Hypogonadism (low testosterone)
Male hypogonadism is a condition in which the testes do not produce enough
testosterone, a hormone that plays an important role in sperm production and in
male sexual development. Sometimes males are born with the condition, but it
can also develop in adulthood as a result of other medical problems. Often
hypogonadism can be treated with testosterone replacement therapy.
If hypogonadism occurs during fetal development, a male will have ambiguous or
undeveloped male genitals. If it occurs during puberty or in adulthood, it may
alter male physical characteristics and can impair normal erectile function and
sperm production, decreasing a man’s fertility. The condition can cause other
physical problems, such as a decrease in muscle and bone mass, and may
sometimes affect cognitive and emotional functioning.
Certain genetic conditions put males at risk for hypogonadism, including
Klinefelter syndrome and Kallmann syndrome. The condition can result from
illnesses such as HIV/AIDS, tumors, and some cancer treatments. A drop in
testosterone is also a normal part of the aging process, and in such cases,
does not necessarily require treatment.
Hypogonadism is diagnosed on the basis of symptoms and on blood tests that
measure testosterone. If your testosterone level is low, your doctor
will order additional tests to make sure you do not have an underlying
condition such as a pituitary abnormality that requires treatment.
Adult men with hypogonadism may be treated with testosterone replacement
therapy to improve sexual function and restore muscle and bone strength.
Testosterone can be delivered in several ways, including through injection,
patch and gel. If a pituitary problem is the underlying cause of hypogonadism,
surgery or replacement pituitary hormones may be indicated. Testosterone
therapy may also be used in boys with underlying genetic conditions to
encourage normal pubertal growth.
Testosterone therapy is NOT a treatment for infertility. In fact, treatment
with testosterone is very likely to make fertility worse. However, several
other treatments are possible for men who have both low testosterone and
The prostate gland is part of the
male reproductive system and is located below the bladder, in front of the
rectum and surrounds the urethra (structure that carries urine from the bladder
out through the penis). Normal prostate glands are about the size and shape of
a walnut and weigh about an ounce. The main function of the prostate gland is
to produce ejaculatory fluid. The prostate gland often enlarges with age,
referred to as benign prostatic hyperplasia or BPH. This condition can cause
symptoms such as difficulty emptying bladder, need to urinate frequently,
straining, post urination dribbling or weak stream. These symptoms are referred
to as lower urinary tract symptoms (LUTS) and occur because the gland is
enlarged and blocking the flow of urine.
BPH is a common condition, estimated to affect 50% of men in their 50s and up
to 90% of men over age 80. In addition to increasing age, other risk factors
include family history of BPH. BPH is not prostate cancer, although the
conditions can exist together. Men should be evaluated by a clinician if
experiencing BPH symptoms, as this is a progressive disease and can result in
bladder damage, infection or kidney damage. BPH symptoms can be treated with
oral medications used to decrease the size of the prostate (5-alpha-reducatase
inhibitors) or to relax the muscles of the prostate and bladder neck (alpha
blockers). Procedures such as transurethral resection of the prostate (TURP),
microwave ablation, needle ablation or laser surgery may need to be performed.
Hematuria (blood in urine)
Hematuria refers to the presence of blood in the urine. If the blood is visible
(appearing pink, red or cola-colored) it is called gross hematuria. Blood that
can be detected only when urine is examined under a microscope, is called
microhematuria. Most men with hematuria do not have symptoms.
Hematuria can originate from any site along the urinary tract, including the
kidneys, ureters, bladder, prostate, or urethra. It increases in frequency with
. It.. It age and lifestyle factors such as smoking.
Hematuria has many causes, including vigorous exercise, sexual activity, viral
illness, trauma/injury, or infection such as a urinary tract infection (UTI).
More serious causes include kidney or bladder stones, cancer in the urinary
tract, and medical conditions such as blood disorders, inflammatory conditions,
polycystic kidney disease, or sickle cell disease.
Overall, the chance of cancer among people with hematuria is only 3-4%, but is
higher in in those men with risk factors, such as smoking, older age, history
of pelvic radiation, and exposure to certain medications and chemicals.
Hematuria can also occur after recent urologic procedures or if you are taking
anticoagulant medications (blood-thinners such as aspirin).
When microscopic hematuria is identified, the next step is to diagnose the
cause. Your physician will take a complete medical history and retest your
urine at 48-hour intervals. If two of three urine samples reveal blood, it is
important to conduct further tests to make sure that the microhematuria is not
related to a serious underlying condition, such as cancer. Likewise, all cases
of gross hematuria merit further testing. Hematuria evaluation may include use
of cystoscopy—looking inside the bladder with a thin, flexible telescope—to
visualize the bladder, and imaging with CT or MRI to visualize the kidneys and
ureters. Urine tests include cytology to look for cancer cells in urine and
urine culture to rule out infection.
There are different types of incontinence.
It is very important to try to sort out which type is playing the greatest role
in causing the incontinence because the treatment can be quite different.
Incontinence refers to loss of urine during coughing, laughing, sneezing or
other movements that increase abdominal pressure and put pressure on the
bladder. Damage to the structures that support the bladder and urethra, such as
during childbirth, can result in stress UI. Urge incontinence refers to sudden
feeling or urge to urinate with subsequent loss of urine, “can’t make it in
time”. This type of incontinence is often caused by inappropriate bladder
contractions (spasms). is much less common and occurs when the bladder doesn’t
empty properly, causing urine to spill over. This can occur with weak bladder
muscles, nerve damage from diabetes or blocked urethra.
Evaluation of UI may involve urinalysis, bladder stress test (cough vigorously
and doctor watches for urine loss), ultrasound, cystoscopy or urodynamic
studies. Treatment will depend on the underlying cause and type of
incontinence. Treatments include bladder training, kegel exercises,
medications, neurostimulation, injection of Botox into the bladder, injection
of bulking agents into the urethra, surgical placement of urethral sling or
surgical repair of pelvic prolapse.
The prostate is a walnut-sized organ
that is part of the male reproductive system. It is located below the bladder
and in front of the rectum. It surrounds part of the urethra, the tube that
carries urine from the bladder to outside the body. The gland’s main function is
to produce fluid for semen, which nourishes and transports sperm cells.
Image of male anatomy including prostate
When prostate cells grow abnormally and form a mass, it is called a tumor. Some
tumors are benign (not likely to be life-threatening) and others are malignant
(cancerous and potentially life-threatening). Over the course of a man’s
lifetime, some prostate cells may become cancerous. Sometimes, the cancer can
be very small, localized, and confined within the prostate. In other cases, the
cancer is present in more than one site of the prostate, often involving both
sides of the gland. Through a process called metastasis, some cancer cells can
spread outside the prostate to nearby regional lymph nodes or organs in the
pelvic area. They eventually can spread to more distant parts of the body
through the blood and lymph systems–most often to the bones. Determining
whether the cancer is confined to the prostate or whether it has spread either
locally or to more distant sites is often done by cross-sectional imaging and
is very important in selecting treatment.
Most prostate cancers in the United States are identified through
prostate-specific antigen (PSA) screening or digital rectal examination (DRE).
Prostate-specific antigen is a protein in the blood produced by prostate cells.
It is widely used as a screening test for prostate cancer. Your PSA level can
be measured with a simple blood test. The higher the PSA level, the more likely
that prostate cancer is present. In a DRE, a doctor inserts a gloved,
lubricated finger into a man’s rectum to feel for any irregular or abnormally
firm area in the prostate. While most prostate cancers are indicated by PSA
results, some cancers produce little PSA but can be detected by DRE.
An elevated PSA may suggest an increased risk of prostate cancer; however,
elevations of PSA can also occur in benign conditions. The decision to proceed
to biopsy of the prostate is based on a combination of factors, such as PSA,
DRE, family history, age, race and other comorbidities and should be done only
after discussing the risks and benefits with a physician.
Deciding how to treat prostate cancer can be a confusing process. Each
treatment has its own mix of benefits, risks and impacts on quality of life.
The good news is that several treatments are very successful for many prostate
cancer patients, either in providing a cure or keeping the cancer under control
for many years. However, your physician cannot always tell you specifically
which treatment to choose, because for most men, the choice is significantly
influenced by personal preferences. We encourage you to visit our
Health for Life web portal for fuller information.
In addition to the tumor risk factors described above, treatment choice is
influenced by factors such as:
• Your age and life expectancy
• Your general health and specific medical conditions
• Cost and practical considerations
• Attitudes about cure and/or living with cancer
• Your needs, concerns, values and social relationships
• Your feelings about specific side effects
As appropriate, you and your physicians may choose a combination of treatments.
Below are brief examples of treatment options for localized prostate cancer:
As previously discussed, many prostate cancers do not pose an immediate risk to
health and may not require treatment. Active surveillance is a way to monitor
low risk prostate cancer (cancer that is not an immediate risk to your health
or well-being) with a plan of timely intervention should the tumor progress.
A radical prostatectomy is surgery to remove the entire prostate gland and
seminal vesicles after a diagnosis of prostate cancer is made. Sometimes, this
also entails removal of the regional lymph nodes, depending on a number of
Radiation therapy is done with the intent of curing the disease by killing
cancer cells.. Radiation can be given as external beam radiation therapy (EBRT)
and/or as brachytherapy (temporary or permanent radiation seed implants). This
treatment is sometimes coupled with hormone therapy because most prostate
cancers are driven by testosterone. Hormone therapy attempts to
establish very low levels of testosterone in an effort to control the cancer
Brachytherapy (Seed Implants)
With brachytherapy, radiation is given from inside the body, with radioactive
seeds placed permanently in the prostate or with narrow, seed-filled tubes that
are placed temporarily for one or two days.
This procedure, used to treat localized prostate cancer, kills the cancer cells
in the prostate by freezing them.
What If Initial Treatment Is Not Sufficient or Your Cancer Recurs?
While the diagnosis and treatment of prostate cancer has improved significantly
in recent years, the cancer can still recur. Not surprisingly, clinical studies
show the likelihood is higher the more advanced the disease was at initial
diagnosis, and the more time that passes since diagnosis and treatment. While
differences emerge between different types of treatment, many other factors
also come into play such as the original staging, Gleason score, extent of the
cancer, and age of the patient. Various statistical tools called nomograms help
assess this risk.
There are usually a number of treatment options that men in such situations can
consider to successfully treat or control the cancer. Choosing among them will
require a new decision-making process. It is still essential that you and your
physician continue to monitor your PSA on a quarterly basis for some period of
time, no matter how successful your treatment has seemed to be.
The kidneys are paired bean-like organs located in the back of the abdominal
cavity in the retroperitoneum. The kidneys play a large role in the regulation
of wastes, electrolytes, water, blood pressure and acid-base balance throughout
the body. Although it is normal to have two kidneys, it is quite
possible to live with just one.
The most common type of kidney cancer is called renal cell carcinoma (RCC).
Risk factors include smoking, regular use of non-steroidal anti-inflammatories
such as ibuprofen and naproxen, a family history of kidney cancer, and renal
disease requiring dialysis.
Most commonly, kidney cancer is detected incidentally on imaging for some other
purpose and has no signs or symptoms. In cases where the cancer has
formed a larger tumor, a patient may experience flank pain, a mass in the
abdomen, or blood in the urine that is either visable or apparent on a dipstick
test. Other tests to help stage the extent of kidney cancer may include a CT
scan of the abdomen and pelvis to help characterize the size of the tumor and
parts of the kidney that are involved as well as to exclude any metastatic
disease in the abdomen or pelvis. Additional tests may include a chest xray or
chest CT scan to rule out any spread of cancer to the lungs. A bone scan to
exclude spread to the bones may be done if there is a high suspicion that these
structures may be involved. A biopsy may also be performed in certain cases to
confirm a diagnosis of kidney cancer.
Kidney cancer is most often treated with surgery. This can involve removal of
the entire kidney or removal of the mass and part of the kidney, to spare as
much normal tissue as possible. Treatment can also involve heating
the tumor with radiofrequency ablation or freezing the tumor with
cryoablation. If the tumor mass is small of if the patient has
significant comorbidities, the mass can be monitored with active surveillance.
This involves periodically imaging the mass to see if it has grown and
intervening if any progression is detected. Finally, there are medications that
may help to shrink mass size and tumor burden, but these have side effects, so
are reserved for more advanced or metastatic disease.