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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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Beth Macmillan is a work of art in her own right. This Sterling Silver Club featured member is also a one-time professional dancer who now takes center stage as the passionate leader of Artown, northern Nevada’s colorful and wonderfully diverse, month-long celebration of the arts –happening throughout Reno in July! So how might we paint a portrait of someone as unique as Beth? We thought an art-full Q&A was a good place to start. Question: Can you tell us how you came to Reno and to your post as executive director of Artown? “I was born in Johannesburg, South Africa and eventually moved to Reno, Nevada to dance in a show called ‘Hello Hollywood Hello!’ at the MGM Grand Resort (now known as the Grand Sierra Resort). I joined Artown in 2001, became executive director a year later and have thoroughly enjoyed my journey there – and here in Reno – every single day since.” Question: What do you love about the arts? “I love how the arts build creative minds in all of us. The arts spark our imagination and encourage innovation. We are all artists. We dress with creative intention, decorate our homes imaginatively and cook meals for ourselves and others to impress and satisfy through culinary artistry.” Beth’s Favorite Color: Green “I love the way green clothing looks on me and makes my eyes sparkle. Green is a calming color and my home is painted a soft and calming green on the interior.” Question: What is your personal vision and hope for the arts community in Reno/Sparks and northern Nevada? “My vision for the arts in our community is that we continue to build a cultural center in northern Nevada. We are a destination for the arts and should continue to build strength in that draw. Reno has become a place where artists are finding a home and are able to work and create artistry in every genre. My hope is that everything that is happening with the arts here is just the beginning.” Question: Do you think a person’s health can benefit from exposure to the arts? “I believe wholeheartedly that the arts are tied to health. Renown has a healing arts program which helps patients heal through creating art. I also know that Artown brings people together and out of isolation, which is one of the biggest culprits for depression. Artown encourages folks to come out and enjoy the outdoors, gatherings with friends and enjoyment of the arts – all of which build a healthy lifestyle. During COVID-19, Artown also helped heal of our community through our Heart own program, which encouraged creativity and inspiration. In short, I feel the arts are essential to our wellbeing, on many levels.” Question: What do you do to stay vibrant and healthy? “I always have a project going. I love to restore furniture, sew, paint, garden, knit and cook interesting meals for friends. I try to eat a healthy diet with tons of veggies and fruit. I also enjoy hiking, paddle boarding, gardening and yoga, all of which keep my working-out enjoyable and satisfying.” Beth’s Artown Highlight “When we brought Mikhail Baryshnikov to Reno… it made me proud of our community. It was one of the best performances I have ever seen and I didn’t have to go to a major market to see him perform.” Question: What do you appreciate most about your life at 55+ and what advice would you offer to other club members to help them live their best lives? “I lost my husband to cancer when he was young. His passing reminds me to cherish every moment of every day and take time to look around and be grateful for life. I am eternally grateful for my two sons. One is an engineer for a local construction company, the other is completing his studies in type theory in Gothenburg, Sweden. And I am in the arts – what a contrast!” Question: What excites you about partnering with the Sterling Silver Club for Artown? “I am excited for what Artown offers Sterling Silver Club members and our entire community. I want everyone to know that the best time in Reno to enjoy one another and the arts is in July, because we have Artown!” Question: Finally, how would you define the art of life? “The art of life is to create a world you want to read in a book, see in a painting, watch in a ballet, experience in a play and hear in music.” The Sterling Silver Club thanks Beth for being such an inspiring ambassador and for her tireless dedication to celebrating and supporting the arts in our community through Artown! Sterling Silver Club The Sterling Silver Club’s exclusive benefits are designed with you in mind. From social events and lectures to entertainment, special discounts, and health insights and tips. Sign Up for the Club!

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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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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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