dr. Patti Taylor: in age management.

Dr. Harvey Bartnof: And it’s my understanding she’s writing yet another book and the next book will be on testosterone issues in men actually.

Dr. Patti Taylor: Well is it any wonder. It sounds like this is turning out to be a very exciting field, right?

Dr. Harvey Bartnof: It is. As baby boomers are getting older and quality of life is declining, and it doesn’t have to be that way.

Dr. Patti Taylor: Really. Well you said it. Well we’re going to bring our show to a close, so before we do that I again invite you to share with us some inspiring thought that we can take with us.

Dr. Harvey Bartnof: I would say the inspiring thought is to get your hormones checked and embark upon a complete program of age management medicine to improve your quality of life and so you can improve your relationships and better ensure that you’re going to be around to meet your grandchildren and great grandchildren and to love your family and your loved ones.

Dr. Patti Taylor: A very beautiful thought. So thank you so much Dr. Bartnof. It’s been a joy and very, very educational as well having you on this show with us today, and thank you for our listeners as well.

Dr. Harvey Bartnof: Thanks Patti.

Dr. Patti Taylor: Yes. Okay, so with that we’re going to close the show. Thank you so much for listening. Please send me, Patti, email at [email protected]. For texts and transcripts of this show and other shows on the Personal Life Media network, please visit our website at personallifemedia.com, and please visit me, Dr. Patti Taylor, at expandedlovemaking.com where you can join my mailing list and find out more about my products, services and events. This is Dr. Patti Taylor and that’s all for now. I remain yours in ever expanding lovemaking, and I’ll see you next week.