So, You Think You Have Low T? We Need to Talk…

“Low T” means Low Testosterone levels. Low T is the latest health epidemic to affect American men, at least according to the multiple, million-dollar advertising campaigns you see on TV, hear on the radio and see in the glossy magazines.

Guys, Have you been wondering if you have low T? You are not alone. Let’s talk frankly about this, you and I…

So, you think you have low T? “Low T” means Low Testosterone levels. Low T is the latest health epidemic to affect American men, at least according to the multiple, million-dollar advertising campaigns you see on TV, hear on the radio and see in the glossy magazines. Don’t believe everything you hear on TV or from Dr Google. Take it from me, a board-certified specialist in Reproductive Endocrinology and Infertility with decades of experience, you do not have low T. Yes, I am talking about you! The guy sitting in my office who is tired and stressed and not sleeping well and whose libido is just not what it was when he was younger and did not have a mortgage and a crazy boss. You want to feel better and taking a pill, or a shot or some gel sounds like a good idea. What could be the harm?First of all, why do you think you have low T? Low energy and low libido could be caused by hundreds of things and Low T is not in the top 10 causes. Stress, lack of sleep, an bad diet, those extra 20 pounds, smoking, lack of exercise….Is it possible these things might have something to do with you not feeling at your best?

I am sitting here discussing your symptoms with you and you are growing a beard as we speak. You are not having problems with erection or ejaculation and you and your partner are here to see me because you are trying to have a baby. You complained to your family doctor about being tired a few months ago and you were given a prescription for testosterone gel or testosterone shots. Or some guys at the gym got you some “stuff” – anabolic steroids to help you build up your muscles, raise your energy level.

Well, guess what, testosterone will shut your testicles down. For some reason the people that are giving out testosterone like it is a multivitamin forgot to tell you that taking testosterone tells your testicles that they can take a break. They don’t need to do their normal job of making testosterone because there is already a lot of testosterone around. The problem is when the testicles stop producing testosterone, they stop producing sperm as well. The testicles actually will physically shrink in size with testosterone treatment. Theoretically, once you stop the testosterone the testicles should resume normal function, normal size and normal sperm production but some men can permanently damage their testicles if they take enough testosterone for long enough. Some men will be come completely azoospermic (no sperm at all, zero, nada, nothing).

So….what am I saying? That perhaps you could try eating a healthy diet, losing those extra pounds, getting some regular exercise, getting 7 to 8 hours of sleep at night, quitting smoking and maybe have just one glass of wine or beer with dinner instead of the bottle or the six pack. Perhaps you just might start feeling a lot less tired and a lot healthier. These things will actually help you live longer and you will feel better – more energy, more sex drive, even a little happier and more confident. All good things, right?

If these things still do not work or you can’t grow a beard, your muscles are shrinking or you are having consistent problems with getting or maintaining an erection (everyone has a bad day once in awhile), then see a specialist about possible Low T. An excellent medical endocrinologist can diagnose this issue and treat you without having a negative impact upon your fertility and should be able to optimize your fertility. Low testosterone levels are consistently below 200 ng/dL in the am. Many men can drop below these levels throughout the day and still have normal production, so checking a single level is not enough. You need a full evaluation by a board certified medical endocrinologist, not just one blood test with your family doctor. A good urologist can evaluate an isolated erectile dysfunction problem. Most cases of erectile dysfunction are not due to low T.

If you really have low T and are trying to conceive, then your doctor should be able to raise your testosterone level without using testosterone, to maintain sperm production. A medical endocrinologist has the training to accurately evaluate and treat true low T safely and effectively without harming sperm production.

Low T is not an epidemic and treating low T with testosterone will stop sperm production in its tracks. Make sure you get expert advice and think about finishing your family before taking this very potent and potentially destructive hormone.

Copyright Serena H. Chen, MD 2015

Take Care of Your Penis and He’ll Take Care of You

Overall health can make a dramatic impact on sexual health. Dr. Serena Chen explains why living well can make your sex life better.

Take Care of Your Penis and He’ll Take Care of You


Eureka! After so many years of counseling hundreds, maybe thousands of males about their reproductive health, it finally dawns on me that I need to focus on something that will grab their attention, something that they focus on every day, something critical to a man’s life, happiness, self-image and health – his PENIS. Duhhhhh!!!!

Forgive me, I am basically a vagina doctor – so I guess it never occurred to me to concentrate more on the penis. I am a reproductive endocrinologist and I treat infertility. Many of my male patients are members of heterosexual couples trying to have a baby. Some of my male patients are gay couples trying to have a baby and a handful of my male patients are single men trying to have a baby. So, even though I am by training a gynecologic specialist, I treat and advise a lot of men regarding their reproductive health and any other issues impacting their ability to help conceive a baby. Most infertility testing and treatment tends to focus on female health and wellness. The male contributes the sperm and we don’t need much sperm to make a baby.Most of my female patients will ask again and again – what else can I do to improve my chances to have a healthy pregnancy and a healthy baby? They also ask – what else can my husband, male partner, boyfriend do to be healthier? I spend a lot of time at the initial visit talking about health and wellness. How smoking by either the male or the female partner is associated with a higher rate of infertility, miscarriage and birth defects. How overweight and obesity in either partner is also associated with higher rates of infertility, miscarriages and birth defects. How to limit alcohol so it does not have a negative impact upon health or reproduction, some ideas for stress management, how getting enough sleep can impact fertility, etc.

One day, not too long ago, I was sitting down with a nice couple struggling with infertility. She is a nurse, he is a physical therapist. He has diabetes. They are both overweight. We talk about diet, exercise, ideal weight goals, diabetes. They are both knowledgeable about health and the things they need to do to get healthier. She seems very motivated – he seems on board – kind of. I mention, “by the way….you know that controlling your sugar will lower your risk for heart attack, stroke, kidney failure, amputation, etc” He nods. Yes he is well aware of the reasons to control his sugar. “Did you know that poor sugar control can dramatically increase the risk for erectile and ejaculatory dysfunction?”He sits bolt upright. Yes – it makes sense – he kind of knew that in the back of his mind – but he never thought about it that way before. Hmmmmm. Poorly controlled diabetes can harm your penis! If you control your sugar, your penis will be healthier and you will be happier!

Here are a few other things that can hurt your penis:

  • Being Overweight – Extra weight increases the risk for vascular disease, diabetes, heart disease, and lowers testosterone levels, all if which will have a negative impact on erectile function
  • Heart disease – let your blood pressure go or not watching that cholesterol can lead to heart disease which is the major cause of ED
  • Smoking – doubles your risk for ED and can even shorten your penis
  • Enlarged prostate gland can lead to premature ejaculation
  • Drinking – too much alcohol can both deplete testosterone and cause ED

If you can’t do it for you, do it for the man downstairs. He will thank you in a big way.