Posts Tagged ‘infertility’

Clomid: Not Just For The Ladies

August 20, 2016

Andrew Siegel MD 8/20/2016

Gender_differences_male_female

Frank Palopoli, Father Of Fertility

Frank Palopoli, the chemist who developed Clomid (clomiphene citrate), died last week at age 94. He conceived (pun intended) Clomid in the 1950s, a medication that stimulates ovulation and became the most widely prescribed fertility drug for women, resulting in pregnancy in millions of women who otherwise would not have been able to do so. Approximately 80% of women whose fertility is due to failure of ovulation respond to Clomid enabling conception. Clomid works by increasing production of hormones that spur egg ripening and release.

What’s Good For The Goose Is Good For The Gander

Clomid is not just for the ladies! In urology we have used it for many years to stimulate sperm production in infertile men with low sperm counts. But here is a little secret: it also raises testosterone levels nicely. It does so by stimulating the testes to secrete natural testosterone, as opposed to the other testosterone replacement products on the market that are external sources of testosterone that actually shut down testes production of sperm and testosterone. No shrunken testicles that have their function turned off, but respectable family jewels, happily churning out sperm and testosterone, as nature intended.

Clomid Biochemistry In A Nutshell (no pun intended!)

Clomid is a selective estrogen receptor modulator (SERM). It works by increasing levels of the pituitary hormones that trigger the ovaries to produce eggs and the testes to produce sperm and testosterone. It blocks estrogen at the pituitary, so the pituitary sees less estrogen and makes more LH (luteinizing hormone) that stimulates the testes to make testosterone, and more FSH (follicle stimulating hormone) that stimulates the testes to make sperm. This is as opposed to external testosterone, which does the opposite, increasing estrogen levels that prompt the pituitary to make less LH and FSH, which causes the testes to cease production of sperm and testosterone.

Clomid usually works like a charm in increasing testosterone levels and maintaining sperm production, testes anatomy (size) and function. Its safety and effectiveness profile has been well established and minor side effects occur in proportion to dose and may include (in a small percentage of people): flushes, abdominal discomfort, nausea and vomiting, headache, and rarely visual symptoms.

 One issue is that Clomid is not FDA approved for low testosterone, only for infertility. Many physicians are reluctant to use a medication that is not FDA approved for a specific purpose, requiring it to be used “off label.” However, Clomid is effective and less expensive than most of the other overpriced testosterone products on the market and has the major advantage of stimulating natural testosterone while not shutting down testicular function.

Bottom Line: By virtue of a very sophisticated biofeedback system involving the pituitary gland in the brain and the testes, the use of external testosterone to boost native testosterone results in whatever feeble function the testes might have had to virtually cease completely and the possibility of atrophied, non-functional testes that no longer produce any sperm or testosterone.

 Clomid is an oral, less expensive alternative to testosterone replacement that stimulates natural testosterone production as well as sperm production. Kudos to Dr. Palopoli, whose magic drug has not only helped millions of women get pregnant, but has also helped enable countless men to fertilize their partners as well as raise their testosterone levels. Clomid is safer and much more sensible than traditional testosterone replacement.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

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Tobacco Keeps Me Way Too Busy As A Urologist

February 25, 2012

 

 

 

Blog # 47       Andrew Siegel, M.D.

To paraphrase Dr. David Katz—the master levers of our medical destiny are our fingers, forks and feet: fingers that may or may not bring cigarettes to our lips; forks that may or may not bring healthy food to our mouths; feet that may or may not participate in exercise and fitness pursuits.  The negligent use of our fingers, forks and feet is the leading causes of premature death and conversely, the appropriate use of them is capable of preventing 90% of diabetes, 80% of cardiovascular disease and 60% of cancers.

Bottom line:  Most everyone is knowledgeable about the role of tobacco in contributing to cardiovascular disease, stroke, lung cancer and emphysema.  However, the complications of tobacco abuse go way beyond the heart and the lungs; physicians in every medical and surgical specialty bear witness to the havoc that tobacco wreaks on every system in our body.  As a urologist, I am on the front lines of the deleterious and deadly effects of tobacco. Tobacco has clearly been linked to several urological cancers as well as numerous other non-malignant conditions. Tobacco is a major factor in the occurrence of bladder cancer, kidney cancer, sexual dysfunction, and infertility in both men and women.  Smoking cessation can help reverse these serious issues.

Bladder cancer is an incredibly prevalent cancer.  It is the 4th most common cancer in men and the 8th most common cancer in females.  It is highly correlated—hugely so—with the use of tobacco.  Cigarette smoking is the number one environmental cause and greatest risk factor for bladder cancer.  Cancer-causing chemicals known as carcinogens get inhaled into the smoker’s lungs, are absorbed into the bloodstream and are filtered by the kidneys, from where they pass into the urinary bladder.  In the bladder, these carcinogens have prolonged, direct contact time with the bladder lining, where they induce changes that ultimately can become malignant.  There is a many-year “latency period” from the time of exposure of the carcinogens to the actual occurrence of cancer—often several decades.  So the smoking that you did in your teens and twenties can come back to haunt you in your forties and fifties.

Continuing to smoke leads to worse bladder cancer outcomes compared to patients who discontinue tobacco use. Ongoing smoking after the diagnosis of bladder cancer greatly increases the risk of morbidity and mortality, treatment-related complications, recurrence of the cancer and the development of a second malignancy.  Smoking cessation will diminish all of the aforementioned consequences.  It is estimated that elimination of smoking could decrease the overall incidence of bladder cancer by 50%.

Prostate cancer is the most prevalent cancer in men and keeps our office bustling with patients.  Although smoking does not increase the risk of being diagnosed with prostate cancer, men who smoke at the time of prostate cancer diagnosis have an increased risk of recurrence and death from prostate cancer and also face an increased overall mortality from cardiovascular disease. Conversely, those who quit smoking at least a decade before the diagnosis of prostate cancer was made have mortality similar to those who never smoked.

Smoking is also strongly correlated with both male and female sexual dysfunction.  Anything that compromises blood flow to the genitals is going to interfere with sexual function, and the chemicals in tobacco do a marvelous job at constricting blood flow.  Approximately 40% of men with erectile dysfunction are smokers.  There is a direct relationship between the quantity of smoking and the extent of sexual dysfunction. Smoking cessation will help restore lost function, but tobacco takes its toll as former smokers have been shown to be at an increased risk of developing sexual dysfunction later in life.

Smoking adversely affects the reproductive system in both sexes.  As compared to non-smokers, the semen of smokers demonstrates poorer parameters, particularly sperm motility. Thus, sperm from smokers has reduced potential for fertilizing an egg.   Females who smoke have a higher prevalence of fertility issues including an increased risk of ectopic pregnancy and fare poorer than non-smokers when assisted reproductive techniques are needed.  Women who smoke during pregnancy increase their risk for bearing male children born with undescended testicles. Smoking has also been associated with increased risk of acquiring HIV infection, HPV infection, invasive cervical cancer, and pelvic inflammatory disease.

An estimated six trillion cigarettes are smoked worldwide every year.   It is not only the smokers who suffer the ill effects of tobacco use.  The health of individuals exposed to smokers is also at risk due to second-hand smoke. Second-hand smoke is a mixture of the smoke given off by a cigarette, pipe or cigar and the smoke exhaled into the air we breathe from the lungs of smokers.   Second-hand smoke is involuntarily inhaled by non-smokers and can linger in the air for hours after tobacco products have been extinguished.  There is no safe level of second-hand smoke, and even brief exposure can be harmful. Second-hand smoke clearly is associated with serious diseases and is responsible for shortening life spans. Second-hand smoke has been classified by the Environmental Protection Agency as a cause of cancer in human beings, causing approximately 3,000 lung cancer deaths and about 50,000 cardiac deaths in non-smokers in the United States annually.  Second-hand smoke is particularly harmful to young children, being responsible for hundreds of thousands of respiratory tract infections in those under 18 months of age.

There at least 43 carcinogens and more than 300 polycyclic aromatic hydrocarbons in second-hand smoke, as well as many other toxins including arsenic, carbon monoxide, lead, cyanide, DDT, formaldehyde and polonium 210. Polonium 210—a highly toxic radioactive poison that was brought to the attention of the public because of its use in the poisoning of a former KGB agent—is inhaled along with the tar, nicotine, cyanide, and other chemicals.

Smoking is a vile, incredibly harmful, self-destructive and miserable habit and addiction.  It is the single greatest cause of illness and premature death in modern society.  Every cigarette that is smoked can be thought of as another nail in one’s coffin.

Years ago, smoking was an excusable habit simply because we didn’t know any better.  It was thought of as a sophisticated, glamorous and sexually alluring and was so glorified on television, in magazines, and in Hollywood on the silver screen.   Magazine advertisements depicted physicians smoking and one slogan went so far as to state: “More doctors smoke Camels than any other cigarette.”   Even my father, a physician, smoked; however, as soon as he caught wind of the fact that smoking was dangerous to his health, he stopped immediately.

The greatest irony is that there are many smokers who have a pervasive fear of terrorism and potentially pandemic bacterial and viral illnesses such as avian bird flu, mad cow disease, SARS, anthrax, West Nile virus, etc.  What they fail to realize is that the cocktail of carcinogenic chemicals entering their lungs and bloodstream via smoking and being delivered to every single cell in their body can be thought of as little terroristssuicide bombers if you will, that can and certainly will ultimately wreak havoc on their health and their lives.  Smoking really is just a form of slow, voluntary suicide.  While we do not have a great deal of control over terrorist acts or deadly pandemics, we certainly have the ability to live a smart lifestyle that avoids self-destructive behavior such as smoking.

What truly is a source of amazement to me are the smoking lounges in the airports.  Glassed in like fish in an aquarium, these ridiculous-appearing humans are puffing away in unison, garnering not only the ill benefits of first-hand smoke, but also second-hand, third-hand, and every other permutation imaginable!  A motley group of men and women collectively inhaling and exhaling, hacking and choking within this absurd observatory, with plumes of smoke floating around like clouds—this glass menagerie is a showcase for the folly of humankind.

This folly is certainly aided and abetted by Big Tobacco. In 2006, a federal judge named Gladys Kessler ordered strict new limitations on tobacco marketing, sticking it to the cigarette manufacturing companies for their disingenuous behavior and forcing them to stop labeling cigarettes with deceptive descriptors including “low tar,” “light,” or “natural.”  The tobacco industry was shown to have “marketed their lethal product with zeal, with deception, with a single-minded focus on their financial success and without regard for the human tragedy or social costs that success exacted.”  She further stated that “cigarette makers profit from selling a highly addictive product that causes diseases leading to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system.”

The WHO (World Health Organization) estimates that by the year 2020, cigarettes will be responsible for the deaths of 10 million people annually.   Cigarettes killed 100 million people in the period between 1900 and 2000, and we’re on track for nearly a billion tobacco-related deaths for the 21st century.  About half of all smokers will die of smoking-related diseases. Habitual smoking decreases general life expectancy by an average of 8-12 years. Many smoking-related deathsare not pleasant and quick deaths, but are often protracted and associated with significant suffering.

There is a magic pill—inexpensive, readily available, free of side effects and safe for all ages—that taken daily will reduce the risk of getting any major chronic disease by 80% or so. This pill is called healthy lifestyle, and if you don’t have it in your medicine cabinet yet, it would make all the sense in the world to acquire it.

 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

 Now available on Amazon Kindle

www.PromiscuousEating.com

 

For my educational video on bladder cancer:

http://www.youtube.com/watch?v=WvEOcCzw2gQ