Questions on Testosterone Levels & Aspirin a Day

Dear Dr. Spence,
I have been told that my testosterone levels are low. Would you suggest therapy?
Signed, Les Lustin

Dear Les,
Testosterone deficiency is another under-diagnosed condition we see quite regularly in our clinic. It is estimated that 20% of males age 60-69 have clinical deficiency with nearly 50% of those older than 80 affected. Low levels of testosterone can produce a number of symptoms. Most commonly, patients present with fatigue, depression, decreased sexual desire and/or erectile dysfunction. In younger patients, checking prolactin or LH levels is advisable to rule out other causes of testosterone deficiency such as pituitary gland dysfunction. Testosterone is generally either replaced via intramuscular injection or by topically applied gels or patches. Injections, though cheaper, do not provide the same smooth release that gels may offer and tend to result in transient supraphysiologic levels that quickly drop in a matter of weeks. Gels and patches provide improved delivery but are quite pricey. Men with prostate cancer should not receive testosterone supplementation. Treated patients should have blood work on a regular basis to monitor hemoglobin levels and prostate specific antigen (PSA). Not all patients experience resolution of symptoms, therefore a careful case-by-case analysis of response should be undertaken to determine efficacy and need for continuation of the medication on a long-term basis.

Dear Dr. Spence,
Should I take an aspirin a day?
Many thanks, Lotta Thinblood

Dear Lotta,
The general consensus, after rigorous analysis of the data, is no. Unless a patient has substantial risk factors for heart attack or stroke, aspirin therapy is considered potentially harmful (i.e. the risks outweigh the benefits). Risk factors include diabetes mellitus, hypertension, coronary artery disease, cerebrovascular disease and hypercholesterolemia among others. Patients with these underlying conditions should receive aspirin as a preventive medication. Doses of 81 mg are probably sufficient. An otherwise healthy adult taking aspirin may be more at risk for gastric ulceration with the potential for resultant peptic ulcer disease and possible gastrointestinal bleeding. Again, in this case, the small benefit from taking aspirin is overshadowed by the possible adverse effects. An apple a day may be better. As a side note, I provide some interesting information regarding diet and health. Researchers have suggested that daily intake of a proposed "Polymeal" may decrease heart disease by 76% and increase actual longevity by up to 6.6 years. There are no pills, no hefty costs and minimal side effects. The "Polymeal" consists of the daily ingestion of four ounces of red wine, a small piece of dark chocolate, a handful of almonds, one clove of garlic, and multiple servings of fruits and vegetables. Combine the above with four servings of fish per week and you have a recipe for good heart health (albeit with some less than desirable halitosis).

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.