Blog - Castellano Health Institute
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There are plenty of advertisements and commercials talking about erectile dysfunction.  By now we all know that Erectile dysfunction (ED) is the inability to achieve a full or consistent erection for satisfactory sexual activity. It’s common after forty and by the time men reach fifty years of age, half of men have it.

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What’s often left out of these commercials is that 80% of erectile dysfunction cases are due to chronic diseases such as Diabetes, Vascular Disease, and Testosterone Deficiency or a side effect of a medication used to treat these chronic conditions. The other thing that is left out is that if you can identify the cause, you can sometimes treat it or at least prevent it from getting worse.

When it comes to erectile dysfunction, lifestyle choices have a significant impact on outcomes. We address lifestyle so that our patients have the best chance at improving their overall health and performance. We have all the standard medications used for erectile dysfunction as well as some your doctor may not be familiar with. For example, in those patients who have failed or are unable to take the PDE-5 inhibitors, intracorporal injections of Prostaglandin (PGE1) monotherapy, Bimix, or Trimix work best.

We understand that you have questions and need guidance figuring what works best for you. Don’t worry, our appointments allow for a thorough understanding of your options when it comes to treating erectile dysfunction. Your well-being is our highest concern.

Cardiovascular Death and Testosterone

If you listen to most docs who are unfamiliar with TRT, they steer men away from testosterone because somewhere in their training they were told that testosterone leads to heart attacks.  To their credit, if what they were told was true, that would be the right thing to do. But is it? Is the information they were spoon fed correct?

Up until 2015, there was no study that looked at testosterone replacement therapy (TRT) and cardiovascular death rates. Fortunately, Sharma et al., did a study with 83,010 veterans on TRT and looked at cardiovascular outcomes including heart attacks and strokes. The aim of the study was to look at what happened to outcomes when testosterone (T) levels were normalized.

Cardiovascular Death and Testosterone

The veterans were broken into three groups, one received no treatment, one received treatment off/on (no normalization of T levels), and the other group received TRT with normalization of T levels. The median age of participants was 66 years and time of follow-up was 6.2 years.

The end data showed that the group who had testosterone levels normalized, were 56% less likely to die from all causes compared to the non-treatment group. They were 36% less likely to have a stroke and 24% less likely to have a heart attack.  There was no difference in heartattacks and stroke rates among the partial treatment group and the non-treatment group.

This was the largest study done on TRT and normalization of T levels.  It shows that TRT is beneficial if you have low testosterone and are trying to avoid not only early death, but strokes and heart attacks.  The only problem with this study is that it was done in Europe and appeared in the European Heart Journal and most American Docs only read American Journals.  But here it is, presented to you, so that you can show it to your loved ones that are nervous for those of you on TRT.  Feel free to share it with your doc if they are warning you against TRT

Are you skinny-fat?

Most insurance companies use your BMI (body mass index) to asses health risk, but the BMI can be misleading. BMI is a simple calculation using height and weight to risk stratify individuals. The problem with using body weight is that body fat, muscle, organs, bone, and total body water make up your weight. The big variables in calculating your BMI are how much total body fat and total muscle mass you have. If your muscle mass is high, are in great shape, and work out, your BMI could be misleadingly high.Athletes and military personnel, who are in great shape, often get misdiagnosed as overweight or obese due to a high BMI, yet they are healthier and at less risk of dying than the BMI would have you believe.

If you have a normal BMI, it doesn’t mean you are necessarily healthy. You could still suffer from a condition I call “skinny-fat”. What is skinny-fat? Skinny-fat is a condition where an individual has a normal weight but has very little muscle mass and excess body fat. This is more common in women, as they tend to lose a lot of muscle mass from yo-yo dieting. Currently there are more than 300,000 adults in the US who fit the description of skinny-fat.

Most docs never check a body fat level and thus will never know if you are at increased risk of an earlier death. A recent study showed that 50% of people who had body fat levels in the obese range had normal BMI’s. About 18% of those adults had Metabolic Syndrome. Being skinny-fat also increases your risk of cardiovascular mortality. BMI can mislead your doc, don’t let it mislead you!

Testosterone Replacement Therapy and Mortality

Clinical guidelines recommend Testosterone Replacement Therapy (TRT) for men suffering from clinical symptoms of low testosterone when low Testosterone levels are documented. The most common symptoms of low testosterone include low sex drive/libido, low energy/fatigue, erectile dysfunction, and loss of muscle mass.  Currently there are 2.4 million men, ages 40-69, who meet the criteria for Low Testosterone (Hypogonadism).  With such large numbers of men qualifying for treatment, the question of safety arises.  Since the leading cause of death in men is cardiovascular disease, does prescribing testosterone therapy contribute to heart disease?

Contrary to current thinking, we know from studies that Low Testosterone is associated with a higher risk of cardiac events.  Most studies looking at testosterone replacement and cardiovascular disease have been relatively small and have shown some conflicting results.   But a recent large European retrospective study looked at the effect of Testosterone normalization on overall mortality, MI (Heart attacks), and strokes. 83,010 male veterans, with documented low testosterone levels were broken down into three groups and followed over 15 years.  At the end of the study, when comparing the normalized testosterone group (Gp1) to the non-treatment group (Gp3), there was an overall 56% decrease in mortality, 24% decrease in MI’s, and a 36% decrease in strokes in the Gp1. This large study showed that if your testosterone levels are low, you are less likely to die if you raise your testosterone levels to normal.

Even now, some patients are denied testosterone therapy by their physicians because they still believe that testosterone causes prostate cancer, leads to ‘Roid Rage’ or cardiovascular disease. We know these old myths take time to die off, but in the meantime, we are here to service those patients that can’t wait for their physicians to catch up with the latest scientific information. Unlike most physicians, Dr. Castellano knows that low testosterone is a risk factor for early death and that keeping your testosterone levels optimized reduces all causes of death.  At Castellano Health Institute, we stay on top of the latest medical knowledge so we can offer our patients the cutting edge of medical therapies.

Dr. Castellano is aware that all hormones have an interplay and a balance that must be maintained for optimal health. At Castellano Health Institute, we continually monitor total testosterone levels, estradiol, cbc, etc.  We know that testosterone is not the end-product, it breaks down to 6 other molecules, all which can have side effects.  We also know that each person is similar but different in how they may metabolize medicines, so therapies are always individualized.  At Castellano Health Institute, we specialize in all things Testosterone related, from treating low testosterone, erectile dysfunction, to the treatment of hair loss.