Every few years testosterone becomes a hot topic in men’s health. The media capitalize on this by advertising products that promise to enhance everything male. The “before” pictures show a male who is tired and dejected looking. The “after” pictures show him smiling, surrounded by people having the time of their lives. So what is the real story?
Testosterone is a hormone made in the adrenal glands and testicles. The amount of testosterone produced dramatically increases during puberty. This increase is responsible for deepening the voice, growing more body hair, increasing muscle mass and enlarging sex organs. In adulthood, testosterone keeps a man’s muscles and bones strong and maintains his interest in sex. It is natural for men to experience a gradual decline in testosterone levels after the age of 30. This loss can be as much as 2 percent a year.
The only way you can be sure of your testosterone level is to have a simple blood test. You do not have to fast before this test, but it is recommended that you have your blood drawn in the morning when the level is at its highest peak. The normal level for testosterone ranges between 300ng/dL and 1,200 ng/dL and can vary greatly during the course of the day.  Though researchers have come up with various sets of age-related ranges of “normal” testosterone levels, no one knows what the optimal levels are.
According to the American Urological Association, the incidence of low testosterone is approximately 20 percent in males older than 60, 30 percent in males older than 70 and may reach 50 percent in males over the age of 80. There are several conditions that lower the level of testosterone including:  injury to the testicles, infection, pituitary disorders, sarcoidosis, hemochromatosis, chronic liver or kidney disease, hypertension, type II diabetes and obesity. It is estimated that between 30 percent and 50 percent of men with type II diabetes have low testosterone levels.
Chronic use of narcotics, methadone and alcohol can also decrease testosterone levels. One study showed that almost 75 percent of men using narcotics daily experienced low testosterone levels. Several other medications and genetic conditions can lower testosterone levels. In some cases the cause is unknown.
Some of the symptoms of low testosterone levels are infertility, erectile dysfunction, breast enlargement, decrease in muscle mass, osteoporosis, decreased sex drive, fatigue, difficulty concentrating, mood swings, irritability and hot flashes. Most men with low testosterone levels have no symptoms. Low testosterone is not considered a problem unless it is accompanied by symptoms unexplained by other conditions.
Testosterone is a controlled substance available only by prescription. The supplements available without prescription cannot contain testosterone by federal law. Because they are classified as supplements, there is no regulation as to what they contain or how they are made. Taking these supplements at best can waste your money; at worst can lead to heart, liver or kidney damage. Selling unproven supplements has become a billion-dollar industry. Don’t be fooled by advertisements.
Testosterone replacement therapy is not without risk. It can cause enlargement of the prostate leading to difficulty urinating, prostate cancer, breast enlargement, heart, kidney and liver problems. It can make sleep apnea worse. Treatment benefits may include increasing bone density, restoring sex drive, improving energy and improving depression. It may also decrease body fat which can lead to other serious conditions, but the evidence regarding the effectiveness of testosterone replacement is mixed. There have not been any long term clinical trials measuring effectiveness or long-term risks.
The take-home message is that low testosterone levels do exist and can cause symptoms.  If you are experiencing erectile dysfunction, fatigue, mood swings or any of the other symptoms, it is important that you discuss this with your health care provider. You might have undiagnosed heart disease, hypertension, diabetes, sleep apnea or depression and left untreated these can be very serious. Don’t accept that the changes you are experiencing are  age related.  Life is too short not to enjoy it to the fullest extent.

This week has been named National Men's Health Week. Unfortunately there has been very little in the way of advertisement to promote or discuss health issues facing men. So what are some of these issues? The top five causes of male death are: heart disease, cancer, incidental injuries, stroke and chronic lung disease.

Heart disease: The number one cause of death remains heart disease. More than 25 percent of men will die of heart disease. Major risk factors for developing cardiovascular disease include high blood pressure, smoking, diabetes, obesity, high cholesterol and a strong family history. The risk factors for stroke are the same.

Hypertension: High blood pressure has been called a silent killer because for the most part there are no symptoms until some organ like the heart, brain or kidney suffers damage. Starting at age 18, The American Heart Association recommends have your blood pressure checked at least every two years . Experts also recommend having your cholesterol checked starting at the age of 20 and rechecked every five years.

Diabetes: there are 13 million men in this country living with diabetes. An additional 7 million people in this country have diabetes and don't know it. One of the major risk factors for the most common type of diabetes is obesity. Screening for diabetes is a simple blood test that should be done starting at the 35 and repeated every 5 years. Screening should start earlier if you are overweight, have high blood pressure, take certain medications or have diabetes in your family.

Smoking: smoking is an equal opportunity killer from all cardiovascular diseases and chronic lung diseases ( such as COPD and emphysema) and cancer. You are two to four times more likely to suffer a heart attack or stroke than a non-smoker. You are almost three times more likely to drop dead of a cardiac event. Lung cancer is responsible for more deaths than breast, colon and prostate cancer combined. Over 90 percent of lung cancer deaths are related to smoking. Higher rates of other cancers such as bladder and breast are also seen in smokers. Smoking is a significant cause of erectile dysfunction.

Cancer: The second most common cancer for men is prostate. One in six men will develop prostate cancer in their lifetime. Symptoms of prostate cancer are similar to having an enlarged prostate. The third most common cause of cancer deaths is colorectal cancer. Colon cancer may not cause symptoms until it is advanced. A screening colonoscopy is recommended at the age of 50 or earlier if you have certain risk factors.

Accidental injuries: The third most common cause of death in men of all ages are accidental injuries. There are 4 male deaths for every female death from accidental drowning, motor vehicle accidents and falls . Men are 3 times more likely to die in a motor vehicle accident. The rate of death from falls is 49 percent higher in men than women.

Suicide and depression: Suicide is ranked number eight in the causes for male death. According to the CDC, adult men age 75 and older have the highest rate of suicide: 37 per 100,000 men .

Many experts feel that one of the most underdiagnosed conditions in the elderly is depression. The signs of depression in men include: fatigue, increased irritability, loss of interest in work, activities and sex, sleep disturbances — either too little or too much, increased drinking or other substance abuse.

So what can you get the male in your life for Father's Day? My suggestions may not be glamorous or appreciated, but they might give him a longer and healthier life.

1. Make an appointment for him to have the recommended screening tests and a physical exam if he hasn't seen a healthcare provider in years. Have him use one of the free blood pressure machines located in many of the pharmacies to check his blood pressure regularly.
2. Encourage him to stop smoking. If you smoke — stop. It will make it easier for him to stop. Start by agreeing not to smoke in the house or in your vehicles.
3. Buy him protective gear so he is safe and discourage risky behavior. Wearing a life preserver is far sexier than ending up in the bottom of a lake or river. Wearing a helmet is sexier than ending up in a nursing home from a brain injury.
4. Buy gym memberships, exercise equipment or join him in an exercise program. If this doesn't fit the budget, make a pact to set aside some time at least 3 days a week to go for a walk. You are much more likely to stick with exercise if you do it with a partner. It will also give you "couples" time away from the distractions of everyday life.
5. Take time to show appreciation for who he is and what he does. Be willing to listen to the good and the bad. Show support when things aren't going well and if you see signs of depression encourage him to seek help. Guns are used in 57% of male suicides, so if you see signs of depression think seriously about locking up or removing the guns from your house. Suicide can be an impulsive act, especially if alcohol is involved.

Cindy Holloran is an adult nurse practitioner at Saco River Medical Group in their new clinic located at the Grant Plaza in Glen. She is currently accepting adult patients 15 years old and older. For an appointment call 383-3005.

Father's Day is just around the corner and the media is awash with suggestions for the "perfect gift" for dads and granddads. The truth is that the gift men might most benefit from is better and earlier interaction with the health care system. Not only would it improve their length and quality of life, it would enhance the lives of their spouses, partners and children.

June is recognized as Men's Health Month, and this year's theme is "Awareness — Prevention — Education — Family." On May 31, 1994, President Bill Clinton signed the bill establishing National Men's Health Week as the week leading up to Father's Day. The goal is to heighten awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.

Men generally fail to become actively engaged with the health care system when they are young, and it is a trend which accelerates as they near retirement. According to Medicare, men enter retirement in poorer health than women, and have a much higher mortality ratio in later years. The U.S. Administration on Aging (AOA) reports that more than half of elderly widows now living in poverty were not poor before the deaths of their husbands.

Although life expectancy has seen dramatic increases over the past several decades, it has been increasing at different rates for the genders. At birth, males outnumber females 105 to 100, but by age 34, there are more women than men — a difference that continues to grow with age. By retirement, there are fewer than 80 men for every 100 women.

Men's greater risk for health problems begins with the fact that a higher percentage of them have no health care coverage. Compared to women, men make half as many visits to health care providers for prevention-related services, and many adopt less healthy lifestyles with increased risk-taking behavior at an early age.

As our population continues to age, we need a sustained focus on engaging men in prevention and wellness activities. Men's contributions as fathers, grandfathers, uncles, sons and spouses benefit our entire society and deserve our attention and support. This Father's Day, encourage the men in your life toward a healthier lifestyle with these simple suggestions:

• Make Prevention a Priority. Many health conditions can be prevented or detected early with regular checkups from your health care provider. Regular screenings may include blood pressure, cholesterol, glucose, prostate health and more.
• Eat Healthy. Start by taking small steps like saying no to super-sizing and yes to a healthy breakfast. Eat many different types of foods to get all the vitamins and minerals you need. Add at least one fruit and vegetable to every meal.
• Get Moving. Play with your kids or grandkids. Take the stairs instead of the elevator. Do yard work. Play a sport. Keep comfortable walking shoes handy at work and in the car. Most importantly, choose activities that you enjoy to stay motivated and involved.

At the 1994 bill signing that established Men's Health Week, Congressman Bill Richardson (D-NM) addressed the true significance of men's health. "Recognizing and preventing men's health problems is not just a man's issue. Because of its impact on wives, mothers, daughters and sisters, men's health is truly a family issue."

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For more information about how our agency can help you live life to its fullest, call Visiting Nurse, Home Care & Hospice at (603) 356-7006 or 1 (800) 499-4171. Every Wednesday from 9 a.m.-4 p.m., the public is invited to stop by with questions or concerns for our "Walk-In Wednesday" services. The agency is located at 1529 White Mountain Highway, just past the Green Granite Inn, and on the web at vnhch.org.

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"Home Care Matters" is a bi-weekly column sharing information on today's important home health issues. The articles are written by Sandra Ruka, RN MSN and Sharon Malenfant, MS APR for Visiting Nurse, Home Care & Hospice of Carroll County.

Pictured here are (back row, from left): Lindsey Campbell, RN, CNOR; Nancy Gill, RN, CNOR; Stacey Lessard, RN; and Diane Monico, RN, CNOR. In front is Helen Baker, RN, CNOR.WOLFEBORO — Huggins Hospital honored National Time Out Day on Wednesday, June 12. Time Out Day was created by the Association of periOperative Registered Nurses (AORN) in 2004 as a way to raise awareness about the importance of requiring the entire surgical team to pause before all invasive procedures to communicate as a group and confirm key information about the patient and procedure to help prevent errors from occurring.

When most of us think of a "time out," we may think of a child being disciplined or a coach calling for a brief stop in the action during a sports event. However, in the operating room, a perioperative time out takes on a very different meaning. A surgical time out is a surgical safety pause that takes place before an incision is made.

During this time, the surgical team of nurses, surgeons, and anesthesia providers pauses for a moment to confirm everything from the patient's identity, the procedure, and surgical site to the surgical team and each role of the team. Similar to a checklist a pilot may use before initiating take-off to ensure passenger safety, a surgical time out is that one final check to ensure patient safety.

"Here at Huggins Hospital, we utilize the time out process in our operating rooms to ensure safer care for our patients," said Dr. Bill Barton of Wolfeboro General Surgery. "We pause to confirm that we have the right patient, we are performing the correct procedure, and have the proper functioning equipment in order for you to have the safest surgical encounter."

So is a perioperative time out effective? Huggins Hospital has had zero wrong site surgeries and zero wrong patient surgeries. In addition, Huggins Hospital has had a zero percent infection rate for joint replacement surgery since 2009, when the data began being collected by the hospital. For overall surgical procedures, Huggins Hospital has one of the lowest rates of surgical infection in the state, according to the N.H. Quality Care website. The Surgical Care Improvement Project (SCIP) tracks each hospital's results in reducing the risk of wound infection after surgery by providing the right medications at the right time on the day of surgery. The national average for the overall SCIP score is 91 percent. The New Hampshire state SCIP score is 93 percent. The Huggins Hospital SCIP score is 97 percent, one of the best scores in the state.

These scores reflect the most recent time period posted on the N.H. Quality Care website, which is July 2011 to June 2012. To learn more, visit www.nhqualitycare.org.

"As the Director of Surgical Services at Huggins Hospital, I'd like to take a moment to recognize the dedication and exceptional care that our staff, surgeons, and anesthesia providers commit to every day, every case, and with every patient," said Helen Baker, RN, CNOR. "We are dedicated to your safety in our Operating Rooms. This is another example of our quality patient-centered care at Huggins Hospital."

For more information about Surgical Services, General Surgery, or Orthopedic Surgeons, visit the Huggins Hospital website at www.hugginshospital.org.