>> mcfarland: welcome to healthy body, healthy mind. i'm dr. scott mcfarland. when hormones of the human body rise above or fall below their proper levels, serious health conditions can result. that's true for the male sex hormone testosterone. if the level of this hormone falls, it can create a condition called hypgonadism. >> the term "hypgonadism" means that the gonad, the testes for men, don't work the way they should. >> they may have symptoms such as loss of libido, fatigue, memory loss, and in some extreme cases, they have muscle loss and bone loss as well. >> men lose testosterone. as soon as they turn 40, they lose perhaps at a rate

of 1% to 2% a year. >> mcfarland: but aging isn't the only culprit that can bring on hypgonadism. it can also be the result of a chromosomal issue or a medical condition. >> i worried a lot about the future, specifically melissa being able to have the type of relationship that a typical couple would have. >> i was getting low energy, and, you know, my sleep habits were not good. muscle aches. i felt like my age was processing. >> mcfarland: but no matter the cause, hypgonadism can affect much more than energy levels and sexual intimacy. this time on healthy body, healthy mind, we'll carefully explore the condition of adult male hypgonadism--its causes, symptoms, and treatments. [upbeat instrumental music] ♪

>> male announcer: major funding for healthy body, healthy mind is provided by: endo pharmaceuticals, an integrated health care solutions company focused on providing patients with branded products, specialty generics, and a suite of complementary devices and services. and by amgen, a biotechnology company committed to providing novel therapeutics to address unmet medical needs in the treatment of cancer patients. additional funding provided by: genzyme, a sanofi company. and by sonosite. >> mcfarland: testosterone is

referred to as the sex hormone of the male body and is produced in the endocrine system, which is the system of hormone-producing glands and organs. hormones have a fascinating mission in the body. they act as message carriers from one organ to another. because of this, they help control the operation of many important functions of the body. the human body is a miraculous machine. on the more physical side, it's made up of millions of moving parts, large and small. on a cellular level, things become microscopic, chemical. this is the world of the human hormone. >> a hormone is a chemical that is made in an organ, an endocrine organ, and that hormone, that chemical,

is secreted into the bloodstream. >> mcfarland: here at the johns hopkins university school of medicine, dr. adrian dobs is professor of medicine and oncology. >> the kind of hormones that people are most familiar with, here's an example, is a thyroid hormone. thyroid hormone is made in the thyroid gland. thyroid gland sits in the neck. and that thyroid hormone comes out of the thyroid gland, circulates throughout the body through the blood, and has multiple effects on the heart, on the skin. >> hormones are protein messengers. the way that people communicate through speech, hormones-- organs within the human body communicate with each other through these protein messengers. >> hi, dr. miner, how you doing? >> i'm doing well. how are you? >> good, good. >> good.

>> mcfarland: dr. martin miner is associate clinical professor of family medicine and urology at the warren alpert school of medicine, brown university, and co-director of the men's health center at the miriam hospital in providence, rhode island. >> all hormones originate from cholesterol, which is interesting because we think of cholesterol as something that's negative, but cholesterol really serves as the basis of all hormones. >> mcfarland: the sex hormone testosterone is in the family of steroid hormones. it travels by way of the bloodstream to the cells of organs, where they carry out their functions. the group of hormones that influence the growth and development of the male reproductive system are called androgens, and the most active androgen is testosterone, produced in the testes.

>> and a boy who goes through puberty, he begins to masculinize. therefore, his genitals grow, he now has a beard, he changes his musculature, he'll have more muscle, and he becomes more manlike, or more masculine. when the levels are inappropriately low, that means that the individual is considered hypogonadal. "hypo" means low, so it's low gonad-- hypgonadism. >> i discovered it nine years ago. i felt the aging process. i was 65 at the time. >> narrator: donald bollhorst is a part-time travel consultant in the baltimore area. he also owns and operates his own airport shuttle service. donald's discovery of low testosterone came with aging. he is now 74. >> and all of a sudden, i felt

like i was getting low energy, and, you know, my sleep habits were not good. muscle aches. i felt like my age was processing. >> now, for men, men lose testosterone. as soon as they turn 40, they lose, perhaps, at a rate of 1% to 2% a year. >> mcfarland: testosterone levels are measured numerically in a reference range of nanograms per deciliter. >> there's a threshold of testosterone levels, and what i mean by that is the normal range from 300 to 1,000. >> mcfarland: for men, a drop in testosterone below the 300 mark can lead to some very noticeable symptoms. >> some of the problems in an adult male would be loss of

interest in sex, loss of libido. so he's unable to have sexual activity. and sometimes it's even more nonspecific than that. he could complain of a little bit of depression, of not feeling the same amount of energy that he had before. >> so i said, "there's something going on here." so johns hopkins university had some studies for people my age, checking out their health. it included studies on low testosterone. and so they did various tests on me--scans, prostate examination, whatnot. mostly blood work, the most thorough blood work i have ever had done. >> mcfarland: as we've seen, hypgonadism can present itself as we age. however, age isn't always the

cause of hypgonadism. and when that is the case, finding out just where the disease is originating in the body can be a bit more complex. >> and it turns out, testosterone that is made in the testicles of men are actually regulated from something above the gonad, and what i mean by that is, there's something called the pituitary gland. >> the control of these hormones are from the pituitary gland, which is at the base of the brain. >> mcfarland: dr. robert tan is the director of opal medical clinic in houston, texas. >> over here we have the cerebellum, which is for balance, and the brain stem, and right on top over here, this round little--oval, rather--oval gland over here, about slightly less than 1 centimeter, will be the pituitary gland. it's a round, small, little organ the size of the tip of my

little finger over here that sends signals to these organs to produce these sexual hormones. in males, the pituitary gland will send signals to the testes to produce the testosterone. >> the pituitary gland makes two very important hormones called f.s.h. and l.h. >> mcfarland: f.s.h. stands for follicle-stimulating hormone. these hormones regulate the development of bodily growth and the maturing process in puberty. it also helps regulate the reproductive process. l.h. stands for luteinizing hormone, and it plays a role in triggering testosterone production. and in fact, the problem could be even more upstream than the pituitary gland. that's because the hypothalamus gland plays a big role in the the hypothalamus makes the

hormone gonadotropin-releasing hormone, or gnrh, which travels through the bloodstream to the pituitary gland. gnrh is actually responsible for the release of f.s.h. and l.h. in the pituitary. >> so, really, for there to be a problem with the sex hormones, the problem could be due to hypothalamus, pituitary, or the gonad itself. >> mcfarland: and that's how the two types of hypgonadism are determined. if the problem originates in the gonad, or testes, it's considered primary hypgonadism. if it originates in the pituitary or hypothalamus gland, it is secondary. though rare, there are other causes of hypgonadism that are chromosomal in nature. in boys, it's called klinefelter syndrome, where

a problem exists within the chromosomes themselves, causing an extreme delay in puberty. still, other causes of hypgonadism can be directly related to medical issues. >> when i was 26 years old, i was diagnosed with testicular lymphoma. as a result of the lymphoma, i was required to undergo chemotherapy and radiation. >> mcfarland: mark botelho is now 34 and lives in fall river, massachusetts, with his wife, melissa. as is the case with a few other types of cancer treatments, mark's therapies didn't just create a temporary drop in testosterone; they created a permanent one. >> it lowered my testosterone levels. my levels tended to slowly

taper off over time. and i was tired. i was frequently tired. i didn't really want to do much. >> i cried a few times, and then--but it was like, all right. him seeing me like that made it worse for him, so i just kind of... you know, i got strong about it. >> i worried a lot about the future, specifically melissa. and what did the future hold for us in terms of having children someday, being able to have the type of relationship that a typical couple would have. >> and at that time, you were feeling well. the symptoms that men should be looking for in regards to the fact that they may have

low testosterone include a sudden change in their sexual desire, sudden change in their energy, not just feeling tired but an overwhelming sense of fatigue, that their mood is depressed. those are probably the key symptoms that men should be alerted to. >> he would come home from work and he would just be so tired, and he didn't want to do anything. he would fall asleep by, like, 6:30, 7:00 at night, so it was like communication kind of fell through. >> mcfarland: conducting blood tests to determine testosterone levels is usually the first step in diagnosing hypgonadism. in younger patients, doctors typically conduct a thorough physical exam to note whether a patient's sexual development

is consistent with his age. coming up, we'll meet hypgonadism patient dr. terry bilhartz, find out more about the potential consequences of this condition, and learn of the treatments available today. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: because testosterone makes its way throughout the body by way of the bloodstream, a decline in this hormone that leads to hypgonadism can have

far-reaching effects. >> we've known for a long time that there's a bidirectional relationship between low testosterone and what we call metabolic syndrome. metabolic syndrome is characterized by five components: an elevated blood sugar, an elevated blood pressure, a low hdl cholesterol, an increased waist circumference, and elevated triglycerides. there seems to be a relationship between low testosterone and overall cardiovascular events and cardiovascular mortality. when i say cardiovascular events, i mean myocardial infarction or a heart attack and stroke. >> mcfarland: diagnosing whether a patient has primary or secondary hypgonadism can

quickly determine the proper treatment measures. >> and it's usually done by a very good physical exam to determine where the problem is. also, blood tests can be very informative. and then sometimes, an mri test of the brain to see whether or not there is any tumor in either the hypothalamus or the pituitary gland. >> and once again, hold your breath. >> when we went to this wellness clinic, we had a variety of tests. we had blood tests. we did some bone scans. >> mcfarland: dr. terry bilhartz is 61 and professor of history at sam houston state university in huntsville, texas. dr. bilhartz's discovery of low testosterone took place 11 years ago. >> it was, of course, the blood work that identified the low testosterone. i knew i wasn't in optimal health at age 50.

i knew i was slightly overweight. i knew that my cholesterol levels were too high. i knew that my blood pressure was slightly higher than it should be. but nevertheless, grading myself on the curve, i felt that i was healthy. >> mcfarland: unlike many hypgonadism patients, dr. bilhartz experienced no noticeable symptoms of this condition. >> very interestingly, not all patients become symptomatic, and that's an area of research. we do not know why. >> well, the basic question is, what can i do about it? and the answers i've received, i think, was a very wise answer, that there are really three steps to improvement. one is improved diet, and two is exercise, and then three is actually the hormone therapy itself. >> the treatment right now that's been approved by the fda is replacing

testosterone, in different ways. you can give testosterone by a gel, which is a topical substance that you rub on your body so that the testosterone gets absorbed in your blood system and goes around the rest of the body, or you could give an injection. the injection right now is a mid-term sort of injection. you get injections either once every week or once every two weeks. >> mcfarland: along with testosterone gels and injections, there is a third hypgonadism treatment. it comes in the form of small implantable pellets. >> well, the treatments, as an all-endocrine, hormonal problem, is really giving back the hormone that's missing. >> mcfarland: regular and ongoing monitoring of hormone replacement therapy is crucial. too much testosterone, for instance, can create an overproduction of red blood cells.

>> you have to monitor the changes in the red blood cell volume very closely, because you stimulate the bone marrow to produce red blood cells, and you don't want to make the blood too viscous or thick. >> that can be dangerous. so it's important that a man be monitored both for his testosterone level, to make sure he's getting just the right amount. also, he should be monitored for his red blood cell count to make sure that's not becoming too high. >> we monitor what we call the complete blood count, looking particular at the hematocrit in the hemoglobin... to make sure that it's not too thick. monitoring is actually for safety. we will always want to keep the levels of the testosterone in what we call physiological levels, not above physiological levels. superphysiological levels can sometimes lead to problems,

including blood clots, heart attacks, strokes, and so on. >> mcfarland: and for a man who uses gel therapy, it's important that the gel dries completely and the application site is covered before making direct contact with his partner or children especially. >> the psa, i must say, is not a test for cancer, but it helps us evaluate the possibility of cancer. testosterone, as we all know, does not cause cancer. however, if testosterone is given to somebody who has cancer, certainly the cancer will grow. >> there are newer forms of testosterone that's coming out, but they give it

in different ways. they're more concentrated. therefore, there's less volume that has to be applied. so, you know, a lot of exciting things that are coming out about testosterone replacement therapy. >> we don't really have a cure. we don't have an answer today, but who knows? in our lifetime, we may see this for patients that suffer from low sex hormones. >> i think the treatment has helped me... it's made me realize some of things that i was encountering before. >> come on, good girl. >> i think it's impacted our relationship...in good ways. that would be very funny. you know that? >> he's got the energy level to do things, and it's just-- it's just, like, a totally different thing. we have that time again. we can actually have conversations. >> some that are around my age,

low 70s or middle 70s, they'd rather be retired and enjoy an easier life, i guess--what they think is an easier life. it's just not for me. i don't want to become a tv couch potato. >> i have no problem with aging, but i want to live life to my fullest. i want to have the energy, i want to have the sex drive, i want to have the capacity to achieve my goals and enjoy life and the pleasures of life. >> mcfarland: hypgonadism can be the cause of many difficult trials, so if symptoms such as extreme fatigue, hot flashes,

or loss of sex drive occur, contact a health care provider right away. that's it for this edition of healthy body, healthy mind. i'm dr. scott mcfarland. see you next time. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: to answer any specific questions you may have, be sure to contact your health care provider. to comment on today's program, please call: or email: or visit our website at: >> announcer: major funding for healthy body, healthy mind is provided by: endo pharmaceuticals, an integrated health care solutions company focused on providing patients with branded products, specialty generics,

and a suite of complementary devices and services. and by amgen, a biotechnology company committed to providing novel therapeutics to address unmet medical needs in the treatment of cancer patients. additional funding provided by: genzyme, a sanofi company. and by sonosite. captioning by captionmax www.captionmax.com

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