Low testosterone, also known as hypogonadism or “low T,” is a condition where the body produces insufficient levels of testosterone—the primary male sex hormone responsible for developing and maintaining masculine characteristics. Testosterone plays a crucial role in muscle mass, bone density, red blood cell production, and overall mood and energy levels. Recognizing the symptoms and understanding the management options is essential for maintaining health and quality of life.

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Symptoms of Low Testosterone

Low testosterone can manifest through a variety of physical, emotional, and cognitive symptoms. These may develop gradually and can often be attributed to other health issues, making diagnosis challenging. Common symptoms include:

1. Reduced Libido and Sexual Function
   • Decreased Sex Drive: A significant drop in sexual desire.
   • Erectile Dysfunction: Difficulty achieving or maintaining an erection.
   • Infertility: Reduced sperm production leading to challenges in conceiving.
2. Physical Changes
   • Fatigue and Low Energy: Persistent tiredness despite adequate rest.
   • Loss of Muscle Mass: Decreased strength and muscle tone.
   • Increased Body Fat: Particularly around the abdomen.
   • Decreased Bone Density: Higher risk of fractures due to osteoporosis.
   • Hair Loss: Reduction in body and facial hair growth.
   • Hot Flashes: Sudden feelings of warmth.
3. Emotional and Cognitive Symptoms
   • Mood Changes: Irritability, depression, or anxiety.
   • Difficulty Concentrating: Memory lapses or trouble focusing.
   • Reduced Motivation: Lack of enthusiasm or drive.
4. Sleep Disturbances
   • Insomnia: Trouble falling or staying asleep.
   • Sleep Apnea: Disrupted breathing during sleep.
5. Other Signs
   • Anemia: Low red blood cell counts leading to fatigue.
   • Gynecomastia: Development of breast tissue in men.

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Causes of Low Testosterone

Several factors can contribute to decreased testosterone levels:

• Aging: Natural decline in testosterone production begins around age 30.
• Medical Conditions: Including type 2 diabetes, obesity, metabolic syndrome, and chronic illnesses.
• Injuries or Infections: Damage to the testicles or conditions affecting the hypothalamus or pituitary gland.
• Medications: Certain drugs can interfere with hormone production.
• Lifestyle Factors: Poor diet, lack of exercise, excessive alcohol consumption, and stress.

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Diagnosis

Diagnosing low testosterone involves a combination of symptom assessment and laboratory tests:

• Medical History and Physical Examination: Evaluating symptoms and overall health.
• Blood Tests: Measuring total and free testosterone levels, typically in the morning when levels are highest.
• Additional Tests: Checking luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and estradiol to determine underlying causes.

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Management and Treatment Options

Treatment aims to restore testosterone levels to the normal range and alleviate symptoms. Management strategies include:

1. Testosterone Replacement Therapy (TRT)TRT can be administered through various methods:
   • Injectable Testosterone: Injections given intramuscularly every 1 to 4 weeks.
   • Topical Applications: Gels, creams, or patches applied daily to the skin.
   • Implantable Pellets: Placed under the skin, releasing testosterone over several months.
   • Oral Medications: Less common due to potential liver effects.
   Benefits of TRT:
   • Improved libido and sexual function.
   • Increased muscle mass and strength.
   • Enhanced mood and energy levels.
   • Increased bone density.
   Considerations:
   • Regular monitoring is essential to assess effectiveness and adjust dosage.
   • Potential side effects include acne, sleep apnea, elevated red blood cell counts, and prostate concerns.
   • TRT may not be suitable for everyone, such as those with certain cancers or severe heart conditions.
2. Lifestyle Modifications
   • Healthy Diet: Emphasizing whole foods rich in vitamins and minerals.
   • Regular Exercise: Combining cardiovascular and strength training.
   • Weight Management: Achieving a healthy body weight to improve hormone levels.
   • Adequate Sleep: Aiming for 7-9 hours per night to support hormone production.
   • Stress Reduction: Techniques like meditation, yoga, or deep-breathing exercises.
3. Treatment of Underlying Conditions
   • Addressing medical issues such as obesity, diabetes, or thyroid disorders can improve testosterone levels.
4. Avoiding Substance Abuse
   • Limiting alcohol consumption and avoiding illicit drugs that can affect hormone production.
5. Alternative Medications
   • Clomiphene Citrate: Stimulates the body’s own testosterone production, often used in younger men who wish to maintain fertility.
   • Human Chorionic Gonadotropin (hCG): Mimics LH to stimulate testosterone production.

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Monitoring and Follow-Up

Regular follow-up with a healthcare provider is crucial:

• Periodic Blood Tests: To monitor testosterone levels and adjust treatment.
• Assessing Symptoms: Evaluating the improvement of symptoms and quality of life.
• Monitoring Side Effects: Checking prostate health, red blood cell counts, and cardiovascular status.

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Potential Risks and Side Effects

While TRT can offer significant benefits, it’s important to be aware of potential risks:

• Cardiovascular Issues: Possible increased risk of heart attack or stroke in some individuals.
• Prostate Health: Monitoring for prostate enlargement or cancer.
• Sleep Apnea: TRT may exacerbate existing sleep disorders.
• Blood Clots: Elevated red blood cell counts can increase clotting risk.

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When to Seek Medical Advice

If you experience symptoms associated with low testosterone, consult a healthcare professional. Early diagnosis and treatment can improve outcomes and enhance quality of life.

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Conclusion

Low testosterone is a treatable condition with a range of management options available. Through medical intervention and lifestyle changes, individuals can restore hormone levels and alleviate symptoms. Collaboration with a qualified healthcare provider ensures a personalized approach tailored to individual needs and health status.

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Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a healthcare provider for diagnosis and treatment recommendations tailored to your specific condition.

Performance-enhancing drugs (PEDs), including anabolic steroids, human growth hormone, stimulants, and other substances, can lead to a wide range of health complications affecting multiple organ systems. Effective screening is essential for early detection and management of these potential adverse effects. Below is an overview of expected complications and the methods used to screen for them through patient history, physical examination, bedside tests, blood tests, imaging, and specialized tests.

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1. Cardiovascular Complications

Expected Complications:

• Hypertension (high blood pressure)
• Cardiomyopathy (enlargement or thickening of heart muscle)
• Arrhythmias (irregular heartbeats)
• Atherosclerosis leading to coronary artery disease
• Myocardial infarction (heart attack)
• Stroke

Screening Methods:

History:

• Symptoms: Chest pain, shortness of breath, palpitations, dizziness, syncope.
• Risk Factors: Family history of heart disease, smoking, high cholesterol.
• PED Use Details: Type, dosage, duration, and route of administration.

Physical Examination:

• Vital Signs: Blood pressure measurement in both arms, heart rate.
• Cardiac Examination: Auscultation for murmurs, gallops, or extra heart sounds.
• Peripheral Vascular Assessment: Checking for edema, cyanosis, or diminished pulses.

Bedside Tests:

• Electrocardiogram (ECG): To detect arrhythmias, ischemic changes, or hypertrophy.

Blood Tests:

• Lipid Profile: Total cholesterol, LDL, HDL, triglycerides.
• Cardiac Biomarkers (if symptomatic): Troponin I/T, CK-MB.
• C-Reactive Protein (CRP): Marker for inflammation.

Imaging:

• Echocardiogram: Evaluates heart structure and function.
• Stress Test: Assesses cardiac function under exertion.
• Cardiac MRI/CT: Detailed imaging for structural abnormalities.

Specialized Tests:

• Holter Monitor: 24-48 hour ECG monitoring for intermittent arrhythmias.
• Coronary Angiography: If ischemic heart disease is suspected.

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2. Hepatic (Liver) Complications

Expected Complications:

• Hepatotoxicity: Liver cell damage.
• Cholestasis: Impaired bile flow.
• Peliosis Hepatis: Blood-filled cysts in the liver.
• Hepatic Tumors: Both benign (adenomas) and malignant (hepatocellular carcinoma).

Screening Methods:

History:

• Symptoms: Jaundice, right upper quadrant pain, fatigue, dark urine, pale stools.
• Risk Factors: Alcohol use, viral hepatitis exposure.

Physical Examination:

• Abdominal Examination: Palpation for liver enlargement or tenderness.
• Skin Examination: Signs of jaundice, spider angiomas.

Blood Tests:

• Liver Function Tests (LFTs):
  • Alanine Aminotransferase (ALT)
  • Aspartate Aminotransferase (AST)
  • Alkaline Phosphatase (ALP)
  • Gamma-Glutamyl Transferase (GGT)
  • Total and Direct Bilirubin
• Coagulation Profile: Prothrombin time (PT), International Normalized Ratio (INR).
• Albumin Levels: Indicator of synthetic function.

Imaging:

• Ultrasound of the Liver: Detects structural abnormalities.
• CT Scan or MRI: For detailed imaging of liver lesions.

Specialized Tests:

• Liver Biopsy: If imaging suggests significant pathology.
• Viral Hepatitis Panel: To rule out viral causes.

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3. Renal (Kidney) Complications

Expected Complications:

• Acute Kidney Injury (AKI)
• Chronic Kidney Disease (CKD)
• Glomerulonephritis
• Electrolyte Imbalances

Screening Methods:

History:

• Symptoms: Swelling in extremities, fatigue, decreased urine output, hematuria.
• Risk Factors: Dehydration, hypertension, use of nephrotoxic agents.

Physical Examination:

• Vital Signs: Blood pressure, heart rate.
• Edema Assessment: Peripheral edema, periorbital puffiness.
• Skin Examination: Dryness, pallor.

Bedside Tests:

• Urinalysis (Dipstick): Checks for protein, blood, glucose, specific gravity.
• Urine Microscopy: Identifies casts, cells, or crystals.

Blood Tests:

• Serum Creatinine and Blood Urea Nitrogen (BUN): Assess renal function.
• Estimated Glomerular Filtration Rate (eGFR): Measures kidney filtration capacity.
• Electrolytes: Sodium, potassium, calcium, phosphate.

Imaging:

• Renal Ultrasound: Evaluates kidney size, structure, and obstructions.

Specialized Tests:

• 24-Hour Urine Collection: Quantifies proteinuria.
• Renal Biopsy: For definitive diagnosis of glomerular diseases.

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4. Endocrine and Metabolic Complications

Expected Complications:

• Hormonal Imbalances: Suppression of natural testosterone production.
• Gynecomastia: Development of breast tissue in males.
• Infertility: Reduced sperm production.
• Insulin Resistance: Leading to type 2 diabetes.
• Dyslipidemia: Abnormal lipid levels.

Screening Methods:

History:

• Symptoms: Fatigue, weight changes, decreased libido, erectile dysfunction.
• Reproductive History: Fertility issues, menstrual irregularities in women.

Physical Examination:

• Anthropometric Measurements: Weight, BMI, waist circumference.
• Examination of Secondary Sexual Characteristics: Testicular atrophy, body hair distribution.
• Breast Examination: Checking for gynecomastia.

Blood Tests:

• Hormonal Panel:
  • Total and Free Testosterone
  • Luteinizing Hormone (LH)
  • Follicle-Stimulating Hormone (FSH)
  • Estradiol
  • Prolactin
  • Sex Hormone-Binding Globulin (SHBG)
• Glucose Levels:
  • Fasting Blood Glucose
  • Hemoglobin A1c (HbA1c)
• Lipid Profile: Total cholesterol, LDL, HDL, triglycerides.

Specialized Tests:

• Oral Glucose Tolerance Test (OGTT): Assesses insulin resistance.
• Semen Analysis: Evaluates fertility in men.
• Thyroid Function Tests: TSH, T3, T4 levels.

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5. Psychiatric and Behavioral Complications

Expected Complications:

• Mood Disorders: Depression, anxiety.
• Aggression and Irritability: Sometimes referred to as “roid rage.”
• Psychosis: Rare but possible.
• Dependence and Withdrawal Symptoms.

Screening Methods:

History:

• Behavioral Changes: Increased aggression, irritability.
• Mood Symptoms: Feelings of sadness, hopelessness, or excessive worry.
• Sleep Patterns: Insomnia or hypersomnia.
• Substance Use: Including PEDs and other drugs.

Physical Examination:

• Observation: Appearance, eye contact, psychomotor activity.
• Mental Status Examination: Assess cognition, thought processes, and judgment.

Specialized Tests:

• Psychological Assessments:
  • Beck Depression Inventory (BDI)
  • Hamilton Anxiety Rating Scale (HAM-A)
• Referral: To a mental health professional for comprehensive evaluation.

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6. Hematological Complications

Expected Complications:

• Polycythemia: Increased red blood cell mass.
• Thromboembolism: Increased risk of blood clots.
• Anemia: In some cases due to bone marrow suppression.

Screening Methods:

History:

• Symptoms: Headaches, dizziness, visual disturbances, unexplained bruising or bleeding.

Physical Examination:

• Skin Examination: Flushing, cyanosis, petechiae, or ecchymoses.
• Vital Signs: Blood pressure, heart rate.

Blood Tests:

• Complete Blood Count (CBC):
  • Hemoglobin and Hematocrit: Elevated in polycythemia.
  • White Blood Cell Count and Differential
  • Platelet Count
• Coagulation Profile: PT, aPTT, D-dimer if thrombosis is suspected.

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7. Dermatological Complications

Expected Complications:

• Acne Vulgaris: Particularly severe or cystic acne.
• Hirsutism: Excessive hair growth in women.
• Alopecia: Hair loss, particularly male-pattern baldness.
• Skin Infections: Due to injections or compromised immunity.

Screening Methods:

History:

• Skin Changes: Onset, progression, treatments tried.
• Hygiene Practices: Especially related to injection sites.

Physical Examination:

• Skin Inspection: Acne distribution, severity, scarring.
• Hair Examination: Hair loss patterns.

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8. Musculoskeletal Complications

Expected Complications:

• Tendon Ruptures
• Premature Epiphyseal Closure: In adolescents, leading to stunted growth.
• Muscle Tears and Injuries

Screening Methods:

History:

• Injuries: History of strains, sprains, or ruptures.
• Exercise Regimen: Intensity and type of physical activity.

Physical Examination:

• Joint Examination: Range of motion, tenderness, swelling.
• Muscle Strength Testing: Identifying weaknesses or asymmetries.

Imaging:

• MRI: For soft tissue evaluation.
• X-Rays: To assess bone growth plates in adolescents.

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9. Reproductive System Complications

Expected Complications:

• Testicular Atrophy
• Impotence
• Infertility

Screening Methods:

History:

• Sexual Function: Libido, erectile function, ejaculation.
• Fertility Concerns: Difficulty conceiving.

Physical Examination:

• Genital Examination: Testicular size, consistency, presence of masses.

Blood Tests:

• Hormonal Panel: As above, focusing on reproductive hormones.

Specialized Tests:

• Semen Analysis: Assess sperm count, motility, and morphology.

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10. Infectious Disease Risks

Expected Complications:

• Blood-Borne Infections: HIV, hepatitis B and C.
• Skin Infections: Abscesses at injection sites.

Screening Methods:

History:

• Injection Practices: Needle sharing, sterility of equipment.
• High-Risk Behaviors: Unprotected sex, multiple partners.

Physical Examination:

• Injection Sites: Inspect for signs of infection or scarring.
• General Examination: Signs of systemic infection.

Blood Tests:

• HIV Testing: Antigen/antibody combination immunoassay.
• Hepatitis Panel: Hepatitis B surface antigen, hepatitis C antibody.
• Syphilis Testing: Rapid plasma reagin (RPR) test.

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11. Neurological Complications

Expected Complications:

• Stroke
• Seizures
• Peripheral Neuropathy

Screening Methods:

History:

• Neurological Symptoms: Numbness, weakness, vision changes, headaches.

Physical Examination:

• Neurological Examination: Cranial nerves, motor and sensory testing, reflexes, coordination.

Imaging:

• CT Scan or MRI of the Brain: If neurological deficits are present.

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12. Cancer Risks

Expected Complications:

• Prostate Cancer
• Liver Cancer
• Kidney Tumors

Screening Methods:

History:

• Family History: Cancer in immediate relatives.
• Symptoms: Weight loss, night sweats, hematuria.

Physical Examination:

• Digital Rectal Examination (DRE): Assess prostate size and texture.

Blood Tests:

• Prostate-Specific Antigen (PSA): Elevated levels may indicate prostate pathology.

Imaging:

• Ultrasound or MRI: Of the prostate, liver, or kidneys if indicated.

Specialized Tests:

• Biopsy: If imaging suggests malignancy.

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13. Immunological Complications

Expected Complications:

• Immune Suppression: Increased susceptibility to infections.
• Autoimmune Reactions

Screening Methods:

History:

• Infection History: Frequency and severity of infections.

Blood Tests:

• Complete Blood Count: White blood cell count.
• Immunoglobulin Levels: IgG, IgA, IgM.
• Autoimmune Markers: ANA, rheumatoid factor.

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General Screening Approach

1. Comprehensive Medical History:
   • Detailed PED Use: Types, doses, frequency, duration.
   • Lifestyle Factors: Diet, exercise, substance use.
   • Psychosocial Factors: Stress, mental health history.
2. Thorough Physical Examination:
   • Vital Signs: Including blood pressure in multiple positions.
   • Systemic Examination: Cardiovascular, respiratory, abdominal, neurological, musculoskeletal.
3. Laboratory Investigations:
   • Baseline Blood Tests: CBC, LFTs, renal function, electrolytes.
   • Specific Tests: Based on suspected complications.
4. Imaging Studies:
   • Ultrasound, X-Rays, MRI, CT Scans: As indicated by clinical findings.
5. Specialized Tests:
   • Functional Tests: ECG, echocardiography, pulmonary function tests.
   • Endocrine Assessments: Dynamic hormonal testing if needed.
6. Referrals to Specialists:
   • Cardiology, Endocrinology, Nephrology, Psychiatry, Oncology.
7. Counseling and Education:
   • Risks of PED Use: Provide clear information.
   • Harm Reduction Strategies: Safe injection practices, gradual cessation plans.
   • Mental Health Support: Access to counseling services.
8. Regular Monitoring and Follow-Up:
   • Scheduled Appointments: To reassess and monitor progression.
   • Adjustment of Interventions: Based on test results and clinical status.

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Summary

Screening for complications of PED use involves a multidisciplinary approach, integrating detailed history-taking, comprehensive physical examination, and targeted investigations. Early detection and intervention can mitigate risks and improve health outcomes. Healthcare providers should maintain a non-judgmental and supportive stance to encourage open communication and effective management.

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Disclaimer: This information is intended for educational purposes and should not replace professional medical advice. Individuals using PEDs should consult a qualified healthcare professional for personalized assessment and guidance.

Monkeypox is a disease that is caused by infection with the monkeypox virus.

The virus was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. The first case of monkeypox in a person was recorded in 1970 in the Democratic Republic of Congo, and since then has been reported primarily in other western and central African countries.



Can I catch monkeypox?

The virus can be transmitted if a person comes into close contact with an infected person, animal or object.

Person-to-person spread is not common, but may happen through:

• coughing or sneezing of an individual with monkeypox
• contact with clothing and shared linen (such as bedding or towels)
• direct contact with monkeypox rash and/or scabs

What are Monkeypox Symptoms?

Monkeypox often begins with:

• headache
• fever
• back and muscle aches
• swollen lymph nodes
• chills
• exhaustion

The isolation period for monkeypox ranges from 5-21 days. Within 1 to 5 days after the appearance of fever, a rash develops, commonly starting on the face but then can spread to other parts of the body.

Most people recover within several weeks but severe cases can occur in some individuals in which case further medical attention may be required.

Adapted from NHS website, last accessed 10/07/2022 https://www.nhs.uk/conditions/monkeypox/

The two primary supplements that can are often considered are Folic acid and Vitamin D. Folic acid is believed to help prevent certain birth defects, while vitamin D is good for bone health in your baby and can also benefit the heart and nervous system.

The NHS website recommends that you take 400 micrograms of folic acid every day – from before you’re pregnant until you’re 12 weeks pregnant. With regards to Vitamin D, the recommendation is to take 10 micrograms of vitamin D each day. This can come from food sources but you can consider taking a supplement containing this amount between September and March.

Below are some dietary souses of Vitamin D:

• oily fish (such as salmon, mackerel, herring and sardines)
• eggs
• red meat

Vitamin D is added to some breakfast cereals, fat spreads and non-dairy milk alternatives. The amounts added to these products can vary and might only be small.

Because vitamin D is only found in a small number of foods, whether naturally or added, it is difficult to get enough from foods alone.

Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful.

You can get vitamin supplements containing vitamin D free of charge if you’re pregnant or breastfeeding and qualify for the Healthy Start scheme.

adapted from NHS website 2021, accessed 10/07/2022 https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/

Benefits of HRT

The main benefit of HRT is that it can help relieve most menopausal symptoms, such as:

• hot flushes
• night sweats
• mood swings
• vaginal dryness
• reduced sex drive

HRT can also help prevent thinning of the bones, which can lead to fracture (osteoporosis). Osteoporosis is more common after menopause.

Risks of HRT

The benefits of HRT usually outweigh the risks for most women.

The risks are usually very small and depend on the type of HRT you take, how long you take it and your own health risks.

Speak to a GP if you’re thinking about starting HRT or you’re already taking it, and you’re worried about any risks.

Breast cancer

There is little or no change in the risk of breast cancer if you take oestrogen-only HRT.

Combined HRT can be associated with a small increase in the risk of breast cancer.

The increased risk is related to how long you take HRT, and it falls after you stop taking it.

Because of the risk of breast cancer, it’s especially important to attend all your breast cancer screening appointments if you’re taking HRT.

Blood clots

The evidence shows that:

• there’s no increased risk of blood clots from HRT patches or gels
• taking HRT tablets can increase your risk of blood clots – but this risk is still small

Heart disease and strokes

HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age and may reduce your risk.

Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.

adapted from NHS website 2019, accessed 10/07/2022 link