Sex and the City (Village)- Part 2

The patient question of the week: “My husband recently started testosterone replacement and has too much ENERGY. Is there something you can do to slow him down?”

While I don’t agree with slowing him down, I can bring you back up to speed. The best results from starting bio-identical hormone replacement therapy (BHRT) are achieved when both of you have been adequately treated. More energy is great during the day, but can seem a bit excessive around bedtime when you aren’t speaking the same language. Move your bedtime up by 30 minutes, turn off the TV earlier and talk! Most guys aren’t the best at whispering sweet nothings. If you open a dialog and let him know that discussing plans, home life, and the events of your day help you unwind and get ready to get in the mood, he may step up to the plate. Good luck to both of you!

Last week’s article discussed the origin of the well-woman exam and touched on the difference between men and women regarding being physically and emotionally ready for sex. This article will delve into the benefits of a normal testosterone (T) level for men AND women.

Let’s be candid. A man with a normal T level doesn’t need much inspiration for sex. We continually confound the women with our self-inspiration. “Wait a minute. I was going over the shopping list and asking you about what you would like to eat next week. Were you even listening to me? How can you be ready to have sex?”

Guys- try to pay enough attention that you can parrot back the last sentence. Slip in a remark about how her company is the most valuable thing about dinner and how you would be happy with bread and water as long as she is with you. Mention that as she was talking you were paying more attention to her lips than what she was actually saying and you may pull it off. Otherwise, prepare for another cold night as she tries to teach you a lesson about paying attention to what she says.

Gals- remember how it used to be a lot easier to get in the mood? Testosterone is one of the most important sex hormones, and it decreases in women and men as we age. Depending on the study, T levels in women can start to drop as early as age 25, long before estrogen levels start to decrease.

Doc- you’re saying that if I am above age 30 and have symptoms of low testosterone you would recommend starting hormone replacement? Even though I had my levels checked and they were in the normal range? Hormone replacement is a personal decision. Very rarely do I actually recommend patients start BHRT. I discuss their symptoms, review lab results, and review the likely results of starting replacement. We don’t know if your lab results are normal for YOU. We didn’t draw baseline levels at age 14, 18, and 22 when your body was stabilizing hormone production.

I learned to treat the lab results in medical school. “I’m sorry, sir. Your testosterone levels are on the low side, but they are still within the normal range. It’s just part of getting old.” Or worse, “I’m sorry, ma’am. Your symptoms just don’t make sense. Your levels are normal for your age group. It must be in your head.”

Low T made it personal for me. Take a look at the most common symptoms and count how many you have. Low energy or fatigue, poor sleep, depression, difficulty concentrating, difficulty losing weight, difficulty gaining muscle, and low libido. Erectile dysfunction? ED usually occurs as a late symptom after other symptoms have been present for a while.

T replacement is a personal choice. There isn’t a right or wrong answer. My professional medical opinion? I think it makes good sense to treat the person, not the paper. Lab results on paper are standardized for the “majority” of patients, not for you. Your body may not do well on the low end of “normal”. T levels are age adjusted, so the older you get, the lower the chance that your level will be abnormally low. Most of my phone calls to patients reporting their low T begin with “None of your lab levels look like you are dying but your testosterone is low enough that you probably feel like you are dying.” Tired of being tired? Give me a call!

Want to learn more about BHRT? Stay tuned for next weeks article as I bring in a guest writer to discuss more sex hormones!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. Every time he thinks he is an expert on sex his wife adds a new wrinkle. Comments or questions? His email address is: