Author Archives: Carol Savage


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    Yes, it does exist!

    Also known as the “festival of the steel phallus” is held in Japan every year. It is a festival to celebrate fertility, long marriages and healthy births and dates back to the 17th century.

    In the 21st century, it is now based on sex positive messages and a celebration of the penis!

    Remember guys you only get one penis so take good care of it, taking care of your penis means taking care of yourself!

    Good health is really important when it comes to keeping the penis in tip top condition, a healthy diet, regular exercise and alcohol in moderation are of the upmost importance.

    The most common sexual problems for men are;

      -Premature ejaculation

      -Erection difficulties

      – Testosterone deficiency

    All of which are easily treated either by medication, psychosexual therapy or a combination of the 2.

    Premature ejaculation can occur at any age but is most common in younger men, most cases are caused simply by an inability to control the ejaculatory response.

    Studies vary widely but the common view is that it affects 1 in 5 men.

    Erectile dysfunction is very common; half of men between the ages 40 and 70 years will have ED to some degree and the numbers increase with age.

    Testosterone deficiency tends to be found in older men and is particularly common in men with diabetes. Testosterone deficiency can significantly reduce the quality of life for men. The most common symptoms are ED, reduced libido, fatigue and low mood, often mistaken for depression. It can also increase the risk of cardiovascular disease and result in early death.

    However, the good news is that sexual problems are preventable by keeping fit and healthy.


    Exercising regularly, this doesn’t have to mean being at the gym for hours every day but 2 20 minute brisk walks that gets your heart rate up will definitely help keep the penis up too!


    Maintaining a healthy weight is very important as being overweight is also a common cause of testosterone reduction; abdominal fat converts a man’s healthy testosterone to the female hormone estrogen. Clogging up the arteries will definitely cause erection problems, the arteries in the penis are smaller than the coronary arteries so are therefore affected sooner and erectile dysfunction is often an indicator of a cardiovascular risk.


    Keep stress to a minimum, when we feel stressed, we release adrenaline and cortisol, adrenaline narrows the blood vessels which negatively affects the erection. That’s why men with performance anxiety will get erection problems as they release adrenaline with the nervous anxiety.

    Practicing relaxation techniques, meditation and mindfulness will help to keep stress at bay.

    Try to get a good work/life balance and aim for a healthy sleep pattern. If you feel exhausted so will your penis!


    Smoking is a definite NO NO!

    It is believed that men who smoke are twice as likely to develop erection problems than men who do not smoke. We all know that tobacco causes cancer but it also causes erection problems too, it narrows the blood vessels and impairs the blood flow. The good news is, it is never too late to quit! In men under the age of 40 smoking is the biggest cause of ED.


    Whilst alcohol can help you relax and ease anxiety which can help with erections, too much can be a disaster! Too much alcohol decreases the blood flow to the penis and because alcohol is a depressant it can reduce desire to be sexual. Chronic heavy use of alcohol can cause long term erection problems, studies show that men who are alcohol dependent have a 60 to 70 percent chance of suffering with sexual problems.


     (Kegel exercises) women are always encouraged to do their pelvic floor exercises, particularly after childbirth but it is now widely recognised the importance of pelvic floor exercises for men in maintaining good sexual function. The pelvic floor muscles play a vital role in facilitating good erections and ejaculation, this also helps improve the feelings on orgasm as the ejaculation is more powerful when the pelvic floor muscle is strong. (See the NHS website for further instructions)


    Healthy relationships also play a vital role in maintaining good sexual function, if we aren’t getting on in the living room, we are probably not getting on in the bedroom either!

    There are 24 hours in a day and 7 days in a week, yet we often find it difficult to just get an hour together a couple of times a week of true quality time!

    Arrange “date nights” if you didn’t live together you would make plans for when you would see each other next and what you might do with that time, don’t change that just because you live together.

    Carry on dating! Couples that play together, stay together!


  2. Dr. Savage reports back from the webinar held by the European Society of Sexual Medicine 19th & 20th February 21 – Testosterone Treatment and Prostate Cancer

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    A study in Germany in 2016 showed that 83% of doctors felt that testosterone treatment may cause an increased rate of prostate cancer despite the fact that there is no evidence to suggest this.

    There is no association between the level of testosterone in the blood stream and the incidence of prostate cancer, if anything the suggestion is that in patients at time of diagnosis of prostate cancer that those with the lowest level of testosterone are likely to be more aggressive cancers.

    Testosterone therapy does noPost Radical Prostatectomy. Highlights from European Society of Sexual Medicine.t change the incidence of prostate cancer, most experts in the world now agree that testosterone treatment can be started after treatment for prostate cancer with people varying in how cautious their approach is. EAU guidelines in 2019 state that the patient should be at least after initial treatment and that the patient should have a Gleason <8 score, however, interestingly a recent study showed that in patients who had been treated for prostate cancer and followed up after 6 years and who were suffering from testosterone deficiency the untreated group of patients had a much higher biochemical recurrence of their prostate cancer than in those who had been on testosterone treatment.

  3. Dr. Savage “attended” the webinar held by the European Society of Sexual Medicine – Conference 19th & 20th February 2021 and reports back on the following highlights – Diabetes and Testosterone Deficiency

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    Professor A. Morgantaler from Boston, one of the world’s leading Andrologists presented 3 impressive studies about the effects of testosterone treatment in pre-diabetes and type 2 diabetes.

    First study an 8-year observational study by Lead Clinician Yasin, on pre-diabetics with starting testosterone levels < 12nnmol/l in the un-treated group 40% became full blown diabetics over the 8 year period, whereas those treated with long acting testosterone injection Nebido 1000 mg, none became diabetic.http://diabetesERECTILE DYSFUNCTION

    The second study was an 11-year observational study, lead by Lead Clinician Haider, this as of 356 men who had type 2 diabetes and starting testosterones <12 nnmol/l, in the group of patients who were treated with long acting Nebido 1000 mg there was a remission of diabetes in 34% of patients who had complete remission and were able to come off all diabetic medication.

    The third study, Australian RCT study led by Professor Gary Wittert was a 2-year, large study of over 1000 patients, 88 in the treatment group having established type 2 diabetes and 355 pre-diabetes, there was a 40% reduction in the number of patients progressing to diabetes in comparison with those patients treated by intensive life style advice through the Weight Watchers programme.Testosterone deficiency in Type 2 diabetes

    Screening for hypogonadism, there are now many leading endocrine and diabetes organisations which are suggesting screening all type 2 diabetics, those men with erectile dysfunction, obese men with waist size greater than 102cms.http://obesityCase Study

    Remember, it has been found that 42% of diabetics have testosterone levels <12nnmol/l with symptoms of testosterone deficiency.

    Hypogonadism is the commonest cause of osteoporosis and low trauma fracture in men, so all of these patients should be screened.

    Metabolic syndrome doubles the risk of stroke and cardiovascular disease. It is the disease of the 21st century and will lead to an estimated prevalence of type 2 diabetes of 20% by 2030.

    Many authors have stated that the type 2 diabetes epidemic will bankrupt the NHS.

  4. Premature Ejaculation & Testosterone Deficiency.Highlights from the European Society of Sexual Medicine Meeting

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    Premature Ejaculation & Testosterone Deficiency

    Highlights from the European Society of Sexual Medicine Meeting

    Dr. Savage attended the European Society of Sexual Medicine Meeting in Prague 23 – 26th January 2020.

    Premature ejaculation

     One of the topics discussed was the management of premature ejaculation and in particular discussing some newer medications. One of the medications discussed was Fortacin. This is a topical local anaesthetic spray which is used on the tip of the penis prior to sexual intercourse. It is effective and popular with patients. Of the patients who had been prescribed it 60% of them were still using it at 6 month review whereas Priligy tablets (Depoxitine) patients were very disappointed and 90% of them were not using it at 12 month review. Other popular treatments are the use of daily SSRI anti- depressants such as Paroxetine 20mg which are very effective. Dr. Savage finds that treatment very popular with his patients.

    Testosterone deficiency

    Evidence again was shown of the dangers of leaving male Testosterone deficiency patients untreated. In the UK BLAST study of type 2 diabetics with Testosterone deficiency after 5 years in the untreated group of patients, 20% had died versus 3.6% in the patients treated with Testosterone. The best reduction in mortality was seen in the 70 – 80 year old age group.

    Chronic use of opiate pain relievers, such Oxycontin, high strength Co-Codamol can produce a significant reduction in Testosterone in men and having a low level of Testosterone increases risk of death. A study showed that these male patients who have to continue on their pain relievers show a 40% reduction in mortality if treated with Testosterone.

    For some time there has been a suggestion that environmental pollutants, especially chemicals leaking from plastics may be a cause of reduced Testosterone. Dr. Savage learned at the conference that there is some evidence that Testosterone deficiency is commoner in men in the urban population in support of that view.

  5. Post Radical Prostatectomy. Highlights from European Society of Sexual Medicine.

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    Highlights from the European Society of Sexual Medicine attended by Dr. Savage 23 – 26 January 2020

    Post Radical Prostatectomy patients

    Most of these patients suffer with severe erectile dysfunction and even 2 years after surgery only about 50% have regained a degree of potency.

    So, what can be do?

    Most of these patients are prescribed tablets such as Viagra (Sildenafil) or, Cialis (Tadalafil) but unfortunately, most do not respond to these treatments, this is because of nerve damage from the surgery, despite “nerve sparing” surgery. At the conference, we discussed the evidence from animal research that suggested that taking regular tablets i.e. daily dosing with Tadalafil 5mg should help but in actual fact clinical experience in patients is often very disappointing, so that patients are understandably looking for alternative treatments. These will be either self-injection treatment or vacuum pumps or using both.

    Vacuum pumps can be used on a daily basis for penile rehabilitation i.e. they help reduce penile shortening and help keep the penile tissues healthier whilst some degree of recovery occurs with time. Self-injection treatment is very effective in these patients to produce an adequate erection for intercourse and it seems very sad that many of these patients are either not offered that form of treatment or, think it sounds so painful that the patients declines the offer.

    Dr. Savage finds at the Leger Clinic that the self-injection drug Invicorp is highly effective and virtually painless and patients and their partners are generally thrilled with the excellent results.

    Can Testosterone be prescribed post Radical Prostatectomy?

    Traditionally, a diagnosis of Prostate Cancer even after treatment, has been a strict contraindication for Testosterone Therapy but there is now a significant amount of research showing that in many such patients this can be used safely and indeed bizarrely in patients with a high risk of recurrence, that this recurrence rate may well be lower in those treated with Testosterone.  

  6. Protecting fertility in patients on Testosterone

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    Dr. Savage recently attended the Androgen Society Conference in New Orleans. The conference was attended by many of the leading Andrologists in the world. One of the hot topics was protecting fertility in patients on Testosterone.

    Preferably a sperm count should be done prior to Testosterone treatment in the patient where fertility is important . The general consensus was that HCG injectins 500 iu (international units) 3 times a week will preserve most patients fertility when given with their testosterone treatment. However, if fertility is the top priority i.e. the patient and their partner are trying to get pregnant then testosterone should be stopped and HCG at a high dose of 3000 iu 3 times a week plus Clomifene is the recommended regime.


    To make an appointment with Dr. Douglas Savage if this is a topic which affects, then make an appointment to discuss this further with Dr. Savage in person




  7. Highlights of the European Society of Sexual Medicine Meeting in Slovenia February 2019

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    Interesting developments for Female Sexual Dysfunction

    3 products are in advanced stage of development.

    1.  Bremelanotide – this has finished its clinical trials and application is about to be heard at the American Licensing Authority. The results of the trials look promising to treat low libido. As I see it, the main disadvantage is, it has to be given by injection before a likely sexual encounter. Would women want to give themselves an injection to improve their sex drive for just that one sexual encounter? We will keep you posted about it and welcome your comments and thoughts by email
    2. Lybrido – this is a mixture of testosterone and Sildenafil (Viagra) which dissolves in the mouth. 2 studies have been completed with promising results.
    3. Lybridos – which is made up of Testosterone and Buspirone.

    These preparations are not yet available and we could be looking at over a year before they arrive in Europe but of course Testosterone and Sildenafil are available from the Leger Clinic now. To make an appointment and discuss this with a specialist Doctor, visit the website to make an appointment

    Some exciting news for Type 2 diabetes, taking a combination of a statin, a PDE5inhibitor for example, Sildenafil and Testosterone improves the patients survival 4-fold and in 70 – 80 year olds, 5 times better survival.  Some worrying statistics came from a study carried out by Professor Hugh Jones in Barnsley, which showed that in a population of Type 2 diabetic followed up over 7 years:

    20% had died in the patients with untreated testosterone deficiency

    9% had died with normal testosterone levels

    and most significantly only 9% had died who had their testosterone deficiency treated. 

    The sad fact is that most Type 2 diabetics are not having their testosterone levels measured, let alone treated in the UK!

    Why is the UK not following guidelines from leading American societies of Endocrinologists i.e. The American Association of Clinical Endocrinologists and the American College of Endocrinology in their clinical practice guidelines executive summary state

    1. All men with increased waist circumference or who are obese, should be assessed for testosterone deficiency
    2. All male patients with type 2 diabetes should be evaluated to assess if they have testosterone deficiency

    If you are type 2 diabetic and have any concerns about these issues,  please have a look at Testosterone deficiency in Type 2 diabetes

  8. Leger Clinic brings you discounted blood tests from Medichecks

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    The Leger Clinic Ltd has negotiated with Medichecks, the country’s leading private blood testing laboratory for a 10% discount for all Leger Clinic patients requiring a blood test for checking their testosterone levels along with other relevant tests such as Thyroid function.

    To access this discount all you need to do is follow this link: and enter the code LEGER10 when prompted.

    To find out more go to Testosterone Deficiency


  9. The Truth… are we all being poisoned by agents that reduce Testosterone?

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    The term Endocrine Disrupters (EDC) was first coined in 1991 at the Wingspread Conference Centre in Racine, Wisconsin. At this meeting researchers from several different disciplines came to the consensus that “a large number of man-made chemicals” have been released into the environment with the potential to “disrupt” the Endocrine system of humans.

    Recently, there has been a surge of research investigating the role of EDC’s in human health and the Endocrine Society stated in 2015 that this expansion of data “removes any doubt that EDC’s are contributing to increased chronic disease burdens”

    Studies have demonstrated that EDC’s can act at multiple sites in the hormone pathway including binding to the hormone receptor and acting on proteins that regulate hormone synthesis, metabolism and delivery.

    Plastics and Plasticisers

    BPA (Bisphenol A) is one of the highest volume chemicals produced world wide and present in many plastics used for food and drink storage.  One study Li et al demonstrated association between urinary levels of BPA and sexual function in 427 male workers. They found that increasing urine BPA level was associated with decreased sexual desire, more difficulty having an erection, lower ejaculation strength and lower level of overall satisfaction with sex life.

    Phthalate is predominantly used as a plasticiser (a substance added to plastics to modify its properties i.e increase flexibility). It is in many items in common use. There have been many studies looking at the hazards of this chemical with conflicting results.

    PCB’s (Polychlorinated biphenyls) In the last decade there have been several human studies evaluating the impact of PCB exposure to semen quality, again with conflicting results.

    Conclusion: Currently there is a wealth of animal studies linking sexual dysfunction and reproductive abnormalities to endocrine disrupters, however, more research is needed in humans especially with a focus on the impact of different timed exposures.

    (This information was discussed in the December issue of ESSM newsletter.)

    Dr Savage feels that having worked in this field for the last 30 years at The Leger Clinic Ltd., he has been alarmed at the number of apparently “healthy” young men who present with classic symptoms of Testosterone Deficiency and lowish levels of Testosterone. No-one seems to have a good explanation of why these people have this problem.

    Dr. Savage frequently raises his concerns with some of the worlds top andrologists who he meets at international meetings he attends.

    To make an appointment to discuss your concerns about your Testosterone levels please make an appointment at The Leger Clinic Ltd

    Dr. Savage will be attending the European Society of Sexual Medicine, 3 day annual meeting in Ljubljana in Slovenia this February and will be reporting back on the latest research, thinking and developments in the field of Sexual Medicine.







  10. Testosterone as effective as antidepressants for men?

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    An article in The Times  last year stated, “Testosterone is as effective as the use of antidepressants for men with depression, according to an overview of research. Doctors should consider Testosterone as an alternative to medicines that are under increasing scrutiny about overuse and the effects of withdrawal scientist suggested. Psychiatrists said that the results showed that testosterone was likely to have a role in treating depression but that further studies were needed. It was twice as effective as a placebo, a level comparable to antidepressants, a team from Technische Universitadt Dresden said in the JAMA Psychiatry.

    Dr. Savage has seen many patients over the years who have been diagnosed as suffering from depression by their GP and given antidepressants, indeed often several sorts of antidepressants with no benefit to the patient. Some of the patients have raised with their GP following their own research on the internet, “could this be testosterone deficiency?” but this suggestion has mainly been dismissed and indeed, sadly most GP’s have refused to do the appropriate blood tests.

    As you are probably aware, there is great concern about the mental health of young people and indeed, even the worrying suicide rate in young men, one wonders is there  a correlation?

    A patient has even said to me “If you were told that the diagnosis is depression, you have failed to respond to either antidepressants or talking therapies, you would feel desperate, wouldn’t you”.

    At the other end of the age scale, I can always remember seeing a man in his 70’s who had been diagnosed with severe depression by his GP, unresponsive to treatment who had been therefore referred to a Psychiatrist, however, this too made no difference. His wife in particular was severely distressed about her husbands state but told me that what was one of the most distressing things about her husbands symptoms was drenching night sweats to the degree that neither of them could sleep. This was to me a classic symptom of testosterone deficiency and indeed I did the appropriate blood tests to test for low testosterone and we all waited with baited breath to see if in fact this was the diagnosis. IT WAS! He had a fantastic response to testosterone treatment, they told me it had changed both their lives and indeed had given them back their quality of life in retirement.


    To see if this could be your story, book an appointment to see Dr. Savage


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