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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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Once upon a time … in Incline  This issue’s featured member began writing the latest chapter of her life story by retiring on Lake Tahoe’s north shore in Incline Village, NV.  “I had several criteria when selecting a place to retire,” says MaryBeth. “And a healthy lifestyle was number one. The people who have settled in Incline are very active with both their minds and their bodies. It’s not a stagnant population, it is unusually robust. I’ve made wonderful friendships here and we really watch out for each other, which means the world to me.” “I also wanted four seasons a year,” she continues. “And most importantly, I wanted a place that my son, Addison, would love to visit and share with me – and world-class skiing just minutes away scored extra points with both of us!” Zürich and Beyond  Skiing was something MaryBeth and Addison took to with a passion while living in Zürich, Switzerland. A business move to the land of the Alps (and Swiss chocolate) provided the perfect opportunity for an international education for her son and a culturally eye-opening experience for the family.  “I was unprepared for what it was going to be like living in a foreign place, and I learned a lot about empathy as a non-native and the kindness of strangers, or not. Our seven years there gave us many easily available travel adventures on the other side of the globe, and the friendships I made with people around the world have been lifelong.” “Divas” of the Garden  “Tall and showy” is how MaryBeth lovingly describes the “Divas” of her garden, aka the delphiniums. Located in the sunny part of her yard, the plants explode in a variety of colors that accentuate her home’s landscaping and are a well-earned reward for her mountain gardening challenges. “The very first thing you must do when creating a new garden is amend the soil,” explains MaryBeth. “It’s not sexy, but it’s necessary! And that’s when you learn that every shovelful of “mountain” dirt is loaded with rocks of every size – it’s fantastic exercise!” And her neighbors appreciate the hard work. “I’ve made so many friends of all ages in the neighborhood while working outside in my garden,” shares MaryBeth. “They stop, chat, inquire about the plants and take photos all the time.” Then with a smile, she adds, “You could call it my art.” Aging-In to Life with Medicare At 64 and on the cusp of Medicare eligibility, MaryBeth recently tasked herself with learning what she could about the plans and options that would soon be available to her and was overwhelmed. “I made the mistake of entering my phone number on a Medicare website for “wanting more information” and had no less than 15 calls a day from health insurance brokers – from all over the country!” she exclaims. “What one person would tell me would then be questioned by the next. I eventually quit answering the phone.” However, finding a Medicare plan that meets all of her needs is still a priority. “First and foremost, since I am a traveler (at least before the pandemic) I want to have a healthcare plan that will cover me in any state,” MaryBeth explains. “I would also like a policy that allows for alternative treatments, such as acupuncture – which I’ve had great success with in the past. I know that getting a good Rx plan now will save me money down the line, and I also want to be able to see a specialist without seeing a provider first for a referral.”

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“You’re gonna be a dad!” Whether you’ve been waiting years to hear those words or still think you’re too much of a kid to have a kid, the reality of impending fatherhood can be terrifying for any first-time, soon-to-be-dad. But not to worry, Best Medicine has some timely tips to help calm those bundle-of-joy fears and help you rock your new role as a brand-new, baby daddy.   Winter is Where Babies Come From Fact: More babies are born in September than any other month, with spill over (and spit-up) into October. Subtract ten months for the typical 40-week, bun-in-the-oven baking time and early winter stands out as the top baby-making part of the year. Is it the cozy nights before a fire as people avoid the snowman-friendly temperatures outside? Possibly. There could be any number of reasons, both seasonal and otherwise, for what will eventually arrive in the fall and immediately steal your heart — and untold hours of your sleep. Though moms carry most of the baby burden traditionally (and literally for three trimesters), that’s no excuse for the soon-to-be-dad not to step up to the plate and take a swing at being the best partner and father on the planet. Below is a list of tips and resources to help you do just that. So read on, daddy-o.  Tip #1: Don’t Freak Out Ok, you’re probably going to freak out even if we tell you not to. But once you calm down, consider this: human beings have been having babies for millions of years, and many of those soon-to-be-dads had it much tougher than we do today. And guess what? The human race is still going strong. Those first moms and dads did a good job — and you will too, with a little help. Tip #2: Take a Class Knowledge is power. In this case, it's diaper-changing, swaddle-wrapping, 2 a.m.-feeding power. And for you and your partner, taking a parenting class or two should be a no-brainer. You'll both learn what to expect and prepare for as you support each other and bond with your baby even before he or she arrives.   Tip #3: Learn From Other Dads If the thought of sitting in a room full of full-bellied women and their partners makes you uncomfortable, you may opt to stick with bros for your lesson plan. Dad-only classes and soon-to-be-dad support groups — taught and led by seasoned fathers with tales to tell and words of wisdom to share — are available online and in cities and communities around the country. Dad-focused sites also offer advice for new and still-learning proud papas. Here are a few options to check out:  Boot Camp for New Dads City Dads Group Wilderdad.com Fatherly.com Fathers.com  Tip #4: Babies are Required Reading Haven't read a good book lately? Well, if you're expecting a baby, now is the time to flip through a few pages that could make your life a whole lot easier in a few months. There's no such thing as being too-well-read when it comes to your fast-approaching, adorable little poop machine. The least you can do is read a book or two, or seven.  We're Pregnant! The First Time Dad's Pregnancy Handbook From Dude to Dad: The Diaper Dude Guide to Pregnancy We're Pregnant! The First Time Dad's Pregnancy Handbook  What to Expect When Your Wife Is Expanding Be Prepared: A Practical Handbook for New Dads  The New Dad's Survival Guide: Man-to-Man Advice for First-Time Fathers What to Expect When You're Expecting  Tip #5: Be a Prepared Soon-To-Be-Dad Tips 1 through 4 are meant to help alleviate some of your jittery, new-dad anxiety. And we hope they do just that. But if you really want to hold that "Best Dad Ever" coffee mug starting on day one, there are also some practical things you can do to prepare. Check these items off your list now to make life with baby more baby-, mommy- and daddy-friendly from the get-go.  Buy a baby/child car seat. Three out of four car seats are installed incorrectly. Protect your children by ensuring they are riding in a properly secured and age-appropriate car seat. Renown Children’s Hospital Car Seat Station is staffed by certified technicians who provide child vehicle safety restraint education, inspection and installation. Set up the baby's nursery early, including furniture  Stock up on diapers and baby supplies  Cook and freeze 2 weeks of food for nights when no one wants to cook  Research family healthcare  Agree upon a shared diaper-changing/feeding schedule  Ask about paternity leave from work  Get bills and finances up-to-date or pre-pay to avoid late charges   Give the home a thorough cleaning before the baby arrives

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In sailing, when you encounter rough seas, you can’t change the wind pattern, but you can adjust your sails. The same rings true for life. We confront unpredictable circumstances daily, but how we react to them can make all the difference. For Renown patient and avid sailor Robert (Dan) Seifers, recent events make this mantra reign true. A Concerning Alert Monday, Aug. 22, started out just like any other day for Dan. He was on a walk with his dog, enjoying the sunshine, when suddenly he felt a wave of dizziness and a buzz on his wrist. His Apple Watch alerted him that his heart rate had dropped to dangerous levels. Returning home immediately, he notified his wife, Carol. Doing their best not to panic, the couple confirmed the reading with their at-home blood pressure machine. The watch was right – Dan’s heart rate was in the low 30s. After taking some time to see if Dan’s heart rate would return to normal, the couple decided it was time he sought medical help. Conveniently, Carol had a lab appointment scheduled next door to Dan’s primary care physician, Dr. Bonnie Ferrara. The couple headed out the door, not realizing what the rest of the day would bring. The Next 48 Hours Upon arrival at the office, Dan calmly approached the front desk to explain his situation. With no delay, staff members sprang into action, quickly showing Dan to a patient room and notifying Dr. Ferrara. Before he knew it, Dan was receiving an electrocardiogram (EKG). Following a review of the results, Dr. Ferrara returned to let Dan know he needed to get to the hospital immediately. The rest of the afternoon moved quickly for the couple. Dr. Ferrara had already notified the Renown Regional Medical Center Emergency Room staff, who were on standby for the couple’s arrival. “Gee, this must be serious,” thought Dan, who at the time was experiencing no other alarming symptoms other than the low heart rate indicated on his watch. Several doctors and nurses began their analysis, including a chest x-ray, blood test and additional EKG. Confirming Dr. Ferrara’s results, a Renown cardiologists, Dr. Christopher Rowan and Dr. Shining Sun, joined Dan’s care team. Within two hours of checking into the hospital, Dan was admitted, monitored overnight and prepped for surgery to receive a pacemaker the next day. Tracking Your Heart Health Following the purchase of their Apple Watch devices, Dan and Carol were unaware of these heart health features. Like many others, they were looking forward to the next best tech gadget that would help them stay connected with their friends and family. Now, the couple says they will use their experience to spread the word about the importance of ensuring these settings are enabled. According to Apple, you can turn on these notifications from the Heart Rate app on your Apple Watch (Series 1 or later) to alert you to high or low heart rates and irregular heart rhythms. If you receive a notification, an irregular rhythm suggestive of atrial fibrillation (A-Fib) or a low or high heart rate has been identified and confirmed with multiple readings. In Dan’s case, the signal from his watch was the result of a heart block, a condition where the electrical signal that controls your heartbeat is partially or completely blocked. Dizziness and low heart rate are common symptoms of a heart block. But this was not the first time the couple had experienced this type of alert from their watch. More than a year and half ago, Carol’s watch notified her of an irregular heart rhythm that was suggestive of A-Fib. She immediately made an appointment with Dr. Danish Atwal, the lead cardiologist at Renown’s Helaine Greenberg Women's Heart Center. Thanks to medication prescribed by Dr. Atwal, Carol now lives a healthy, active life while managing her A-Fib, continuing to wear her Apple Watch, which can also help track her A-Fib History. “I’ll share our story with anyone who will listen and encourage them to get a smart watch. I consider myself an unofficial spokesperson,” said Carol with a chuckle. A Thankful Heart The Senior Care Plus members could not be more amazed at the way Dan was treated by the staff at Renown. “I wish I could personally thank them all. I will highly recommend Renown to all I come in contact with,” said Dan with his Apple Watch still proudly strapped to his wrist. “I was closely monitored and treated like royalty.” Quick action to medical emergencies like Dan’s is just one of the many reasons why collaboration is part of our four key values at Renown. The open line of communication between our primary care facilities and hospitals helped Dan get the prompt care he needed, right when he needed it. A month post-op, Dan is doing well and back to enjoying the things he loves during his retirement, including playing the harmonica in the Grumpy Old Man Band, exploring the northern Nevada backroads in his jeep and working on his swing at the golf course. Dan can rest assured that while enjoying the winds of life, if his heart begins to beat too slowly again, the pacemaker will send a signal to correct the beat. “The prompt attention to my heart block undoubtedly saved my life,” said Dan in what he calls his 6-star review of Renown Health. “Thank you from the bottom of my heart, which is happily beating at 60 beats per minute.” This article is not sponsored by or affiliated with Apple, Inc. For more information on the Apple Watch and it's features, visit apple.com.

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Although coined the most wonderful time of the year, the holiday season can unfortunately bring with it injuries and illness. Woke up on Christmas morning with the gift of a sore throat and fever? Sliced your finger carving the delicious turkey you spent all day preparing? While no one ever wants to cut their festivities short, the reality is we should all be prepared with how and where we will receive care should we need it. Are Renown Urgent Care Facilities Open During the Holidays? Renown Urgent Care sees patients 365 days a year, with limited hours on holidays, for medical concerns that are urgent but not life-threatening. Urgent care providers can treat everything from cuts and burns to fevers and allergic reactions and appointments can be booked ahead of time online. If no appointments are available, you may also walk into any of our various urgent care facilities. Conditions and injuries treated at urgent care include: Cuts Fractures Burns Sprains Fevers Allergic reactions Animal bites Rashes Sore throats Does Renown Offer In-Home Care Options on Holidays? If you’d like to see a healthcare provider without leaving the house and exposing others to illness, consider a Virtual Urgent Care Visit. This convenient video conference service allows you to see an urgent care provider from the comfort of your home using a cellphone, computer or tablet with video capabilities. Providers are available for video chat from 9 a.m. to 6 p.m. Monday through Friday, and 10 a.m. to 4 p.m. Saturday and Sunday. Scheduling a Virtual Visit is easy directly through MyChart. Login to MyChart and click on the "Talk to a doctor" video icon within the portal to get started. Before scheduling, be sure your illness or injury is included on the following list to ensure a healthcare provider can assist you virtually: Common cold and cough symptoms Muscular, tendon or joint pains not caused by injury Allergy or sinus symptoms Pink eye (no trauma or something in the eye) Urinary discomfort Diarrhea without vomiting Rashes or skin sores Backache Nail problems Screening examination for sexually transmitted illness (without symptoms) Medication refills (not controlled substances) When Should I Go to the Emergency Room? Urgent care and Virtual Visits are great options when experiencing minor illness or injury and it’s too urgent to see your primary care provider. Renown Emergency Rooms are designed to treat patients who need immediate attention for emergencies, such as: Burns Allergic reactions Broken bones Stitches Skin infections Heart attack Stroke Rashes Venomous stings and bites Asthma attacks Choking or poisoning Fainting, dizziness or confusion Head injuries Seizures Severe bleeding Difficulty breathing Severe headache Eye injuries Severe pain Renown Emergency Rooms are open 24 hours a day, 7 days a week, 365 days a year. For life-threatening emergencies, always call 9-1-1 immediately. We know there is nothing jolly about getting sick or injured during the holidays, but we hope you can find some comfort knowing that Renown Health is here with the care you need, when you need it most.

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“In sickness and in health” are words we often hear when celebrating the momentous occasion of marriage with our friends, families and loved ones. For James Breckenridge, these words were the foundation of the love and commitment he and his wife Carolyn showed to each other during their 30 years of marriage. In health, James and Carolyn shared a love of traveling. Hopping in their van, driving across the continental United States and enjoying the views along the way will be a memory James cherishes forever. Unfortunately, their excursions would be cut short when Carolyn fell ill, rerouting to their local hospital, Renown Health. Carolyn has spent more time at the hospital than the average person – including recovering from COVID-19 at Renown South Meadows Medical Center. However, hospital admittance for Carolyn meant the same for James, providing support to his wife during her stay. Following more than 40 years of exceptional experiences with Renown and their most recent discharge from the hospital, James wrote a letter recognizing the efforts of the team members and healthcare providers who not only cared for Carolyn but also James. To Whom It May Concern James began his letter by applauding two Renown Regional nurses they got to know well during their recent visit. Tiffany and Ashley went the extra mile to care for Carolyn attentively. From simple tasks like gathering requested supplies to answering James’ questions in detail, they helped provide a comfortable environment for the couple. To these nurses, these tasks may have felt like another day at work. Still, James’ letter commends them for their acts of service, reminding us that every interaction we have with a patient can be a memorable one. Tiffany and Ashley weren’t the only team members who received recognition in James’ testimonial. He also took a moment to recognize the various nurses, certified nursing assistants, therapists and doctors they encountered during their care journey. All provided the excellent and helpful experience we aim for at Renown. Healing Memories James first brought Carolyn to Renown Regional Medical Center, formerly known as Washoe Medical Center, in 1980, but it was 1996 when things changed for him. Carolyn was admitted to the hospital for a procedure they originally anticipated would come with a difficult prognosis. To their surprise, doctors found the opposite. It was in that joyous moment that James’ perspective of hospitals shifted, now viewing them for what they truly are – a place people go to get better. “Every time I walk around Renown Hospital, I remember all the times Carolyn was healed there,” James wrote in the latter half of his letter. Healing Isn't Just for the Patient James took advantage of the many support resources accessible to family members during their time at Renown. These donor-funded hospital initiatives are a valuable mental health resource in difficult circumstances. Whether it was an afternoon stroll with his wife through Fianna’s Healing Garden or quiet time alone in the Spiritual Center, James never hesitated to turn to these resources in his time of need. “Although I know the Tahoe Tower is the modern, state-of-the-art part of Renown, I prefer the Sierra Tower because that is where most of my memories are.” Even a simple daily walk to the on-campus Starbucks was a notable part of his day – grabbing a cup of coffee for himself and often a treat for Carolyn. An Inspiration in Healthcare When asked to describe Renown in one word, James chose “inspirational.” His collective experiences with Renown, James said, “helped him to be a better healthcare advocate” when his wife received care at other hospitals. As a healthcare leader, we challenge ourselves to go above and beyond for the health of our entire community. Collaborating with our patients and their families is at the center of everything we do at Renown. Positive reviews mean the absolute world to us, and something about this handwritten letter feels even more special. We could not be more appreciative to James for sharing how our vision to inspire better health in our community was reflected in his 40 years of experience with Renown. We were saddened to hear of Carolyn’s passing during a recent meeting to thank James for his letter. We take solace hearing James’ beautiful memories of his wife and knowing that Renown Health was there in times of sickness and health. We offer our sincere condolences to James, Carolyn’s children and their family members.

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Renown Health patient, Alden Nash, hiking Death Valley National Park just three months after a Transcatheter Aortic Valve Replacement. Alden Nash isn’t your average 80-year-old. For much of his life, he could be found outdoors enjoying nature and hiking some of the west coast’s highest elevations. A husband and father of two, Alden turned his passion into a career as a Yellowstone park ranger in 1965. Alden believes his passion for the outdoors is responsible for his many years of health – until the unavoidable happened. The Hardest Climb The number one doctor recommendation for a healthy heart – lead a healthy, active lifestyle. Any cardiologist would be thrilled to have Alden as a patient due to his robust physical activity regimen. “Don’t have a TV set or a lounge chair in your house and you’re all set,” said Alden when asked how he has remained so fit throughout his senior years. Unfortunately, many other factors come into play when it comes to heart health, one of which is the reason we are telling Alden’s story today. Familial history - it’s a hot topic in the world of medicine. Understanding your genetic risk factors can help care providers develop updated care plans based on your results. Alden’s family has a long history of high cholesterol, which he avoided for much of his life by staying active. This combined with his age resulted in his first heart attack in December 2021. Doctors later determined that Alden was suffering from a type of heart valve disease known as aortic valve stenosis. Aortic stenosis is the narrowing of your aortic valve opening that impedes normal blood flow. Over time, the leaflets of your aortic valve become stiff, reducing their ability to fully open and close. When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve of your body. Eventually, your heart gets weaker, increasing the risk of heart failure. People who are most at risk for aortic stenosis include those who have had certain heart conditions present at birth, have chronic kidney disease or have heart disease risk factors such as high cholesterol and high blood pressure. However, generally, aortic stenosis is a degenerative process of aging with no modifiable risk factors. The incidence of aortic stenosis increases rapidly with age and is very common above the age of 80 – with 1/10 having the condition and 1/50 with a problem severe enough to warrant surgery. When symptoms are present, the disease can be rapidly disabling or even deadly, often progressing over several months unless treated.

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