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Saturday, December 29, 2012

Outcomes of Long-Term Testosterone Replacement in Older Hypogonadal Males: A Retrospective Analysis

Comparison of self-assessment of libido at the 2 year point showed a dramatic improvement in the testosterone group compared to that in the controls (Fig. 1). The incidence of new illnesses during the course of the study was not significantly different in the two groups for coronary artery disease, peripheral vascular disease, myocardial infarctions, angina, diabetes mellitus, or transient ischemic attacks (Table 3). Benign prostatic hypertrophy (BPH) has long been a concern associated with long term testosterone administration. This study found that the control group had a higher rate of BPH than the study group, but the difference was not statistically significant.

The 2 yr changes in serum and hematocrit values of the two groups are compared in Table 2. There were no significant differences in the prostate-specific antigen concentration. The urea nitrogen to creatinine ratio dropped in the study group, but the change was not statistically significant. Only hematocrit showed a significant increase in the testosterone-treated group compared to that in controls. Eleven subjects (24%) in the testosterone group developed polycythemia (hemoglobin, >17 g/dL; hematocrit, >52%), warranting temporary withdrawal of testosterone therapy or phlebotomy. Of these, the first occurrence of polycythemia was within the first year of therapy in six (33%) subjects, between 1–2 yr in 3 (6.7%) subjects, and beyond 2 yr in two (4.4%) subjects.

Thursday, December 20, 2012

Testosterone May Benefit Seniors with Chronic Heart Failure

The exercise plus testosterone group experienced improvements from baseline in peak oxygen uptake (P<.01), Beck Depression Inventory (P<.05), leg strength (P<.05) and several Medical Outcomes Study Short-Form quality of life domains (P<.05). These improvements were generally not observed in the exercise plus placebo group, according to the abstract. Similar improvements in shuttle walk test (18% vs. 19%), body mass (–1.3 kg vs. –1 kg) and hand grip strength (2.1 kg vs. 2.5 kg) from baseline to 12 weeks were recorded in both groups.

Testosterone May Benefit Seniors with Chronic Heart Failure

Saturday, December 15, 2012

Should Testosterone Be Tested Under Fasted Conditions?

CONCLUSION: "Until the mechanism behind this effect has been explored, we suggest that assessment of S-T for diagnostic purposes should be collected in the morning after an overnight fasting."

Andrologia. 2012 Dec;44(6):405-10. doi: 10.1111/j.1439-0272.2012.01296.x. Epub 2012 Apr 23.

S-testosterone decrease after a mixed meal in healthy men independent of SHBG and gonadotrophin levels.
Lehtihet M, Arver S, Bartuseviciene I, Pousette A.

SourceKarolinska Institute, Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden.


Reproducible and accurate assessment of serum testosterone (S-T), S-LH and S-SHBG is of crucial importance for assessment of testicular endocrine function and diagnosis of hypogonadism and investigating male health in a broader sense. Testosterone secretion has a circadian rhythm with the highest component in the morning and is influenced by a series of factors including physical activity, mental stress and nutrition. For diagnostic purposes, analysis of morning samples is recommended and reference values are generally based on samples drawn between 7 and 10 am. In the literature, there are also indications that food intake can influence serum levels but fasting has not been a standard procedure. 

To carefully address the influence of food intake, we analysed S-testosterone, S-LH and S-SHBG after an overnight fasting compared to samples taken after a standard meal of 550 kcal. 

We found no change in S-LH or S-SHBG but a decline of S-T of 30% from 60 to 120 min after food intake compared to samples taken in the fasting state. This decline may give false low S-T values and overestimate the number of men with suspected hypogonadism. Until the mechanism behind this effect has been explored, we suggest that assessment of S-T for diagnostic purposes should be collected in the morning after an overnight fasting.

Wednesday, December 12, 2012

Nelson's Tips and Suggested Supplements

Here are some tips and suggestions :


Zinc/Copper: One, twice a day with food (this supports healthy testosterone and low chances for acne):

Carnitine, 1000 mg with breakfast and 1000 mg with lunch:

Vitamin D (4000 IU per day): 

Coenzyme Q-10 (200 mg per day):

Whey Protein (1 or 2 servings a day, no need for a blender- This is the most tolerable and light of all)

Creatine (5 grams per day, two hours before exercise- NOT for people with kidney dysfunction)

Pill box:

For studies and references on each supplement, visit:

Sunday, December 9, 2012

Find the best drug prices from verified online pharmacies was founded by a medical doctor in 2003 to help consumers safely save money on medication by identifying the lowest drug prices from reputable online pharmacies. It independently checks the credentials of online pharmacies and lets you easily compare drug prices. Its online pharmacy verification program and drug price comparisons have been referenced by AARP, Smart Money, U.S. News and World Report, and many others.

Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical Considerations

Morgentaler A. Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical Considerations. The Journal of Urology 2013;189(1, Supplement):S26-S33.


urpose Pertinent literature regarding the potential use of testosterone therapy in men with prostate cancer is reviewed and synthesized.

Materials and Methods A literature search was performed of English language publications on testosterone administration in men with a known history of prostate cancer and investigation of the effects of androgen concentrations on prostate parameters, especially prostate specific antigen.

Results The prohibition against the use of testosterone therapy in men with a history of prostate cancer is based on a model that assumes the androgen sensitivity of prostate cancer extends throughout the range of testosterone concentrations. Although it is clear that prostate cancer is exquisitely sensitive to changes in serum testosterone at low concentrations, there is considerable evidence that prostate cancer growth becomes androgen indifferent at higher concentrations. The most likely mechanism for this loss of androgen sensitivity at higher testosterone concentrations is the finite capacity of the androgen receptor to bind androgen. This saturation model explains why serum testosterone appears unrelated to prostate cancer risk in the general population and why testosterone administration in men with metastatic prostate cancer causes rapid progression in castrated but not hormonally intact men. Worrisome features of prostate cancer such as high Gleason score, extracapsular disease and biochemical recurrence after surgery have been reported in association with low but not high testosterone. In 6 uncontrolled studies results of testosterone therapy have been reported after radical prostatectomy, external beam radiation therapy or brachytherapy. In a total of 111 men 2 (1.8%) biochemical recurrences were observed. Anecdotal evidence suggests that testosterone therapy does not necessarily cause increased prostate specific antigen even in men with untreated prostate cancer.

Conclusions Although no controlled studies have been performed to date to document the safety of testosterone therapy in men with prostate cancer, the limited available evidence suggests that such treatment may not pose an undue risk of prostate cancer recurrence or progression.

Saturday, December 1, 2012

Free Androgel and Other Testosterone Products for Men

Here is a table showing all patient assistance programs for different testosterone products in the United States


Friday, November 16, 2012

Nelson Vergel on CNN Talking About Testosterone

For CNN Story, Click Here

Testosterone replacement therapies come in many forms, according to Nelson Vergel, author of "Testosterone: A Man's Guide." The hormone can be injected into muscle, absorbed through the skin via a cream/gel, or released slowly through a small pellet that's inserted into the body. A doctor does regular blood tests to determine the correct dosage.
No magic pill
You've likely read that there's no magic pill for perfect health. While direct-to-consumer marketing may make it seem otherwise, testosterone is no exception, Vergel says.
"I'm just amazed how many men start a hormone without doing research," he says. "It's a wonderful thing to start if you need it. It also has some side effects if not done properly."
The hormone will help you lose weight and build muscle, but not without proper exercise and nutrition. It will also improve your sex drive; what it won't do, Vergel says, is make you into a teenage Casanova.

Wednesday, November 14, 2012

How to More Accurately Calculate Free and Bioavailable Testosterone

Often, physicians managing testosterone replacement will look at the Free Testosterone (FT) or Bioavailable Testosterone (BT). The assay methods used by labs are not usually accurate. Instead, the widely accepted use is to use a calculation based on the SHBG and Albumin. Free & Bioavailable Testosterone calculator -

Tuesday, November 6, 2012

How to Maximize Your Health - Practical Tips For Men and Women

By Nelson Vergel

From the book: Testosterone: A Man's Guide (available on amazon)

These are practical tips that anyone can start adding to their lives.  Most have been proven to work by different scientific studies.

  • Exercise with weights/machines three to four times a week for no more than one hour; this helps build muscle. On alternate days do cardiovascular exercise (elliptical trainer, fast walking, light jogging, etc.) for at least 30 minutes a day; this helps with stamina and overall health. Make sure that you sweat! Discuss your exercise program with your doctor before you start.
  • At the start of any exercise program and every three months measure your chest, thighs, arms, and abdomen. Weigh yourself weekly.
  • It is not a bad idea if you are over 40 to ask your doctor for a full body DEXA (dual X Ray Absorptiometry) scan so that you can know how many grams of muscle, fat and bone you have in every part of your body, and then repeat every three years to monitor changes. 
  • Sometimes it is difficult to find a radiology clinic that does full body DEXAs since they are usually accustomed to doing only DEXA's of the hips or spine area for post menopausal women with bone loss.
  • Take at least a multivitamin a day with meals. I like the Energy Pack from Super Nutrition.
  • Motivate yourself with a buddy or support system. I don't mean just for exercise either; surround yourself with some wise and up-beat people.
  • If you have to use stimulants, such as coffee and green tea, use them only in moderation.
  • Get good quality sleep. Talk with your doctor if you're not getting it.
  • Manage stress with relaxation techniques and hobbies. Learn to let go of anger and unrealistic expectations.
  • Get at least 20 minutes a day of sunshine (avoid the face, though). Your body needs it to make vitamin D for bone health. Get your vitamin D blood levels checked and supplement at with at least 2000 IU per day if found to have low blood levels (ask your doctor about this test).
  • Sweat. Use a pedometer to try to walk at least 10,000 steps a day. Increase your cardio by parking far away, taking the stairs, walking the dog, or dancing. Make it fun!
  • Choose your supplements wisely. Beware of companies claiming that their "growth hormone precursors" work; they don't. Most weight loss supplements have stimulants that can affect mood and increase blood pressure and cardiovascular risks.
  • Treat depression quickly with exercise, therapy, antidepressants, and a good support system
  • Get a Pneumovax vaccine every five years. Pneumovax is a vaccine against bacterial pneumonia.
  • If you've never had hepatitis A or B, ask your doctor about getting vaccinated against them.

How to Protect Your Heart

  • Do not smoke!
  • Manage stress and keep your blood pressure in check.
  • Decrease high triglycerides with Omega 3 fatty acids (cold water fish oils) and by cutting down on sugars. The American Heart Association (AHA) recommends at least two 3 oz servings of fish per week. Some experts recommend eating four 3-ounce servings of fatty fish per week for people with heart disease or cardiac risk factors. The following have higher levels of omega-3 fatty acids:
    • Anchovies
    • Bluefish
    • Carp
    • Catfish
    • Halibut
    • Herring
    • Lake trout
    • Mackerel
    • Pompano
    • Salmon
    • Tuna

  • Improve fat utilization with 2 to 4 grams a day of L-Carnitine (prescription Carnitor).
  • Increase your HDL (the good cholesterol) if it's low with Niacin 5500-1500 per day. Start with lower dose to minimize "flushing" and take an aspirin 20 min before (Niaspan is the prescription grade)
  • Maximize soluble fiber (see below).
  • If everything else fails to lower your cholesterol and triglycerides, use prescription lipid lowering agents (statins, fibrates, etc).
  • If you take lipid lowering drugs, don't forget to take 300 mg a day of Coenzyme Q10 since it has been shown to be low in those taking those medications. This supplement can protect the heart and muscle tissue from damage.
  • Take an 81mg baby aspirin a day (with your doctor's approval).

Nutritional Tips:

  • Shop mostly in the outer part of the grocery store where the fresh produce, meats, and milk products/eggs are.
  • Do not skip breakfast (keep an eye on sugar and refined flour products!)
  • Try to eat several smaller meals or snacks instead of two to three large ones.
  • Eat more almonds, walnuts, pecans and pistachios (good cholesterol lowering fats).
  • Eat fruits and vegetables of all colors.
  • Avoid sodas, sweet drinks and fruits juices (fruit sounds healthy but the juice part brings in too many sugars).
  • Drink lots of water.
  • Eat a high protein, complex carbohydrate- rich meal after work outs.
  • Minimize caffeine (it reduces appetite but can increase anxiety).
  • Get a slow cooker so that you come back from work to a warm meal.
  • Cook for the week and freeze in individual serving sized containers.
  • Reduce saturated (animal) fats, fried foods and hydrogenated oils.
  • Use good fats: olive oil, nuts, avocados, flaxseed.
  • Minimize sugars like fructose (sweets, sodas, and many processed foods are high in fructose corn syrup).
  • Eat adequate amounts (0.7-1 gm/lb/day) of protein (fish, eggs, cottage cheese, lean meats, chicken, whey, yogurt, nuts, etc).
  • Eat more high-fiber, nutrient and fluid-rich, low calorie, low glycemic carbs like: Oatmeal, multi-grain breads, vegetables, fruits, roots, greens, wild rice and beans.
  • Grocery shopping list:
    • Almonds and other nuts
    • Beans and other legumes
    • Spinach and other green leafy vegetables
    • Low fat dairy, yogurt (Greek style)
    • Hummus
    • Whey protein (I like the Isopure brand since it does not give me gut problems and it is very light)
    • Oatmeal (not the little packets; those are loaded with sugars)
    • Eggs (free range or Omega 3 enriched if possible)
    • Lean meats
    • Whole grain breads and pasta
    • Peanut, almond, cashew butters
    • Olive oil and avocados
    • Raspberries and all berries. Whole fruits (remember, not juices)
    • Occasional glass of red wine per day (optional)
    • Flaxseed, pumpkin and sunflower seeds
    • Sweet potatoes and wild rice
    • Green tea
More on healthy eating:click here

General Exercise Suggestions:

There is controversy in the literature about the effects of exercise on testosterone blood levels. Conflicting results may be explained by differences in the intensity and duration of the activity and the physical characteristics of the individual (e.g. age and fitness level).
Relatively short duration intense activity may lead to transient increases in testosterone concentrations. Athletes who train intensively may experience reductions in testosterone levels but not below normal clinical range. This is not necessarily a consistent phenomenon.
The important thing to remember is that when done correctly, exercise can have the following proven benefits that go beyond just looking good:

  • Improved muscle function and strength.
  • Reduced trunk (belly) fat
  • Increased muscle mass
  • Decreased LDL (bad cholesterol).
  • Decreased triglycerides. Muscle hypertrophy (enlargement) induced by resistance training, may decrease triglycerides in those with high levels.
  • Improved mood and decreased stress.
  • Increase bone density in men and women.
  • Improved aerobic function and lung capacity.

Getting Started

There are some things to consider before you start an exercise program.. Get your blood pressure, heart rate, weight, body dimensions, fasting cholesterol, triglycerides, and blood sugar measured. Your doctor should be able to advise you if you are capable of exercising without health risks.
If you feel too tired and weak, start by walking every day to your best ability. Walking can increase your energy levels so you can start a more intensive exercise program as you feel better. Use a cheap pedometer to measure your daily steps; try to reach 10,000 steps a day since that amount has been associated with good cardiovascular health and fat loss.
There are two types of exercise: resistance (weight) training and cardiovascular (aerobic) exercise. Resistance training uses weights to induce muscle growth. Cardiovascular exercise improves your body's aerobic capacity (the way it uses oxygen). It also increases your metabolism so that you can burn fat, lower your bad cholesterol and triglycerides, and lower your blood sugar.
Do low-impact aerobic exercise for 20-40 minutes, three to four times a week. Exercises like walking fast, bike riding (stationary or the two-wheeler), stair stepping, and using an elliptical trainer or treadmill are all effective. Switching between different exercises can help keep your interest going. Be careful about aerobic exercise if you are losing weight involuntarily, if you are overly tired or recovering from illness.


Train with weights and machines three times a week for no more than one hour. Starting with machines is the safest way until you get familiar with the exercises. As you feel more confident and strong, bring in free weight exercise (hopefully with the help of a workout buddy). As you get stronger, increase your weights in every exercise. Exercise one body part per week, and do three exercises per body part. One light warm-up set and two heavier sets of eight to ten repetitions to momentary muscle failure (until you cannot do another rep) are enough for each exercise. If you do not have access to a gym, do push-ups on the floor and squats holding books or large bottles full of water at home. As long as you are "resisting" your own body weight, you are doing resistance exercise. You can also get an exercise ball and follow this great home-based workout.

Important Things to Remember

  • Learn how to do each exercise correctly. Concentrate on using strict form to get the most out of each exercise and to prevent injuries.
  • Make sure your muscles are warm before targeting them with more challenging weights. Warm them up with a light, high-repetition exercise set.
  • Don't use your body to add momentum; cheating this way takes work away from the targeted muscles. Use a deliberate speed to increase the effectiveness of the movement.
  • Use a full range of motion on all exercises. Feel the muscle stretch at the bottom and go for a momentary peak contraction at the top. Don't go too fast!
  • Warm up before you work out and stretch afterwards to prevent injury. Briefly stretch the major muscle groups before your training. This helps flexibility and muscle recovery.
  • Feel the muscles working by keeping your head in what you're doing. Focus on your muscles contracting and relaxing. Concentrate on your body exercising, not on random thoughts or people around you.
  • If the weight is too light (more than 12 repetitions), try using a heavier one or do the movement more slowly and really feel the contraction. You should be barely able to finish the tenth rep if your weight is the right one. Of course, as you get stronger with time, increase your weights.
  • Keep rest periods to no more than about 20-30 seconds, or shorter, depending on how tired you are from your last set. This will also help to give your heart a mini-workout.

Safety First

Always remember -- safety first! If something you do in an exercise hurts, stop! Ask for help to figure out what you're doing wrong. Maybe it's improper form. If you hurt yourself, you will hinder your progress because you won't want to work out. Learn proper form! Do not exercise if you feel you are coming down with a cold.

Commit Yourself

If you can afford it, join a gym. If you spend the money, you'll be more likely to stay with it, and consistency is the key to success in any exercise program. Also, try to find someone who is enthusiastic to train with, or get a personal trainer (if you can afford one). It's easier to stay motivated when you train with someone else who has a vital interest in your mutual success. It's also safer to have someone to spot you when you lift heavy weight.

Avoid Overtraining

Working out for more than an hour can cause overtraining which can destroy your muscles and decrease your strength. Overtraining is probably the factor most ignored by exercise enthusiasts.Prolonged exercise (overtraining) may lead to suppression of testosterone levels, possibly lasting up to several days.

In order to build muscle the body has to receive a stimulus, a reason, to grow bigger (hypertrophy). It's really very simple: the body only does what it needs to do, what it is required to do. It isn't going to suddenly expand its muscle mass because it anticipates needing more muscles. But if it is challenged to move weights around, it will respond by growing.

Another way to look at it is, if you take any bodybuilder and put him in bed for weeks at a time, he'll begin to rapidly lose muscle mass because the body will sense that it doesn't need the extra muscle any more. By lifting weights one delivers the needed stimulus to begin muscular hypertrophy.

However, overdoing exercise stresses out the body and actually initiates the process of breaking down muscle mass as the body begins to burn its own muscles to use for fuel. This overtraining is why so many people don't grow at a satisfying rate. Even worse, these same people often will think they aren't training hard enough. They increase their exercise routines, thinking they just need more stimuli! And this is where the biggest error is made -- more is not necessarily better! It seems paradoxical that you could work out less and grow more, but this is very often the case.

Any exercise beyond that which is the exact amount of stimulus necessary to induce optimal muscle growth is called overtraining. I know this sounds non-specific but the idea is that it will vary from person to person. You need to listen to your body.

A Workout Log Is Recommended

The best reason to keep track of your workouts is so that you can see graphically what you are accomplishing. You will be able to see whether you're gaining strength at a reasonable rate. You can also analyze your pattern to see if you're overtraining. You will find when you log your workouts, that if you are overtraining, you won't be gaining in strength or muscle size. Document your workouts by keeping track of the weight you lift and the amount of reps you lift for each exercise. Then when you go in to train again the next week, you'll know what you are trying to improve upon. If you find out that you're weaker than you were the time before, and everything else like nutrition, etc. is in line, you may be training too often.

Food and Hydration

Drink at least eight glasses of water a day to keep hydrated. Dehydration can rob you of energy for your workouts. Drink plenty of water while working out. Avoid sugary drinks, since they will cause fatigue after an initial burst of energy. Some people like to drink green tea or creatine supplements in water before a workout to help increase energy levels through a workout.

A light carbohydrate meal (fruits, carbohydrate drinks, etc.) before a workout and a protein-rich one afterwards is advisable. Keep yourself well hydrated with plenty of water throughout the workout. And get plenty of rest afterwards.

Do not work out right after eating a regular meal; wait at least two hours. If you need a snack, have some fruit and a slice of toast with peanut butter one hour or more before working out. Do not consume protein shakes before working out (leave them for after the workout). Digestion will slow down your workouts and bring your energy down. Within 30-60 minutes after the workout, feed your muscles with a balanced meal containing protein, good fats (olive oil, flaxseed oil), and complex carbohydrates, like fruits and whole grains.

Supplements like glutamine, creatine, and whey protein may be a good thing to consider. A shake containing one heaping tablespoon of glutamine, two tablespoons of Omega 3 oils, one or two scoops of whey protein, some fruit, and milk (if you are lactose intolerant try almond or rice milk, though not soy, since it may increase estrogen in both men and women), provides a good balanced meal after a workout.

Home Based Economical Exercise Helpers

I love the following three cheap devices:

1- An exercise (medicine) ball and elastic bands. You can get one at $14 at Target or any retail store. Make sure it comes with its own pump

2-I love the chin-up (pull-up) bars that you can install on door frames.

3- Get yourself a cheap pedometer in any store to make sure you wear it from the moment you wake up until you go to bed. Ensure that you reach close to 10,000 steps a day for best aerobic capacity. I like the Omron-HJ-150-Hip-pedometer available at

Exercise Resources

Several exercise routines are provided on our website,

Video:Click here

Monday, November 5, 2012

L-Carnitine Increases Sperm Motility and Quality

L-carnitine is concentrated in the epididymis, where sperm mature and acquire their motility (86). Two uncontrolled trials of L-carnitine supplementation in more than 100 men diagnosed with decreased sperm motility found that oral L-carnitine supplementation (3 grams/day) for three to four months significantly improved sperm motility (87, 88). However, no information on subsequent fertility was reported. A cross-sectional study of 101 fertile and infertile men found that L-carnitine concentrations in semen were positively correlated with the number of sperm, the percentage of motile sperm, and the percentage of normal appearing sperm in the sample (89), suggesting that L-carnitine levels in semen may be useful in evaluating male infertility. More recently, a placebo-controlled,double-blindcross-over trial in 86 patients with male infertility found that L-carnitine (2 grams/day) supplementation for two months led to significantly improvements in sperm quality, evidenced by increases in sperm concentration and motility (90). Similar improvements in sperm motility were observed in a subsequent placebo-controlled, double-blind, randomized study conducted by the same group, but the patients received combination therapy consisting of L-carnitine (2 grams/day) and acetyl-L-carnitine (1 gram/day) for six months (91). Interestingly, in both studies, the most dramatic carnitine-induced improvements were noted in patients with the lowest baseline sperm motility measures (i.e., most severe cases) (90, 91). Another group of researchers also reported improved sperm motility following combined carnitine therapy. In this placebo-controlled, double-blind, randomized study, 44 patients with idiopathic asthenozoospermia (reduced sperm motility) received placebo, L-carnitine (3 grams/day), acetyl-L-carnitine (3 grams/day), or a combination of L-carnitine (2 grams/day) and acetyl-L-carnitine (1 gram/day). The combination therapy as well as acetyl-L-carnitine, alone, resulted in significant increases in sperm motility (92). Together, these data suggest that carnitine therapy may be useful in disorders of sperm motility and male infertility; however, large-scale clinical trials are undoubtedly necessary.


The Best Scientific References on Testosterone Replacement Therapy


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