Author: William Brant, MD

Common Signs of Low Testosterone

Testosterone is a sex hormone produced mainly in men by their testicles, although it’s present at low levels in women, too. A lot of men think of it as a pure “sex” hormone, meaning that it’s only function is to improve erectile function.  However, testosterone has much more widespread effects.  Testosterone affects facial and body hair growth as well as sexual development, including stimulating sperm production and supporting a man’s libido, or sex drive. It also helps build muscle and bone mass to produce the characteristic “male” appearance.  Additionally, it is involved in mood, brain health, heart health, and so on.

Low testosterone diagnosis is shown using a text.Testosterone production usually decreases with age, and according to the American Urological Association, about two out of 10 men over age 60 have low testosterone levels (low T), while three out of 10 men in their 70s and 80s have low T. Low T, though, can happen at any age and for a variety of reasons from diet to blood pressure to thyroid problems.

According to the Food and Drug Administration, a normal T range is typically 300-1,000 ng/dL, which is determined by a serum testosterone blood test. If the level drops below 300, men can experience a wide range of symptoms.  The testing for low T is a bit more complicated than this range, and those numbers are often not quite accurate, but they are a good starting point.

Here at the office of urologist Dr. William Brant, we specialize in men’s health issues, including low T, and we can provide you with the treatment you need to feel like yourself again. Here’s what you need to know about recognizing the signs and symptoms of the condition.

What are common symptoms of low testosterone levels?

There are a number of symptoms of low T in men. Some of the most common include:

Low libido

Testosterone plays a large part in a man’s sex drive. Though men can experience a lowered libido as they get older, someone with low T will experience a more noticeable drop in their desire to have sex.

Erectile dysfunction

Testosterone not only supports sex drive, but it also helps to achieve and maintain an erection. It’s only one of many components to do so, but it works by stimulating brain receptors to produce nitric oxide, a molecule that triggers a series of chemical reactions required to produce an erection.

With low T, men can have difficulty achieving an erection before sex or having spontaneous erections, though it’s only one component in the process. Research, however, is inconclusive about the value of testosterone replacement in treating ED.

In a review of studies, nearly half showed no improvement in erectile problems with testosterone replacement. That’s most likely because other factors, such as obesity, diabetes, thyroid problems, stress and anxiety, and high cholesterol and blood pressure, also play a role.

Hair loss

Male pattern baldness has a strong genetic component, and it’s a natural part of aging for most men. Testosterone is converted to another hormone, which is responsible for the loss of hair on the head.  Some men with very low T may experience a loss of body and facial hair.

Loss of muscle mass

Testosterone plays a key role in building muscle, so men with low T might might experience a decrease in muscle mass, or a new inability to gain muscle at the gym. Studies, however, have shown that although low T does decrease muscle mass, it may not necessarily affect muscle strength or function.

Decreased bone mass

Osteoporosis and osteopenia, the thinning of bone mass, is a condition normally associated with women — especially small, white women of European descent. However, men with low T can also develop osteoporosis since testosterone helps produce and strengthen bone. That means they have lower bone volume and are more prone to bone fractures. Bone density can easily be measured with a DEXA test, and there are medications available to treat the condition, although it’s preferable to get testosterone levels back in the normal range.

Increased body fat

Men with low T not only experience increases in body fat, they can also develop gynecomastia, or enlarged breast tissue. Current understanding pegs this as an imbalance between testosterone and estrogen (the female hormone, which men have in small quantities), since the testosterone level is no longer where it should be.  It is important to not just check T in these cases, but also the estrogen level.

Difficulty sleeping

Men with low T can have a hard time falling or staying asleep. They also have an increased risk of sleep apnea, a potentially serious disorder in which a person temporarily stops breathing. This not only disrupts sleep, but it can also cause a wide range of physical problems, including heart disease.

Decreased energy levels and mood changes

Low T can reduce energy levels and lead to fatigue, even after adequate rest. And according to some evidence, this may also be paired with mood alterations, including a lack of focus, irritability, and depression.

Schedule an Appointment for Low Testosterone in Salt Lake City

Are you experiencing any of these symptoms, or do you just need a regular men’s health checkup? Call Dr. Brant’s office at 801-207-7922 to set up an appointment, or book one online. We have solutions.

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What Causes Testicular Pain?

man in pain holding crotch.As any guy who’s worn a jockstrap can tell you, the testicles are incredibly sensitive parts of the male anatomy, and pain in that region is nothing to sneeze at. But testicular pain comes from many causes and presents in a number of different ways; it’s important to know when you have a problem.

Board-certified in urology and men’s sexual health, Dr. William Brant has extensive knowledge of testicular pain and its causes, and he’s an expert in its treatment. He’s put together this guide to help you understand what might be at the root of your pain and what you can do about it.

What are the causes of testicular pain?

Testicular pain is discomfort felt in the testicles (testes) or the scrotum, the sac that surrounds them. It may start mildly, building in strength, or it can come on suddenly, depending on the cause. It’s caused by many different things, ranging from blunt trauma to infections to neurological disease to torsion. Let’s examine a few of these.

Trauma

The large majority (85%) of testicular injuries are caused by blunt force trauma, such as would be sustained by a direct kick or punch to the groin, sports injuries, and straddle injuries. Such a blow to the testicles can cause sudden, excruciating pain that may linger, as well as bruising and swelling. In addition, the testicle may rupture or develop a hematocele, where blood pools around the testicle and presses on it. Any disruption to blood flow can be serious, so if you’re experiencing pain and swelling after direct force, seek medical attention as soon as possible.

Epididymitis

Epididymitis is an infection of the epididymis, the organ in which sperm mature before leaving the body. The infection can come from a number of sources, such as sexually transmitted diseases, including chlamydia and gonorrhea, and urinary tract infections.

Symptoms may include:

  • Pain that increases gradually
  • A scrotum that’s hot to the touch
  • Swelling

The doctor will usually treat the infection with antibiotics.

Kidney stones

Kidney stones are hard balls of calcium that get lodged in the organ responsible for excreting liquid waste, and they can cause pain that radiates to the testicles. This is known as referred pain — pain that occurs beyond the region causing the problem.

Some common symptoms of kidney stones include:

  • Blood-tinged urine
  • A burning sensation when urinating
  • Pain at the top of the penis
  • A sharp, cramping pain that radiates from the back to the groin
  • Frequent urination
  • Nausea and vomiting

If the stone is small, it may pass on its own. If the stone doesn’t pass, though, and you begin to experience symptoms of an infection, such as a fever or discharge, seek medical treatment as soon as you can. Treatment options usually include surgery to remove the stone, or shockwave lithotripsy, where shock waves aimed at the kidney break up the stones, which are then excreted.

Testicular torsion

Testicular torsion is a serious medical condition that’s most common in men under 25 years old. It occurs when the testicle twists around the spermatic cord, the duct that carries sperm from the testicles to the urethra. According to the American Urological Association, testicular torsion happens on the left side more so than on the right.

Symptoms that accompany torsion include:

  • Sudden, severe pain on one side of the scrotum
  • A red or darkening color on the scrotum
  • Swelling in the scrotal sac
  • Nausea and vomiting

The pain from the torsion may be sudden, but some men experience a pain that worsens slowly over several days.

Torsion is a life-threatening condition, as it cuts off the blood flow to the testicles and may result in testicular loss. Treatment almost always involves surgery to undo the twisting, but if the surgeon cannot repair the damage for some reason, he may have to remove the testicle. Since torsion usually affects just one testicle, removing it doesn’t impact the man’s fertility.

Hernias

A hernia is an event in which tissue pushes through a weak spot in the abdominal muscles. An inguinal hernia can push its way into the scrotum, causing testicular pain and swelling. Surgery to repair the hernia can lead to lingering pain, and the doctor may treat this with an anesthetic injection.

Schedule an Appointment Testicular or Scrotal Pain in Salt Lake City Today

Are you experiencing testicular or scrotal pain, with or without knowing its source? If your pain is a life-threatening emergency, dial 911, or go to your local emergency department. Otherwise, contact Dr. Brant to learn more about your condition and your treatment options, by phone at 801-207-7922, or by booking an appointment online today.

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The Pros and Cons of Penile Implants

tablet showing penile implantation words.Penile implants may sound like an extreme solution for erectile dysfunction, but is it? Often, for men with ED, implants offer a safe option for regaining satisfaction in your sex life and have higher satisfaction rate than more conservative methods.

Based in Salt Lake City, Utah, urology specialist William Brant, MD, FACS, FECSM is an expert at identifying the causes of erectile dysfunction and designing a personalized treatment plan to help restore your ability to have an erection. Dr. Brant is currently accepting new patients and will explain more about the pros and cons of penile implants, so you can decide if it’s right for you.

What are penile implants?

Penile implants is a general term that covers a wide array of implants designed to help you get and maintain an erection. If you’re worried that penile implants may be difficult to conceal under clothes, don’t fear — the most common implants only harden your penis when you’re ready to have an erection, otherwise, your penis will remain in a normal, flaccid state.

Some of the most popular types of penile implants include:

  • One-piece implant – This device is made up of semi-rigid cylinders that are placed in the area of your penis responsible for erections. This is the least complicated kind of prosthesis and easiest to use; however, it offers the least natural-looking and natural-feeling erection as compared to the other implants.
  • Two-piece implant – This implant adds a pump in your scrotum to fill the cylinders in your penis with fluid, creating an erection. You can drain the fluid out by bending your penis in a certain direction. Although it’s effective, this device is not the best at maintaining total flaccidity. It may not be a good option if you’re thin or have a larger penis.
  • Three-piece implant – This device involves the same mechanism as the two-piece, but the pump can both inflate and deflate the penis. The pump pulls the fluid from a reservoir placed in the lower abdomen area in order to create the erection and sends it back to the reservoir ro return your penis to a completely flaccid state.  These are, by far, the most commonly used implants in the U.S.

Dr. Brant typically recommends the three-piece penile implant to his patients, unless there is a safety or medical concern that prevents you from getting it. The three-piece device offers great rigidity and flaccidity, and most importantly, gives you total control over your erection as well as allowing you to be totally discreet about having an implant.

What should I consider before getting a penile implant?

Penile implants offer amazing benefits, but there are a few drawbacks you should consider before getting one. Here is the breakdown of the pros and cons.

Pros

Some of the pros for getting a penile implant include:

  • Allows you to control your erection
  • Long-lasting, good for up to 20 years, although this depends on a combination of use and luck
  • High patient satisfaction rate
  • Returns your penis to a flaccid state when not in use (by deflating for the two or three-piece or bending the semirigid cylinders for the one-piece)
  • Easy to use
  • Best solution for ED that either doesn’t respond to medication or other treatment, or if those treatments are unsatisfactory.

Each device also comes with its own added benefits. As previously mentioned, the three-piece implant creates the most natural-looking erections, offering both excellent rigidity and total flaccidity. The one-piece device has a very low chance of malfunction (due to its simple construction) and is great for patients with limited dexterity.

Cons of penile implants

The biggest drawback to penile implants is its permanence. In most cases, once you receive a penile implant, you will no longer be able to achieve an erection by natural means. This also applies if you were to have the implant removed.

Other cons of penile implants include:

  • Outpatient procedure, which involves recovery time at home
  • Higher chance of malfunction with the two or three-piece device
  • Less rigid erections (with the one-piece)
  • Constant pressure on the penis (with the one-piece), which may cause injury in certain kinds of patients
  • Slight risk of infection (very rare, as many modern implants come with an antibiotic coating to prevent this from happening).  Using modern techniques and protocols, Dr. Brant’s rate of infection is less than 1% (outside of unusual circumstances).

Dr. Brant takes the time to explore all nonsurgical treatment options for your ED, including medication and therapy, before suggesting penile implants. If you have concerns about penile implants, he answers all your questions and makes sure you understand both the pros and cons of penile implants before proceeding.

The procedure itself only takes about an hour, and you’ll be able to go home afterward. During the procedure, Dr. Brant makes a very small incision on the upper area of your scrotum to be able to insert the implant. The incision heals in about a week, and you’ll be recovered and able to resume having sex after two to six weeks (depending on the procedure and type of implant).

Schedule a Penile Implant Consultation in Salt Lake City

If you’ve been struggling with erectile dysfunction that just won’t respond to treatment, you may be a good candidate for penile implants. Contact our Salt Lake City, Utah, office by calling 801-207-7922 or by sending a message on our website to schedule a consultation with Dr. Brant.

Request Appointment

Life After Prostate Cancer: What Can You Expect?

Prostate cancer has a high survival rate, and for most men, the treatment can completely eliminate the cancer.

doctor holding light blue ribbon.However, although completing your cancer treatment is definitely a reason to celebrate, life after prostate cancer can be a little bit challenging.

The good news is that many of the side effects of surgery, hormones, and radiation therapy are temporary. Even if the side effects don’t go away on their own, there are other treatments and procedures medical professionals can recommend to increase your quality of life.

We asked our urology specialist, William Brant, MD, FACS, FECSM, all about life after prostate cancer. Read on to find out what side effects you may experience, as well as what management therapies can counteract these side effects.

Side effects of radical prostatectomy

Radical prostatectomy, or the surgical removal of the prostate gland, stops cancer from spreading. While this surgery is life-saving for many, it can pose some challenges throughout the recovery.

Urinary Incontinence

Urinary incontinence is a common side effect of prostate surgery, although typically it is mild or even goes away within a few months. If you’ve had your prostate removed, you may experience stress incontinence, which means you may leak urine when you cough, sneeze, or laugh.

Some people experience stress incontinence only in the first three months after the surgery, whereas others may experience it for longer and may benefit from pelvic floor exercises. If the urinary incontinence persists (for around 10% of men after prostatectomy), you also have the option of implanting a male sling[this should link to the sling portion of the website] or an artificial sphincter, depending on your situation and the severity of the incontinence.

Erectile Dysfunction

Erectile dysfunction (ED) is another common side effect of the surgery. All men who undergo a prostate removal will experience ED for at least a short period, due to nerve mobilization during the prostatectomy. However, if you experience persistent issues, Dr. Brant can determine which treatment method can best help you return to a healthy sex life.

He may recommend one or a combination of the following:

  • Medications
  • Penile injections
  • Penile implants
  • Low-intensity extracorporeal shock wave therapy
  • Vacuum erection device (VED)

Side effects of radiation therapy

After completing radiation, you may see a change in your bowel movements anywhere between two to six weeks. You may also notice a burning sensation or other issues when you urinate, erection dysfunction, fatigue, and lymphedema (swelling around damaged lymph nodes).

Dr. Brant is here to help recommend the best treatment methods for your symptoms, with a focus on noninvasive treatment methods such as training exercises to strengthen specific muscles and lifestyle changes.  Side effects such as erectile dysfunction have many solutions that he can offer.

Side effects of hormone therapy

Androgens stimulate cancer cell growth, so many people undergoing cancer treatment also need androgen deprivation therapy.

However, when the production of androgens is partially blocked, you may experience symptoms such as:

  • Weight gain
  • Depression
  • Hot flashes
  • Low libido
  • Growth in breast tissue (gynecomastia)
  • Anemia
  • Fatigue
  • Erectile dysfunction

The good news is that after you’re done with androgen deprivation therapy, your body may return to producing enough androgens on its own. Your age, lifestyle, and overall health play a role in how long it takes for your androgen production to normalize.

Learn more about life after prostate cancer

Beating prostate cancer is difficult enough. You shouldn’t have to deal with the aftermath of the treatments as well. Dr. Brant specializes in helping prostate cancer survivors get much-needed treatment for side effects related to urinary and sexual health.

Contact our Salt Lake City, Utah, office by calling 801-207-7922 or by sending a message on our website to learn how you can experience a smooth and healthy recovery after prostate cancer.

How to Know If a Vasectomy Is Right For You

Are you looking for a hormone-free contraception method? Many men have partners who can’t tolerate birth control pills or simply want an alternative to female birth control.

A vasectomy is one of those alternatives, and unlike other contraception methods, it doesn’t impact your hormone levels. In many cases, the procedure can even be reversed if you change your mind down the line.

To help you get a better grasp of the pros and cons of a vasectomy, we asked our men’s sexual health specialist and skilled urologist, Dr. William Brant, the following questions: What is a vasectomy, and what are the benefits of getting one? Keep reading for the answers.

Vasectomy 101

Tablet with the text Vasectomy.Vasectomies are a widely used form of male contraception. In the United States alone, 1 in 10 males opt for a vasectomy.

During a vasectomy, Dr. Brant cuts, separates, and seals the vas deferens, the sperm-carrying tubes, so the sperm doesn’t end up in your semen. Instead, the sperm gets reabsorbed by your body without any side effects.

You may have read or heard about vasectomies being linked to heart disease, cancer, or autoimmune diseases. However, the risk of developing these as a consequence of a vasectomy is extremely low if it exists at all.  This remains a controversial subject but, for the vast majority of men, the benefits of a vasectomy far outweigh the risks.

Vasectomy recovery and long-term benefits

The procedure takes about 30 minutes to complete, and it’s done on an outpatient basis. Some patients may experience some swelling after the procedure, but most men can go back to their daily routine.

That said, playing sports, lifting heavy weights, and doing any high-intensity activities on the days following the procedure isn’t recommended, because these activities may cause bleeding in your scrotum. Additionally, you can resume having sex with your partner within about a week.  Overall, Dr. Brant recommends taking it relatively easy for around 2 weeks.  Enjoy the rest!

A few weeks after your procedure, Dr. Brant will ask you to come back to his office for a test to see if there’s any sperm in your semen so you can be certain that the procedure was successful. He recommends using a backup form of birth control during sex until you receive testing confirming that your semen is free of sperm.

Vasectomies are one of the contraceptive methods with the highest success rate, as it doesn’t rely on following a pill schedule or remembering to put on a condom to prevent pregnancy.

Can it be reversed?

A vasectomy is often thought to be irreversible. That’s actually not true. If you do change your mind later down the line, Dr. Brant does offer vasectomy reversals to restore fertility.

Success rates (depending how you define success) after a vasectomy reversal range anywhere between 30% to 90%, depending on how long it’s been since you had the procedure, as well as your age and overall hormonal health. Pregnancy, which is the outcome that most couples care about, is actually more dependent on the age, health, and fertility status of the female partner.

If you still have questions about getting a vasectomy or want to schedule a consultation with Dr. Brant, contact our Salt Lake City, Utah, office by calling 801-207-7922 and find out if a vasectomy aligns with your goals.

 Schedule a Vasectomy consultation at the office of William Brant, MD, FACS, FECSM, online or call the office today at (801) 965-2767.

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