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You probably know testosterone (T) plays an important role in how boys physically develop into men. But is that all you know? What happens when a man's T levels are off? Are there symptoms men should look for? And what are the treatment options? Dr. Bobby Kahlon, MD, Renown Medical Group provides answers in a Testosterone Q&A.   What does testosterone do for men?  "Testosterone is known as the 'manly hormone' for a reason," says Dr. Kahlon. "Though women also naturally produce small amounts of it, men produce testosterone at much higher concentration levels. And it affects men in more physical and obvious ways. How much hair a man has on his chest, how deep his voice is, or how muscular he is are all attributable in some way to testosterone. It's also responsible in large part for sex drive and bone strength and affects how men think, learn and experience their surroundings."  Testosterone in men:   Powers virilization (male physical characteristics) and sexual function Builds muscle mass and strength  Supports bone density  Improves cognition  T Trivia: Discover Magazine reveals that “manly” testosterone and other sex hormones evolved long before we did — 500 million years ago — from the ultimate “female” hormone, estrogen. Can you have too much or too little testosterone?  Though high testosterone isn't a concern for most men, low testosterone or low T occurs more frequently and develops for two primary reasons.  Dr. Kuhadiya explains, "Subnormal testosterone concentrations occur either due to pituitary or testicular failure and the causes for each need to be discussed with your physician."  Pituitary failure: Approximately one-third of men with obesity, type 2 diabetes, or metabolic syndrome (which includes increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) have low free — or "bioavailable" — testosterone. These health conditions can cause the pituitary gland to "fail" to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which are essential for triggering testosterone and sperm production. And that can cause low testosterone (hypogonadism). Testicular failure: Though less common than pituitary failure, testicular failure may also be responsible for low T. It's caused by diseases or illnesses affecting the testicles, injury or trauma to the testicles, or certain medicines and treatments such as chemotherapy or opioid pain medication. Providing your complete medical history to your doctor is always the first step toward a proper diagnosis.  What are the symptoms of low T?  The following indicators could be a sign that you have low T, say the doctors.  Lack of motivation and determination, including mild depression  Loss of physical endurance and muscle strength  Loss of or diminished early morning erections  Reduced libido (sex drive)   Erectile dysfunction (ED — difficulty achieving or maintaining an erection)   Gynecomastia (male breasts)  Small testes  T and Time: T levels in men naturally begin to decline by about 1% a year starting at age 30.  How do you test for low T?  "There are different methods for testing testosterone levels," says Dr. Kuhadiya. "Each approach uses a blood sample to evaluate total testosterone, which includes free and attached testosterone that combines with proteins albumin and sex hormone-binding globulin (SHBG). For the most accurate results, testing is based on samples collected in the morning after fasting, and from tests on two different days."  What treatment options are available?  "Well, your best natural option may be YOU," says Dr. Kahlon. "Men with pituitary failure are often able to treat their low T by losing weight to increase levels of the hormone. And even if you don't lose weight, exercise can help boost your testosterone. Unfortunately, if you have testicular failure, weight loss and exercise may not have the same effect."  So, are there other options? "You may want to consider Testosterone Replacement Therapy (TRT)," says Dr. Kuhadiya. "TRT is only available to men who are hypogonadal — with a clinical diagnosis of low T. Injection, gel, skin patch and nasal spray are available TRT options. The best option is the one that works best for the patient. Convenience, insurance coverage and cost are all factors to consider." Dr. Kahlon's TRT preference? Daily gel treatments, which are applied directly to the skin. On the other hand, Dr. Kuhadiya recommends intramuscular injections, which take place once a week or every two weeks.  But both doctors agree on this: physicians and their patients need to weigh the benefits and risks of TRT before proceeding with treatment — especially if your low T condition may require lifelong treatment. "In my clinical practice, I have seen some very good long-term results with an improved quality of life," says Dr. Kuhadiya. "However, in certain situations, TRT may increase the risk of heart disease and is not recommended for men with a history of prostate cancer." Dr. Kahlon adds, "Patients receiving any type of hormone therapy need to be closely monitored throughout the treatment process for any changes in their health."   How do you feel about steroids and T boosters?  "I don't recommend them, certainly not for hypogonadism," advises Dr. Kahlon. "There is no evidence to support anabolic-androgenic steroids or testosterone boosters as a safe or effective treatment for low T in men."  "In fact, there continues to be emerging evidence they may lead to side effects that could potentially harm the liver and the pituitary and endocrine functions of the body," warns Dr. Kuhadiya. "And that damage may be irreversible."

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In August 2016, six-year-old Jakob was admitted to Renown Children's Hospital with what seemed like a common ear infection. Jakob's condition quickly progressed, and he started experiencing neurological symptoms such as difficulty speaking and a full-body shutdown. Doctors, neurologists and specialists from Renown worked with doctors from Stanford, where he was ultimately diagnosed with Bickerstaff brainstem encephalitis (BBE). BBE is a rare, autoimmune response that attacks the nerves in the body due to an acute illness such as a cold, flu or, in Jakob's case, an ear infection. Jakob could not breathe or eat and experienced paralysis on the side of his face, throat, stomach, bowels, lungs and legs. In addition, he started to rapidly lose weight as well as body function. Jakob lost half his body weight which resulted in the need for a Gastrostomy tube. This device is placed surgically and gives direct access to the stomach to give the child the nutrition needed. He also needed occupational therapy, and after three and a half months of ICU respiratory therapy, surgeries and treatments, he was released home to regain his strength. Forever Grateful Anica, Jakob's mom, said, "If it were not for the quick response and unconditional support and compassion from the team at Renown, Jakob would not be here today." Jakob's family is forever grateful to the staff, community and expertise at Renown for their unwavering commitment to their son and family during their most trying time in life. "When I met Jakob on the first day of his illness, so much was unknown. My team and I were worried, as his symptoms were very unusual. His rapid deterioration, after being a perfectly healthy child, was clearly terrifying for his parents. Handing over a child's care to a team of strangers is one of the scariest things that can happen to parents,” said Dr. Kris Deeter, Physician in Chief at Renown Children’s Hospital. “However, Anica and Jeremiah were also very clear that they did not want Jakob transferred somewhere else. So, we used all our resources to care for him, arrive at a diagnosis, and start aggressive therapies. They listened to every word we said, educated themselves, and became partners in Jakob's care. We all became part of Team Jakob, and soon, he proved to us just how strong he was." Today, Jakob is 13 years old and thriving in every aspect of his life. He is currently on the honor roll in school and finds joy in his newfound passion for the violin. He loves spending his free time learning about mixing music, making new friends and traveling to different parts of the country. This summer, he will travel to Europe to explore his passion for culture. The family says, "We owe it all to the family and staff at Renown."

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Giving back to the community is important to Rebecca Dickson. For over 35 years, she’s been unwavering in her support of Renown Health and Reno’s non-profit community. Hearing that she’s made a difference in someone’s life feels good. But for Rebecca, the greater reward is something more personal. “Giving back is a way of life,” Rebecca said, “that’s what you do.” Inspired by her parents, the act of generosity was instilled in her from a young age. Growing up, Rebecca remembers her mother’s thoughtful generosity with others. It was her mother, Fianna Dickson Combs, who inspired and helped plan Fianna’s Healing Garden in the heart of the Renown Regional Medical Center campus. The garden is Fianna’s legacy and gift to those in need of comforting, healing and quiet contemplation. Walking through the garden, Rebecca points out the fountain. She talks about choosing it for its calming sound. Birds chirp on the trees overhead. The space is beautiful; it’s tranquil and comforting. Fianna’s Healing Garden was completed in 2009. In 2020, to celebrate the tenth anniversary of the garden, Rebecca and her uncle, Harvey Fennell, led an expansion project to grow the space. Inside the garden, there are pathways, benches, sculptures, fountains and over 2,000 plants and trees. Roses are life “The rose garden is special,” said Rebecca. It was carefully curated in honor of Fianna and her sisters to create a peaceful space for reflection. There are 21 roses of differing sizes and colors. “The roses should be experiential. The fragrance, the colors; they are life with good days and bad. Fianna was a master gardener and felt that gardens tend to the mind, body and soul,” says Rebecca. Honoring Fianna’s Legacy Throughout the hottest days of summer, Rebecca and her partner, David Geddes, visit the garden. They maintain the roses, removing damaged branches and pruning them. “It’s not work,” says Rebecca, “it’s a joyful opportunity that makes us feel good.” Being in the garden reminds Rebecca of her mother and the need for healing gardens in healthcare. When her mother was in the hospital, her doctor encouraged her to get outside and into nature. At the time, Renown didn’t have an outdoor garden space. From then on, it was Fianna’s mission to create a healing garden for patients, caregivers and visitors. Nature reduces stress and anxiety. It also provides comfort and distraction. Healing gardens offer spiritual and healing benefits, and they’ve been proven to improve health outcomes. Before Fianna passed, her plans for at healing garden at Renown were already underway. Making an Impact Rebecca is a lifelong philanthropist. She serves on countless boards, volunteering her time to give back to the community. She currently sits on Renown Health Foundation’s Board. Through her volunteer work, Rebecca not only gets to experience the joy of helping others first-hand, but she also gets an inside view of how non-profits operate and what they need most. That information helps her decide how to direct her support in the most impactful way. Rebecca receives cards and phone calls thanking her for Fianna’s Healing Garden and the comfort it provides. But Rebecca insists that she’s not to thank. Rebecca remembers every person who has supported the garden. Fianna’s Healing Garden is donor-funded, and would not be possible without the support of the community, her uncle, Harvey Fennell, Fianna’s closest friends, Renown physicians and employees, Renown Health Foundation and countless community foundations and local donors. She says, “The garden is a collaborative project. It takes a village to build and maintain, but it’s worth it!” From all of us at Renown, thank you, Rebecca, for your inspiration and dedication to Renown! Fianna’s Healing Garden is located at Renown Regional Medical Center and is open for all to experience the healing power of nature. Click here to take a virtual tour of the garden. Renown Health Foundation’s Why I Give series recognizes donors, volunteers, corporations, foundations and others who provide philanthropic support to Renown. We are fortunate to have generous donors whose funding helps support and expand our efforts to meet the growing needs of the communities we serve. To learn more about how you can support Renown, please email foundation@renown.org or call 775-982-5545.

Read More About Why I Give: Rebecca's Story