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Tuesday, July 31, 2012

New Video by Nelson Vergel: Practical Tips for Optimum Testosterone Replacement Therapy

I am glad to announce that my short video has been posted on youtube.  I summarize in it all I know about testosterone replacement therapy including how to maximize benefits and minimize side effects.

Thursday, July 26, 2012

Popular Diabetes Drug Decreases Testosterone in Men with Diabetes

Effect of pioglitazone on testosterone in eugonadal men with type 2 diabetes mellitus: A randomized double blind placebo-controlled study



Pioglitazone is an insulin sensitizer used for the management of type 2 diabetes mellitus (T2DM). It has been shown to reduce testosterone level in patients with polycystic ovarian syndrome. However, its effect on testosterone in men has not been studied.

Research design and methods

A randomized, double blind, placebo-controlled trial with six months follow-up. Fifty (25 in each group) eugonadal men (well virilized and total testosterone ≥ 12 nmol/L) with T2DM, aged 30-55 yr, and HbA1c of ≤ 7.5%, were randomly assigned to receive pioglitazone 30 mg per day or placebo along with existing glimepiride and metformin therapy.


As compared to placebo, six months of pioglitazone therapy in patients with T2DM resulted in significant reduction in mean total testosterone level (16.1 to 14.9 vs 17.1 to 17.0 nmol/L; p = 0.031), calculated free testosterone (p = 0.001) and bioavailable testosterone (p = 0.000) despite significant increase in sex hormone binding globulin (p = 0.000). Plasma androstenedione (∆4) level increased (1.5 to 1.9 ng/ml; p = 0.051) following pioglitazone therapy. The decrease in testosterone was independent of change in body weight, body fat, and HbA1c.


Pioglitazone therapy significantly decreases total, free and bioavailable testosterone in eugonadal men with T2DM. The effects of these alterations need to be determined by further long term studies.

Friday, July 20, 2012

Testosterone Blood Tests Should Be Done in a Fasted State

Thanks to Dr Scally for this reference ( )

Serum Testosterone Decrease After A Mixed Meal Independent Of SHBG And Gonadotrophins

The secretion and concentration of plasma sex steroids can be affected by both genetic and environmental factors. Testosterone levels have a circadian rhythm with the highest circulating levels during the morning. Sampling for S-T determination is recommended to take place in morning hours between 07 and 11.00 h after a normal night’s sleep to have a truly representative assessment and avoid false low concentrations.

Most clinical protocols have no food intake restrictions prior to blood sampling for S-T assessment. However, earlier reported human studies have indicated an effect of food intake on serum testosterone levels, suggesting that food intake may influence the diurnal rhythm. On the other hand, previous studies have also shown that mixed carbohydrate and protein meal has no effect on total or free testosterone concentrations while acute fat intake decreases S-testosterone level and chronic high fat intake increases S-testosterone level. It has been hypothesized that acute fat intake increases the level of chylomicrons, which can reduce LH-stimulated testosterone production in vitro. However, these findings were not confirmed in vivo in a study that changed dietary fat intake from 37% to 64%.

Hence, several factors may be expected to affect the circadian rhythm of testosterone level and the impact of diet on serum testosterone level needs further investigation. Clinical evaluation of male gonadal activity often requires investigation of the hypothalamus-pituitary-testis axis. Accurate biochemical determinations are crucial to identify and exclude confounding factors that influence testosterone level. Therefore, researchers undertook a strictly controlled crossover study to investigate the effect of fed state compared to fasting state on S-T, S-LH and S-SHBG serum levels during the morning in healthy men.

In summary, their study verifies that food intake decreases testosterone level in serum in healthy men, with a 30% reduction in testosterone compared to the fasting condition. They recommend that the serum testosterone should be measured in starving condition in the morning to reduce the risk of inaccurate low testosterone levels in the investigation of men where there is clinical suspicion of hypogonadism.

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




Though controversial, seasonal variations in testosterone (T) have been observed in several populations of men throughout the world. This finding might impact screening and treatment of hypogonadism.


We examined the circannual patterns of sex hormones in the southwest United States.


A prospectively assembled database of almost 11,000 patients in a men's health practice was used to collect data on T, estradiol (E), sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), and dehydroepiandrosterone (DHEA). Patient age, address, and date of visit were recorded. Of note, T:E ratio and free T were calculated values.


The data were grouped by month and by season (3 month intervals beginning with June, July, and August as summer). ANOVA was used to compare hormone levels between seasonal and monthly data sets with P < 0.05 regarded as statistical significance.


Statistically significant differences in E (P = 0.02), T:E ratio (P < 0.01), FSH (P = 0.02), and SHBG (P < 0.01) were observed between seasons. Peak-to-trough variations were as follows: 6% for E, 16.5% for T:E ratio, 11.0% for FSH, and 11.6% for SHBG. The T:E ratio peaked in the spring and was at its nadir in the fall. No differences in T (P = 0.21), LH (P = 0.25), free T (P = 0.08), and DHEA (P = 0.11) were observed.


Statistically significant evidence of variation in estradiol and T:E ratio were identified in the men included in this study. While this is consistent with seasonal body habitus changes, physical activity levels, and hypothesized hormonal patterns, the variability reported in the literature makes further trials covering a broader geographic region important to confirm the findings.

Pain Killers Lower Testosterone: Opioid-Induced Androgen Deficiency (OPIAD)

Accompanying the upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD).

Smith HS, Elliott JA. Opioid-Induced Androgen Deficiency (OPIAD). Pain Physician 2012;15(3 Suppl):ES145-56.;15;ES145-ES156.pdf

Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males.

Toxic Hepatitis In A Group Of Twenty Male BodyBuilders Taking Dietary Supplements

Hariri AT, Mood MB, Aryan E, Sadeghi M, Zanjani BR. Toxic hepatitis in a group of twenty male body-builders taking dietary supplements. Food Chem Toxicol.

Dietary supplements have been used for decades for enhancing muscle growth. The harm caused by some of these products is well documented. We investigated and reported toxic hepatitis in 20 male athletes following self-prescribing of a number of dietary supplements which are lesser known. The patients' ages ranged from 24 to 32 with a mean of 28 years.

They had taken three kinds of supplements for one year including testosterone optimizer agent T Bomb II, a creatine supplement Phosphagen and an amino acid based supplement Cell-Tech. Based on the history, clinical examination, and laboratory findings the cases were diagnosed as toxic hepatitis. After discontinuation of taking the supplements, clinical recovery and improvement of liver function tests were achieved within 30 days.

Causality assessment with the CIOMS (Council for International Organization Medical Sciences) scale showed a "possible" grade of causality (+5 points) for these supplements. It can be concluded that these newer anabolic supplements may induce toxic hepatitis. Since the health risks of them may be severe, the use of these kinds of dietary supplements should be discouraged.

Monday, July 16, 2012

Free Testosterone Booklet- Boost Your Physical, Mental and Sexual Vitality

Use this link to download a free 14 page chapter of the book "Testosterone: A Man's Guide" with an interview with expert physician Dr Michael Scally who provides details that every man should know

Testosterone Benefits and Potential Side Effects-

 The book can be bought (in paperback and Kindle) at:
Click here

You can also watch a free lecture on testosterone here:
Nelson Vergel Provides Details on Testosterone

Saturday, July 7, 2012

Selective Androgen Receptor Modulators- Future Agents for Aging Related Muscle Loss

Oral selective androgen receptor modulators (SARMs) are investigational agents. Studied since 1998, they are still very much in the infancy of their development and marketing. SARMs may be able to provide the benefits of increased muscle mass and bone density, and fat loss that testosterone and other traditional anabolic/androgenicsteroids provide but without the unwanted side effects (prostatic enlargement). SARMs are not intended to be a form of testosterone replacement therapy. So, why am I talking about them?

More information:
Selective Androgen Receptor Modulators

Tuesday, July 3, 2012

How Long Does It Take for Testosterone to Work?

Objectives: Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are attained.
Design: Studies in PubMed on testosterone replacement so far providing information on time course.
Results: Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer. Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks. First effects on erythropoiesis (increased red blood cells)  after 3 months, peaking at 9-12 months. Prostate specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy. Effects on lipids appear after 4 weeks, maximal after 6-12 months. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3-12 months. Changes in fat mass, lean body mass and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years. Effects on inflammation occur within 3 to 12 weeks. Effects on bone detectable after 6 months but continue at least for 3 years.
Conclusion: the time-course of the spectrum of effects of testosterone shows considerable variation, probably related to pharmacodynamics of the testosterone preparation. Genomic and non-genomic effects, androgen receptor polymorphism and intracellular steroid metabolism further contribute to such diversity.

Monday, July 2, 2012

FDA OKs New Prostate Cancer Blood Test

A blood test for prostate cancer billed by its manufacturer as "an answer to the current PSA [prostate-specific antigen] testing controversy" has won FDA approval, the company said.
Beckman Coulter said Monday that the agency had okayed its premarket approval application for the so-called Prostate Health Index test, which incorporates measurement of a PSA precursor protein called [-2] pro-PSA along with total and free PSA.
The test is indicated for men with regular PSA test results in the range of 4ng/mL to 10 ng/mL, just above the upper limit of normal.
According to the co-discoverer of [-2] pro-PSA, Kevin Slawin, MD, of Memorial Hermann-Texas Medical Center in Houston, the marker is more closely associated with prostate cancer than total and free PSA. Combining the three markers makes the Prostate Health Index more specific than conventional PSA testing.

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