AOPA Pilot Magazine - March 2014 - 26

FLY WELL

Check your
undercarriage

BY DR. JONATHAN M. SACKIER

Five things you need to know about 'T'
"T" IS FREQUENTLY PAIRED with the word "level" and

DR. JONATHAN SACKIER

is an active general
aviation pilot and
British-trained
surgeon living in
Virginia.

26 | AOPA PILOT March 2014

the phrase "should I take some?" I am talking about testosterone-man juice.
Hormones are chemical messengers driving many
functions; endocrinologists are doctors focusing on this
bodily system. Men and women both have circulating
sex hormones; women predominantly are conditioned
by estrogen and progesterone, and men by testosterone-although both have some of each. It is the balance
that dictates its effects.
The Greek word orchis describes both a rare and
precious flower, the orchid, and also the precious male
organ, the testicles, where testosterone is manufactured.
During puberty and adolescence more is produced, and
it helps drive such changes as increased stature, musculature, facial hair, deeper voice, and so on.
A failure to produce testosterone may be caused by
genetic or testicular developmental problems, trauma,
or more complex issues; this usually is recognized by
parents or pediatricians and replacement therapy is initiated. For adults the story is more subtle.
T naturally decreases with age, about 1 percent per
year after 30 years. Testosterone levels are measured
with a simple blood test and, when low, result in body
hair loss, fragile bones, anemia, diminished libido, erectile dysfunction, increased body fat, lethargy, depression,
decreased memory and concentration, and disturbed
sleep. Because these changes occur over time, men-
or their partners-may not register the metamorphosis.
And then along comes the Internet and TV advertising,
and everyone and their uncle is talking about T.
Excessive alcohol consumption can lower T levels,
but abstinence may provoke a turnaround. Loss of one
or both testicles can lower testosterone levels. Obesity,
various chronic illnesses such as kidney disease, corticosteroid drugs, and those used to treat prostate cancer
also can be culprits.
If symptomatic, see your doctor; request a blood
test; and, if levels are low, consider seeing an endocrinologist to obtain therapeutic advice. Self-medication
by purchasing online is not ideal as all benefits and risks
cannot be covered, and the sale of counterfeit drugs
from overseas vendors is a concern.
In the absence of heart, liver, or kidney disease,
which may be worsened by fluid retention; prostate or

breast cancer, which are contraindications to treatment;
or sleep apnea, which can be exacerbated, replacement
therapy can be delivered as an injection every one to
three weeks, a small sustained-release pellet implant
under the skin, a patch, tablets, or gels. The latter are
popular and applied daily to stomach or shoulders,
rubbing in thoroughly, and then washing the hands
carefully to ensure family members or pets do not get an
unwanted hormone boost. Improvements will declare
themselves rapidly but side effects include local irritation from alcoholic gels, breast enlargement, aggressive
mood changes, acne, testicular shrinking, blood pressure changes, impaired urine stream, or waking to use
the toilet. Additionally, bone marrow may manufacture
too many red blood cells, and for these reasons, medical
supervision is sensible.
Hypogonadism might require special issuance,
otherwise report testosterone treatment, which is
acceptable to FAA, to your AME, entering status and
drug in section 17 noting any side effects. If you have any
doubts or concerns, join AOPA Pilot Protection Services
to help you avoid another kind of T-Oklahoma Cityinduced terror!
Although rare-accounting for around 1 percent of
male malignancies-cancer of one or both testicles is
quite nasty and most common in young men. However,
early detection allows successful treatment to achieve
a cure. No known activities or lifestyles, such as bike
riding, have been implicated, although family history, a
previously undescended testicle, or impaired development might play a role.
The most potent way to tackle this problem is learn
how to self-examine once a month. After a warm bath
or shower, stand in front of a mirror and ascertain if
the skin looks different while looking for any change in
size, a lump, fluid in the scrotum, or a dull ache in the
area or lower abdomen. It is normal for one side to be
larger and lower than the other; get used to what "your
normal" feels like. Pain is rarely an issue and most cancers are found by the patient. Once dealt with, a special
issuance is required.
If you see folks wearing a royal blue ribbon next
month, this is for April's testicular cancer awareness
month. Self-exam, and know yourself to a T! Don't be
an April fool and check your undercarriage.
AOPA

AOPA Pilot Magazine - March 2014

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