Latest / Libido Lounge / Is It Low T — Or Is Something Else Wrong? with Arthur L. "Bud" II, MD, MBA, FACS

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Is It Low T — Or Is Something Else Wrong? with Arthur L. "Bud" II, MD, MBA, FACS · Libido Lounge

• 0:00
  Testosterone is linked with libido.
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  Doctor.
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  Arthur Bud Burnett is a globally recognized John Hopkins urologist, researcher, and
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  educator whose pioneering work in men's health and erectile function has transformed care
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  worldwide.
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  Progesterone is kind of the be all and end all kind of factor element.
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  It's a much more complex story than that.
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  There's so many factors that can influence sexual libido.
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  Just try to fix everything just with a testosterone treatment under addressing some
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  other contributing factors.
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  I'm not getting erections.
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  I just need testosterone, doctor.
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  Well, it's not that simple.
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  Erectile dysfunction may have a host of factors involved, not just interpersonal relationships.
• 0:45
  Hey, everybody.
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  Welcome back to another episode of the Libido Lounge.
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  I'm your host, doctor Diane, and I'm so excited to dispel some myths and get to some of the
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  truths behind testosterone today.
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  There are so many misunderstandings about this hormone, and so many people are using this
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  hormone in isolation without understanding the whole totality of what we need to think about
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  with men's health and libido.
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  So I am just absolutely thrilled to introduce to you guys all to doctor Burnett and have this
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  amazing conversation today.
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  So welcome to the show, bud.
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  It's so great to be with you today.
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  Thank you so much for having me, doctor Diane.
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  My pleasure to be with you.
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  It it is a joy.
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  And and let's jump right in.
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  So let's talk about, like, in your experience with what you've seen with working with, I'm
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  sure, which is thousands of patients, How do you feel with what you've seen testosterone
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  affects libido?
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  What have you seen with using it when people are low?
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  Is it fixing it all the time?
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  Just walk us through what you've seen with that.
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  Sure, sure, sure.
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  So testosterone is linked with libido.
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  Libido being sexual interest, sexual drive, sexual desire, that sort of thing.
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  Which is hormones govern many functions in the body.
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  The male side, Androgens, on the female side, Estrogens, testosterone is an Androgen.
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  It has some impact on various aspects of the body.
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  I typically have three pillars cognitive function, physical functioning and sexual
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  functioning.
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  And in the area of sexual function, libido is really where the testosterone has the greatest
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  impact.
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  But the reason why it's so important is because there is the association that testosterone is
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  kind of the be all and end all kind of, you know, factor element, you know, agent sexual
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  functioning in all respects.
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  And it's a much more complex story than that.
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  It may have more to do with sexual libido and it may modify some other aspects of the male
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  sexual response cycle, but really has more to do with sexual libido much more directly.
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  At least I'll start with that concept that it's really that association and I'll just add that
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  the reason that works that way is, you know, hormones influence so much in our body,
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  including brain functioning, it influences maleness, it influences just how from the in
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  utero coming through the stages of early life, how it influences aspects of our brains even.
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  And there is some reality that a man's sexual intersex drive is influenced by testosterone.
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  So how much have you seen as you've prescribed testosterone replacement therapy over the
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  years, how much have you seen that it fully fixes libido or that it's just one part of like
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  the bigger picture and other things need to be addressed as well?
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  Well, I appreciate you're bringing that point up because I think there is the thought that
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  some out testosterone is, you know, the therapeutic drug, you know, the be all and end
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  all from family of youth, all these kind of terms.
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  But I think the point of it is, is there's so many factors that can influence sexual libido.
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  Other factors include, you know, just general health and wellness, interpersonal
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  relationships, you know, you're functioning in other areas of your sexual ability that may
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  influence your sexual interest or your sexual drive.
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  So just try to fix everything just with a testosterone treatment, may be under addressing
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  some other contributing factors.
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  Then what do you find as far as like signs and symptoms?
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  Like if people are listening and they're like, okay, well talking to, you know, board
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  certified urologists, like, when do I need to actually do something about it?
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  Is it are you recommending that any man of a certain age or any man with low libido is
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  getting his testosterone checked?
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  When are you recommending that men actually look into this?
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  Well, think that in terms of getting tested and really considering that this is something
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  that's clinically relevant, may come to a point where, yes, you feel like you're not
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  functioning to whatever your standard may be, seek some professional help.
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  Now, you know, start with your primary care doctor, may then come to urologist or sexual
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  medic specialist.
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  We may then say, okay, let's just go ahead and screen you.
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  If it's truly sexual libido issues, sexual desire issues, we may just go ahead and get a
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  testosterone.
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  Now, how do we define sexual desire?
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  That's a tough one.
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  People could describe it in different ways, upon gender orientation sexual preferences and
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  all these other kinds of things.
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  It may be hard to describe, but I think that certainly in your best circumstances where
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  you're sexually aroused that you may have historically known made some sense for you and
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  you're just not seeing that anymore.
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  Then maybe that's something that, if consistently observed, may prompt this
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  evaluation.
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  What about ED?
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  Like how much have you seen that testosterone is actually fixing an erectile dysfunction
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  imbalance?
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  Well, know, that's a good question because I think there is this concern or maybe confusion,
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  maybe that's the way to say it, that I'm not getting erections.
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  I just need testosterone, doctor Burnett.
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  Just write for me for that and I'm good to go.
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  Well, it's not that simple.
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  Again, may be linked more with sexual desire.
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  Erectile dysfunction may have a host of factors involved, not just interpersonal relationships,
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  but also mental and physical health.
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  Mental health meaning depression, anxiety, physical health meaning other disease states
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  that we may encounter in our lives from diabetes to cardiovascular disease to whatnot.
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  And so understanding that the realm of other factors that may influence a man's ability to
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  achieve an erection is a much more complex matter.
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  And just saying, let's just try and fix it with just testosterone treatment, is just maybe, you
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  know, under appreciating the complexity of presenting condition.
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  Yeah, very much so.
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  So from a standpoint of self advocacy then, if somebody is wanting to talk to their doctor
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  about this and wants to make sure they are getting all, like, the right lab tests done,
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  what are you telling people as far as, like, like with testosterone, are you recommending,
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  like, total free, sex hormone binding globulin, DHEA, things beyond that?
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  Like what are you actually recommending for people from a test perspective?
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  Wow, that's a good point.
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  I mean, you mentioned a bunch of different lab tests that are available out there.
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  And depending on what you're a physician, you may have access to a certain kind of panel that
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  that that you can order through your your facility.
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  For patients, I would just say just just be simple to start.
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  For screening, there's total and free testosterone.
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  Just screen with that, see where that stands, you know, and then depending on on whether
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  something's abnormal there, we would dissect that further with sex hormone binding globulin,
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  some of some of the other factors like luteinizing hormone, follicle stimulating
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  hormone, FSHD, and so forth.
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  So so I would just say just a screen with total and free, probably just to start.
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  And I think you're making a great point.
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  I'll just add this on.
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  I know we wanna keep our flow going, but but know that testosterone therapies should be
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  dictated by two main considerations, okay?
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  A real description of a compromised sexual drive, sexual desire, really, really have to
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  get a sense for really, that's really the impact there.
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  And at least within the realm of sexual medicine now.
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  Now there may be some other issues related to the low testosterone or testosterone deficiency
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  that an endocrinologist may have interest in and we may touch on some of that.
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  But before I would treat somebody, we will make sure that we get a good characterization of the
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  problem and then get the test done.
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  Because if you don't really have a testosterone level that's beneath what we think is a cutoff,
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  and there's a range here which is somewhat broad, but at least assessing for that true
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  level that's not in the normal range, then we really have to be purposeful until that patient
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  may not be a matter of just testosterone replacement.
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  Yeah, makes perfect sense.
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  What about, like, from a treatment perspective?
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  Like, do you ever recommend for men DHEA as a precursor?
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  Do you ever feel like that's enough if a man has true testosterone levels to actually
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  improve the testosterone?
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  Or have you seen that it works just so much better to just go straight with the hormone
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  replacement therapy?
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  Yeah.
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  Yes.
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  Well, there's so many supplements out there, a variety of agents that might be, obtained and
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  used.
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  I tend to just go with the testosterone.
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  Just feel little more confident that that's a supplement that we can more safely prescribe
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  and there are a variety of therapeutic delivery systems out there that meet that goal.
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  So that just has been my practice.
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  That's about what I could take.
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  So so that brings me to my next question because, like, you what you brought up is is
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  accurate.
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  Right?
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  There are so many different ways this can be delivered, and there's even so many things
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  from, a compounding, you know, perspective that so many things that can be compounded with.
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  Have you seen any sort of delivery method system work better than others?
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  Have you seen any, like, thing that's compounded worth with from an absorbability
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  standpoint to work better than others?
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  Do you have any advice on people for that, or do you have a place that you generally start,
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  say injections versus creams versus gels, or is it just all more like patient preference?
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  Where do you tend to start people with?
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  Well, maybe it's good that we have such a range of options, although that makes the whole, you
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  know, kind of kind of, you know, menu more challenging from which to even to prescribe
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  what to do.
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  But you can see that does then include some of the factors you're talking about patient
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  preference, patient accessibility to certain therapies.
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  There are so much that has to do sometimes with, you know, what is covered through
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  insurances and so forth.
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  So all these kinds of things may be some considerations.
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  So there also may be some slightly different impact in terms of how these therapies
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  influence one's, hormonal system in their body.
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  You know, the injections behave in certain ways and the topical therapies in different ways,
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  depending on counter purposes and so forth.
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  It doesn't give preferences for what the individual patients may want to have.
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  Just by way of just elaborating a bit more injections, we're talking about injecting
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  testosterone that's done with some intervals.
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  There may be a surge right after it.
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  You have to be careful about some of the side effects more with hematocrit and blood counts
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  going higher with that.
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  Topicals, a little more even administration, no injections, self administered, at the same time
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  we have to worry about transference to other parties.
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  So you see various elements here may go into each person's preference or how we make
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  decisions.
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  Okay, so it's not necessarily that one way is better than another in what you've seen, it's
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  more around let's talk to the patient and people have their personal preferences based
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  upon some of those concerns.
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  Like, if somebody has a history of high hematocrit, for example, maybe you would go the
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  topical for for example.
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  I probably would, or they feel like they they get such a sensation of just being on the
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  injectable with particularly a surge within a few days afterwards, we'd have to be very
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  careful about just monitoring that patient more closely.
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  So again, it's a matter of each person deciding with me what makes sense.
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  So have you seen then, because with that surge with injections, have you seen when we're
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  talking about symptom relief and, you know, especially if we're talking about things like
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  sexual desire, have you seen that if it's an injection, since because there's that surge in
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  that fall before the next injection, that they're having some days where it's like, oh,
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  my libido is really strong, and maybe I have more vitality.
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  Maybe my workouts are better, and they have some of those testosterone you know, that
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  testosterone relief.
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  Is there any sort of problem that you've seen because of that that surge where one day will
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  feel dramatically different than another?
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  No, I don't really see a problem with that.
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  I think that that certainly is not, to my knowledge, clinically detrimental.
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  Again, I think it's just more to be aware of the side effects with injectables and some that
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  can have these blood count issues.
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  So that's the safety side of it, is the only thing I would say to be concerned about.
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  From a patient standpoint though, and and forgive me if I'm repeating myself, just wanna
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  be clear here, from a patient standpoint as far as how they feel, like I understand the, you
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  know, the clinical side around like, oh, you know, it's like, okay.
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  We got that clinically.
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  There's no concern with this.
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  But more from a standpoint of, like, that patient experience.
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  Have you had patients talk about, like, yeah.
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  Like, I feel really great, you know, day one of injection, day two.
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  But, you know, once we get into day three when things are starting to fall, all of a sudden,
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  I'm, like, losing the vitality.
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  It's like, has that come up at all, or do people not in your experience tend to notice
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  that?
• 13:42
  Yeah, patients have described that.
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  It's not uniform because I've had other patients on it that just say, know, I feel like
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  it's meeting my goals, but they don't feel like things are exponentially different on day one
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  and two versus the last.
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  It's just a gradual decline by and large.
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  And, you know, I guess we just try and tailor it to where therapies are two or three weeks
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  out before we do the next injection.
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  Some may appreciate it to have high highs and low lows, but hopefully we're not anything
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  that's too dramatic that has any implications otherwise.
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  So what other types of things, and I know I'm sure you work in partnership with primary care
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  and other people, but what other types of things when people are using testosterone
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  replacement therapy have you seen to be helpful?
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  Like, you seen, for example, certain lifestyle, like, decisions people are making lead to
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  better therapeutic benefits?
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  Are you having people, like, run insulin tests, monitor blood sugar, look at those kind of
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  things?
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  What what types of lifestyle things, if any, have you seen to positively impact it or
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  negatively impact results?
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  Right, well I think at best it's probably indirect.
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  I think it does make sense to me that, at least in my practice, understanding why are men
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  testosterone deficient?
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  And address whatever those issues, because really correcting that then certainly helps
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  with the therapeutic benefit of testosterone replacement when and if it's appropriate, you
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  know, again, on the symptoms and a proven testosterone deficiency, but by biochemical
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  testing that is.
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  But testosterone issues arise in various disease states of some issues from metabolic
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  syndrome all the way to classic testosterone deficient disorders.
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  Klinefelter syndrome, Kalman syndrome, various other syndromes and so forth.
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  Again, if these things could be properly addressed, then you'll get better benefit from
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  the therapy.
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  But again, it's stressing the underlying problem, but for the large proportion of men
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  out there, adult onset hypogonadism as we call testosterone deficiency.
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  That may just be that there's chronic aging changes and this is where things get a little
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  murky here.
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  You know, what's normal, what's abnormal because it would happen in so many men, is this
• 16:00
  just a normal body's physiology?
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  But on top of that, if they really have some chronic disease states, addressing these from
• 16:07
  diabetes, metabolic syndrome, cardiovascular disease and so forth, that may enhance the
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  benefit of testosterone therapies.
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  So
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  then what are your recommendations?
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  I mean obviously there are commonly age related changes, andropause, you know, these sorts of
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  things at midlife.
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  So what are your recommendations then as far as, like, testosterone?
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  Like, if somebody is low end normal, but they're in range, but they're low normal, and
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  they're not having any symptoms, do you ever still recommend it just from a standpoint of
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  doing other things that we know that testosterone can do?
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  For example, like supporting bone health, do you ever still recommend it, or is it really
• 16:46
  just if they're having testosterone related symptoms?
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  How do men think about when to utilize it from that standpoint?
• 16:53
  Yeah, this is where things are kind of in this gray zone again.
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  And some will adhere to the guidelines in a very strict way.
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  I tend to kind of do that, which is I really want to make sure that I'm defining a true
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  issue symptomatically of decreased sexual desire, whereby I feel comfortable
• 17:14
  administering this.
• 17:15
  Now some other sexual medicine specialists may kind of gravitate a little bit toward being the
• 17:21
  men's doctor and want to follow bone health, to follow muscle mass, want to follow performance
• 17:28
  and so forth.
• 17:29
  And I certainly do not necessarily interfere with that or say don't do that.
• 17:34
  But I think you have to be prepared to accept, you know, variety of testing, variety of
• 17:38
  testing factors that you should be monitoring and you want to take responsibility for that.
• 17:43
  So I think that just good medical practice is such that if you're going to administer
• 17:49
  testosterone with these other issues in mind, you have to be prepared to take that
• 17:53
  responsibility.
• 17:54
  Yeah, makes sense.
• 17:56
  So you mentioned some root causes.
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  Are there any other root causes you have not mentioned that you think are worth mentioning
• 18:02
  from a standpoint of why testosterone would go low?
• 18:05
  Well, there could be other things.
• 18:06
  I mean, I just gave you some broad stroke things, but we can start to delve in other
• 18:10
  things from testicular loss.
• 18:12
  It can happen, some young people have had the disease states requiring various kinds of
• 18:19
  chemotherapies and other interventions.
• 18:21
  Men with testicular cancer, testicle removed, testicle trauma, you remove the testicles are
• 18:27
  the main source of testosterone in men, in the scrotum between the legs and conditions that
• 18:34
  lead to tissue damage or tissue loss of the testicles are certainly related.
• 18:42
  There can also be various kinds of head injuries, brain injuries and so forth, tumors
• 18:46
  of the pituitary.
• 18:47
  I don't want to get too complex for the audience.
• 18:51
  The pituitary gland up in the brain area that also is part of the hormone axis that regulates
• 18:57
  hormones.
• 18:58
  So there might be a variety of things we're going look for particularly testosterone levels
• 19:02
  are profoundly low and we may even go a little bit further testing other things like prolactin
• 19:07
  levels and so forth.
• 19:09
  Again, don't wanna make things too complex for the audience, but just give me kind of a
• 19:13
  general feel here that we may delve into some other more thorough testing and more uncommon
• 19:21
  kind of disease states that we gotta look into.
• 19:25
  Well thank you so much for this, and everybody, we are going to invite Doctor.
• 19:28
  Burnett here back for part two.
• 19:31
  In part two, we're gonna go more into things you need to know about testosterone.
• 19:36
  Can you become dependent on it?
• 19:39
  What to do if you're a child bearing years, were there a risk, and so much more.
• 19:43
  We're going to talk a little bit about prostate health, erectile dysfunction, and more.
• 19:48
  So definitely stay tuned for that.
• 19:49
  And so you don't miss that, make sure you do subscribe if you have not already subscribed to
• 19:55
  the channel so you don't miss that at all.
• 19:57
  And I wanna make sure that everybody knows how to get ahold of you.
• 20:00
  We will obviously have your website and all of your contact information below this video so
• 20:06
  you guys can check there.
• 20:07
  But is there anything that you would like people to specifically know about working with
• 20:10
  you and getting ahold of you?
• 20:12
  Oh, nothing more unique than just what you're gonna show up there.
• 20:14
  I mean, doctor Arthur Burnett, you can look it up, Amazon.
• 20:18
  I've got a couple books out there.
• 20:19
  You can look me up at this.
• 20:21
  I think it's with our social media contacts these days, just just plug my name in, and
• 20:26
  it'll get you some guidance there.
• 20:28
  Beautiful.
• 20:29
  Well, we'll have all of that in the show notes, everybody.
• 20:31
  Thank you again for listening.
• 20:33
  Thank you for being with me today, doctor Burnett.
• 20:35
  It's been a pleasure, and I'm looking forward to part two.
• 20:38
  Thank you.
• 20:41
  Thank you for listening to the Libido Lounge.
• 20:43
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