hi guys welcome back to the channel I'm here again today with dr. Kishan we have
got something very exciting to let you all know about as you know we have been
looking at doing hormones for our patients for some time and we finally
decided to go ahead and do it dr. kish is gonna be available for this
going forwards which I'm very excited about yeah I think we've approached sort
of aesthetics for a long time where we've been addressing the outer the
outer appearance and making people look good you see that has an internal effect
as well you feel good as well however this is taking things one step further
and addressing internal health and internal well-being which i think is
really key even to aesthetics so that's certainly one of the outer signs of
hormonally balanced health that we see so for our first video we are gonna be
talking all about men so why don't you run us through what what is it that you
do is so what testing you doing and what in between so ideally we want to have a
consultation with our patients first I have a face-to-face or we can do it over
Skype consultation we have a at-home testing service as well which includes a
blood sample test and a urine sample test as well so that's actually gives us
a much more comprehensive picture of where you would be at the start of any
hormonal treatment you guys at home and probably all familiar with this term andropause
why don't you
well it's called andropause manopause and you can call it essentially it's a
functional testosterone deficit your testosterone levels tend to fall over as
we get older older realistically it's so gradual that people don't notice
symptoms as you might do as a menopausal female but if you're a a man
in the in his 40s or 50s or 60s going through this particular time you may
start to feel symptoms of of this dysfunctional testosterone deficit and
these include things like lack of energy lack of libido poor skin health
osteoporosis can also occur as well so osteoporosis is basically weakening of
the mineral content of the bones and that leaves us with more brittle bones
as well I've heard people describe it as grumpy old men exactly I mean so this I
think so mood is greatly affected by hormonal imbalance now that can occur at
any age and that really depends what we're putting into our bodies in terms
of our diet stress as we face and also where we're living like what sort of
toxic elements were exposed to as well these all have an impact on hormonal
balance testosterone is the key hormone for men there are others including
thyroid and growth hormone and cortisol as well
however the testosterone seems to take a lot of boxers when it comes to starting
that journey in hormonal balance and I suppose that's what I look at first as
well as sort of a comprehensive look at your hormones in general it's been known
for a long time that a few conditions are related to low testosterone so
cardiovascular ill-health cardiovascular disease as well as prostate disease are
all linked to low testosterone levels actually I think supplementing to a
healthy balanced level confers some protection against cardiovascular and
disease okay so assuming that we're going to be doing some supplementation
you've done all the testing beforehand I get a lot of patients asking me whether
we do injections okay so so inject we're doing injections in the face all the
time and I think you know that it's it's a convenient option for lots of patients
and certainly in America it's probably and here to a certain extent it's it's a
very popular treatment however the research shows that with injections one
gets a serum spike in testosterone levels so that means for the first two
weeks of the normal testosterone replacement like the testosterone and
tonight you will feel improved you'll feel much more hormonally balanced but
then though in the following weeks that feeling declines and you end up feeling
more and more like you were previous to the testosterone replacement injection
so for that reason I tend to use transdermal cream now the advantage of
transdermal cream and it's much more physiological it gives a much more
steady state of testosterone and that for me is a much more reliable option
for my patients what would you say to patients who are worried about maybe the
testosterone converts into DHT so the whole reason we ask our patients to do a
comprehensive hormonal assessment blood and on a urine analysis is that it
actually gives us the complete picture of what happens to testosterone how
active your find alpha reductase enzyme is because that's also got a key role in
producing dihydrotestosterone now this is a component this is a hormonal
component that's actually active in the skin and the hair so this will give you
thinning of the hair and also it can predispose you to acne and more oily
skin as well so it's about guessing that balance correct and just because you
have excess 5 alpha reductase activity it doesn't mean that testosterone
replacement isn't an option for you it just means that we have to tailor make
the treatment for you oh and what about the use of finasteride so exactly if
they're making this like almost precision medicine for you or tailor
made to you is we would use things like saw palmetto finasteride even do tester
I'd and either in a compounded topical format or maybe a very very low dose and
the minimal dose that you need to prevent an excessive conversion of
testosterone to dihydrotestosterone can you maybe speak
you mean the post finasteride syndromes so whatever what I've heard is that
there are increased cases of people reporting long term complications of
being on oral finasteride so these include persistent erectile dysfunction
mood disorder amongst other things and that and the thing is we don't seem to
see that here nevertheless I think we've got a safer a topical version that
perhaps doesn't have as much systemic absorption I think I would prefer to use
that some way and that's what I tend to do what about maybe somebody having an
injection to increase their testosterone and then converting over to the cream
I've heard some people talking about this so that's a strategy but that's not
something I do again it's it's almost about rushing to get to that point I
mean that's fine for some practitioners and fine for some patients but the way I
have preferred to practice is a much more reliable steady state of
achievement hormonal balance. I just find that there's a lot more control in
using a transdermal cream the other advantage is that I can dial it up or
dial it down there's necessary so literally if you start to develop some
symptoms that you don't want it's very very easy to dial that
which downwards with an injection or a pellet therapy which is really popular
in the state and their belief some practitioners used it here as well
there's a degree of how do I say this in flexibility in how you change the dosage
for your patient and where are they applying this cream ah so you can apply
it to the inner arms- the wrist you can apply it to the
hairless skin of the neck you can also apply a little bit to the forehead it's
also it's also got anti-wrinkle activity as well a lot of gentlemen put it on the
abdomen or the sides of the abdomen and on the inner part of the of the groin
what if somebody is younger ah so the the major sort of major consideration I
suppose of testosterone replacement is that it prevents development of sperm so
testosterone replacement isn't isn't an option for a male who wishes to have
children so there are other options and there are medications that we would
discuss with you if that would be something you'd want to do however
testosterone replacement I prefer to treat patients who are in their 40s or
50s who are beyond their years of fertility or beyond their years where
they want to have children so can you maybe explain to the guys at home a
little bit about what we're doing which is different well I think what we're
going to try to provide is a much more tailor-made approach so the future
really is precision medicine yes it doesn't mean initially a lot more
testing and testing further down the line particularly as things change but
that ultimately gives you your unique prescription your unique treatment plan
for achieving proper hormonal balance okay guys so that's it for this week
please join us again next week where we will be talking about hair loss we're
gonna be talking about men and women oh yeah okay I'll see you then