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Monday, June 02, 2014

Official AVEED warnings: Read Before Consenting

What is the most important information I should know about AVEED?
AVEED may cause serious side effects, including:
 A serious lung problem. AVEED can cause a serious lung problem called a pulmonary oil
microembolism (POME) reaction. POME is caused by tiny droplets of oil that have traveled to
the lungs. Symptoms of a POME reaction may include:
o cough or urge to cough
o difficulty breathing
o sweating
o tightening of your throat
o chest pain
o dizziness
o fainting
 Serious allergic reactions (anaphylaxis). AVEED can cause a serious allergic reaction
right after receiving the injection. Some of these allergic reactions may be life threatening.
These reactions can happen after you receive your first dose of AVEED or may happen after
receiving more than 1 dose.
You may need emergency treatment in a hospital, especially if these symptoms get worse
over the 24 hours after your AVEED injection.
These side effects may happen during or right after each injection. To be sure that
you are not having one of these reactions:
 You need to stay in the doctor’s office, clinic, or hospital for 30 minutes
after having your AVEED injection so that your doctor can watch you for
symptoms of POME or a serious allergic reaction.
 You can only get AVEED at your doctor’s office, clinic, or hospital

Thursday, May 29, 2014

Women take note: it is testicular size not penis size that matters!

In man, the penis protrudes from the body in a prominent way.  Anthropologists have demonstrated that penis size, like plumage on a peacock, may confer a reproductive advantage to the well endowed man, as women see this as a sign of fertility.   However, testicular size is far more important.

The majority of a testicles volume is made up of seminiferous tubules, where sperm are made.  Men with very small testis have less of this machinery.   The normal testicle should have a long axis (length) of ~4.5 cm.   One can use a $5 caliper to measure a testicle.  

So if you want kids, find a mate with large testicles.  

Saturday, May 24, 2014

Estrogen Rather Than Testosterone Might Be The Key To Libido

Common and accepted medical belief was that testosterone was associated with libido.  This was due to an association with low T and low libido.  But those of us in the field of men's health recognized that low T did not tell the entire story.  While some men with very low T AND low libido reported improved libido with normalized T levels, the improvements were inconsistent as best and not linear in nature.  By that I mean that after a certain T level was reached, further increases in T did not result in further improvements in libido.

Estrogen: Estrogen and Testosterone are intimately related.  Estrogen in fact comes from testosterone via conversion by aromatase, an enzyme.  Men with low T will also have low E levels and increasing T levels with medication will also increase E levels. Rising E levels in a man on testosterone therapy can cause gynecomastia, which is breast development.  As gynecomastia is an adverse outcome, doctors that do TRT monitor E levels and treat rising E with an aromatase inhibitor like Anastrozole.  I used to do this as well, and still do but much less often than in the past.  Why?  Because I noticed that some of my men on Anastrozole began complaining of dimished libido.  Research studies presented at this AUA14 supported what I noticed several years ago.

Conclusion: estrogen and testosterone are linked and both are needed for libido, but estrogen might be the more important of the 2 hormones in relation to libido.  More studies are needed.

Thanks,
Dr Schoor

Wednesday, May 21, 2014

Painful Intercourse is Real and Treatable

Sexual pain disorders are extremely common.   Sexual pain in women is called dysparunia.   Dysparunia has 3 main causes: endocrine dysfunction, pelvic floor myofascial tension disorder, and neuroproliferative disorder.  Endocrine dysfunction is by far the most common, is easy to diagnose, and is easy to treat.  I'll be discussing that one here.

Males and females have the same reproductive hormones.  These hormones are testosterone, estradiol, FSH, LH, and SHBG.  In men and women, the health of various reproductive organs is vitally dependent on the proper interplay between systemic levels of these hormones, local intra-tissue levels of these hormones, and tissue receptor function to these hormones.  When this system breaks down, the tissue becomes unhealthy.  Women experience this as pain with sexual intercourse.

Most pain with sexual intercourse occurs at the introitus--the opening of the vagina where the penis enters. Sexual pain disorders affects young adults, middle age adults, and the elderly.  The number one culprit by far is the hormonal based contraception--the pill, the ring, the implant--it does not matter so long as the method is based on hormonal manipulation.  If your gynecologist disagrees with this, they are wrong.  It is that simple.  Too much quality basic science and clinical research exists to dispute it.

The only way your doctor would know if you have sexual pain is if 1: you tell him or 2: he/she asks.  It is then imperative that the doctor due a thorough inspection of the external and internal female genitalia with adequate light and optical magnification.  Then blood testing is indicated.  We test for the blood levels of the hormones and proteins mentioned above.

As for treatment, once the specific cause is identified, which is not difficult, treatment is easy as well, and can include a combination of topical testosterone therapy, locally applied estradiol therapy, combination estradiol/testosterone therapy applied locally to the genitalia, systemic progesterone therapy, and others.

In this day and age, thanks to the pioneering work of female sexual health clinicians and scientists across the world, women no longer need to suffer from sexual pain disorders.

Tuesday, May 20, 2014

Age Does Matter For A Male's Fertility

Everyone knows about advanced maternal age.  Everyone knows that as women age it becomes progressively difficult to conceive a pregnancy.   Everyone know that beyond a certain age, women can no longer become pregnant.  Everyone knows that certain birth defects are associated with advanced maternal age.  
But how about men?
Emerging scientific data demonstrate that advanced paternal age exists and is associated with fertility problems.   Advanced paternal age is associated with an increase in sperm DNA damage.   Advanced paternal age is associated with increase incidence of certain both defects (though this is still rare).   Advanced paternal age is associated with an impaired ability of a sperm to fertilize an egg, lower success rates with in vitro fertilization, and lower success rates with ICSI.   
What can one do about it?
Counseling
Sperm cryopreservation prior to age 50
Pre-implantation genetic diagnosis
Sperm DNA testing

Thanks,
Dr Schoor

Tuesday, May 06, 2014

Practice makes better if not perfect.

I am definitely unusual.  Definitely unique. I have a microsurgical practice and training facility in my office.  I use it to hone my own skills and to train others in the technique of microsurgical vasectomy  reversal.  Does it cost me a lot of money?  You bet.  Why do I do it?   Because I don't want to practice on you.  For you, I want to be at my best.  Practice is how I get there.