Low Testosterone (Hypogonadism)
The staff at Men's Health Boston have been pioneers in raising awareness of testosterone deficiency in men, and the importance of treating low T. As many as 20-30% of men over the age of 45 years have symptoms of low T. Younger men may also be affected. Symptoms include reduced sex drive, erectile dysfunction, fatigue, depressed mood, loss of muscle strength and mass, and increased fat, especially in the abdomen. Low T can also cause reduced bone density in men, which in more advanced cases can cause osteoporosis and an increased risk of fractures.
There are now data from a number of scientific studies (some performed at Men's Health Boston) that low T is associated with an increased risk of diabetes or cardiovascular disease, and that treatment can be effective in restoring sexual function, improving mood and energy. Men who are treated will also often experience an increase in muscle, a decrease in fat mass, and improved bone density. Many men experience an improved sense of well-being. Some men tell us they feel "normal again" after treatment.
The staff at Men's Health Boston specializes in the diagnosis and treatment of Low T. A medical history, physical examination, and blood tests for testosterone and related hormones will be obtained. Treatment options include gels, patches, and injections. A particularly popular treatment is placement of testosterone pellets under the skin of the buttock. Men's Health Boston has one of the largest experiences in the world with pellets, which are the only form of long-acting testosterone available in the US. Pellets usually provide 3-4 months of good T levels, and are convenient because they require no additional care between treatments.
Infertility
Male Infertility Evaluation
This evaluation starts with a thorough history and physical examination. Blood tests, specifically identifying any underlying hormonal abnormalities, are often performed along with a semen analysis. The semen analysis allows the physician to assess sperm characteristics that can help or hinder fertility.
Specialized testing may reveal blockages of the tubes or ejaculation abnormalities that prevent the sperm from functioning properly. Testing may also include ultrasound studies to look for varicose veins in the scrotum ("varicocele"), cysts or blockages. We also perform genetic tests when there is a concern that this may be the source of the fertility problem.
Many possible causes of male infertility are possible. At Men's Health Boston we specialize in diagnosing the cause of the fertility problem and in treating the cause. We work closely with top female infertility specialists in the area in order to provide the best possible care for the couple.
Our fertility work has been published in the most respected medical journals, including "Fertility and Sterility" and "Human Reproduction."
Microsurgical Varicocele Repair
Varicoceles are enlarged varicose veins that occur in the scrotum. They are quite common, affecting 15% of men overall and about 40% of men with known infertility.
The most effective treatment technique with the lowest complication rate is the microsurgical varicocele repair offered by Men's Health Boston physicians. This technique preserves the artery to the testicles and ensures that all affected veins are tied off.
Sperm Aspiration
In cases where there are no sperm in the semen, or after a vasectomy, it may be possible to harvest sperm from the testicle or from the surrounding tubes. Over the last ten years the technology to perform this procedure has advanced to where we can find sperm in many cases that were previously considered hopeless. Even small numbers of sperm can now be used to successfully create a pregnancy. Depending on the situation, these procedures can be performed in the office or as a brief procedure in an outpatient operating room.
Vasectomy / Vasectomy Reversal
Vasectomy
Vasectomy is the most reliable form of birth control available today. At Men's Health Boston we offer the no-scalpel technique for vasectomies. It is a painless procedure that takes less than 30 minutes to perform in our office. There is no effect on erections, sex drive, or feeling in the penis. Most men will also notice no change in ejaculation or orgasm, since the amount of fluid that comes out is reduced by only 5-10%. Many men and their partners find sex more enjoyable once they can stop using condoms, birth control pills, or other forms of contraception, without the fear of an unexpected pregnancy.
Vasectomy Reversal
Physicians at Men's Health Boston have a wealth of experience in microsurgical vasectomy reversal. Advances in the technical aspects of this procedure combined with our expertise result in success for a majority of men and their partners, even when it has been longer than 10 years since the vasectomy. We also specialize in the treatment of men after a failed vasectomy reversal done elsewhere.
This is an outpatient procedure, with little postoperative discomfort. If desired, sperm can also be collected and frozen, particularly if the couple wishes to proceed immediately with additional treatments, such as in-vitro fertilization.
Prostate Conditions
Transurethral Needle Ablation (TUNA)
TUNA therapy is one of the exciting and effective advances in the treatment of enlarged prostates offered by Men's Health Boston. Using a telescope, the doctor looks inside the prostate and heats several areas with a small needle. This causes the tissue to shrink over several weeks. The treatment is performed in the office and takes less than one hour. The benefits may last for many years, allowing many men to stop taking medications for their urinary symptoms.
Sexual Dysfunction
Erectile Dysfunction
Erectile Dysfunction (ED) is the inability to achieve and sustain an erection adequate for sexual intercourse. ED affects millions of men in the U.S and world-wide.
There are many risk factors associated with ED such as diabetes mellitus (DM), heart and vascular disease, radical pelvic surgery and other chronic illnesses.
At Men's Health Boston, men with ED receive a comprehensive evaluation which includes a history and physical examination, laboratory tests, and specialized diagnostic tests that provide information regarding the nerves and blood supply to the penis. We have a wide variety of treatments available for men with ED, and can help the vast majority of men who wish to regain their ability to have satisfying sex.
IIEF (International Index of Erectile Function) Questionnaire
Penile Prosthesis (Implant)
The penile prosthesis ("implant") is a highly effective and satisfying treatment option for men with ED or Peyronie's disease. This option is usually reserved for men for whom medical therapies have failed or who are not satisfied with other treatment modalities.
The most common implant is an inflatable device that is placed inside the two erection chambers of the penis, with a pump placed inside the scrotum. When the man desires an erection, he finds and squeezes the pump. Fluid is transferred to the cylinders in the penis and the penis becomes erect. After sex, the penis is deflated.
The surgical procedure takes less than two hours. Men can stay overnight in the hospital or go home the same day, if they prefer.
Most men are surprised at how natural the penis looks and feels after placement of a penile prosthesis. Candidates include men after treatment for prostate cancer, men with diabetes, or any man with erection problems who is not satisfied with other treatments. Physicians at Men's Health Boston have extensive experience with penile prosthesis surgery, and we have published our results in several medical journals. Satisfaction rates are very high, for men, and for their partners.
Peyronie's Disease
Peyronie's Disease causes a number of troubling symptoms for men, including painful erection and penile curvature. It is caused by scar tissue of the tunica albuginea, which is the lining of the penile chambers involved in creating an erection. In some men the scar tissue ("plaque") develops after an injury to the penis, such as severe bending of the penis during sex. However, most men with Peyronie's Disease do not recall any such traumatic event. The cause in these men is unknown, but it is believed that genetic factors may predispose some men to Peyronie's Disease. Men with Peyronie's Disease are often very troubled psychologically by their condition.
A variety of treatments are available. Pills and creams are often prescribed, but studies have not shown these to be consistently effective. The most effective treatments are surgery and injection of medications into the plaque itself. Men's Health Boston has extensive experience and expertise in the treatment of Peyronie's Disease. Many men can be successfully treated without surgery.