Testosterone Injections Helped Obese Men Lose Weight

Introduction: Abdominal adipose tissue suppresses testosterone production by various mechanisms affecting the hypothalamic–pituitary–gonadal axis. Hypogonadism leads to further accumulation of fat mass thus creating a vicious circle. This study analysed the effects of restoring testosterone in obese hypogonadal men.

Methods: Cumulative, prospective, registry study of 181 men (mean age: 59.11±6.06 years) with testosterone levels below 12.1 nmol/l and a BMI of ≥30 kg/m². All men received parenteral testosterone undecanoate 1000 mg/12 weeks following an initial 6-week interval. 89 men were treated 5 years, 114 4 years, 133 3 years, 159 2 years, 181 1 year. The changing numbers do not reflect drop-out rates but are a result of the design as new patients are added once they have received at least 1 year of treatment.

Results: At the end of the observation period, mean weight (kg) decreased from 114.71±11.59 (minimum 87.0, maximum 139.00) to 93.24±8.49 (min 80.0; max 115.0). This decrease was statistically significant vs baseline .

Waist circumference (cm) as a measure of abdominal fat decreased from 111.2±7.54 (min 89.00; max 129.00) to 100.47±7.11 (min 84.00; max 117.00), BMI from 36.72±3.72 (min 30.10; max 46.51) to 30.22±2.6 (min 25.66; max 36.71).

Fasting glucose decreased from 5.84±0.84 to 5.41±0.12 mmol/l, total cholesterol from 7.63±0.95 to 4.9±0.28, LDL from 4.47±1.03 to 2.94±0.93, triglycerides from 3.31±0.56 to 2.17±0.13 mmol/l. Systolic blood pressure decreased from 159.17±15.9 to 139.08±10.99 mmHg, diastolic blood pressure from 96.5±11.01 to 80.39±7.51 mmHg (P<00001 p="">

Conclusion: Normalising testosterone produced loss of weight/waist circumference and improved metabolic profile. These improvements were progressive over 5 years.

http://www.endocrine-abstracts.org/ea/0032/ea0032p740.htm

Clomid (clomiphene) Increases Testosterone and Sperm Count in Men- But No Mention About Sex Drive

Oral Enclomiphene Citrate Stimulates the Endogenous Production of Testosterone and Sperm Counts in Men with Low Testosterone: Comparison with Testosterone Gel. The Journal of Sexual Medicine.  http://onlinelibrary.wiley.com/doi/10.1111/jsm.12116/abstract 

Introduction - Clomiphene citrate is employed off-label in men who have low testosterone and for the restoration of sperm counts in men who have used exogenous testosterone. Clomiphene is a mixture of two diastereoisomers: zuclomiphene and enclomiphene. We evaluated enclomiphene citrate in men with secondary hypogonadism.

Aim - Our aim was to compare oral enclomiphene citrate as an alternative to topical testosterone.

Main Outcome Measures - Blood levels of total testosterone (TT), estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone binding globulin, thyroid stimulation hormone, prolactin, and insulin-like growth factor 1 IGF-1 were measured at certain times after treatment with each agent. Sperm parameters were determined at the same visits. Free testosterone (FT) was calculated.

Methods - This was a proof-of-principle, randomized, open-label, fixed dose, active-control, two-center phase IIB study in 12 men with secondary hypogonadism treated previously with topical testosterone.

Results - After discontinuation of topical testosterone, morning TT values averaged 165 ± 66 pg/dL. After 3 months, there was a significant rise in men receiving enclomiphene citrate and gel that was sustained for 3 months. At 6 months, TT levels were 545 ± 268 and 525 ± 256 pg/dL for groups receiving the gel and enclomiphene citrate, respectively. Only men in the enclomiphene citrate group demonstrated increased LH and FSH. TT decreased one month posttreatment to pretreatment values. Enclomiphene citrate elevated sperm counts in seven out of seven men at 3 months and six out of six men at 6 months with sperm concentrations in the 75–334 × 106/mL range. The gel was ineffective in raising sperm counts above 20 × 106/mL for all five men at 3 months and raised counts in only two or five men at 6 months. At follow-up, only enclomiphene citrate treatment was associated with elevated sperm counts.

Conclusions - Enclomiphene citrate increased testosterone and sperm counts. Concomitant changes in LH and FSH suggest normalization of endogenous testosterone production and restoration of sperm counts through the hypothalamic–pituitary–testicular axis.

Testosterone: Miracle drug or fake science?

Low testosterone. For men, these words have the same foul odor as “impotence,” “shrinkage” or “Justin Bieber.” The topic is taboo. Throughout civilization testosterone has been prized as the lifeblood of manhood, so a deficit would imply, by definition, that we are somehow less manly.

Yet despite this ancient bias, there’s now a growing push in the medical community to help diagnose low testosterone, clear up the fog of misconceptions and treat the issue with Testosterone Replacement Therapy, or TRT.

Let’s imagine that you, or, better yet, “your friend,” is experiencing the symptoms of low testosterone: fatigue, a sense of blahness, low sex drive, an iffy stiffy. Your friend could visit Dr. Alan Shindel at the UC Davis Medical Center, who would first try and identify other possible causes. “Even men with completely normal levels of testosterone can have erectile dysfunction, low sex drive or poor energy,” says Shindel, a urology specialist. “Sometimes the cause of a man’s symptoms is just life — stress, medical conditions, relationship issues, trouble at work.”

But it could be “Low T.” Testosterone, a hormone, does more than just power your sexual engine. The body uses it to help support muscle growth, strengthen bones, regulate the count of red blood cells, boost psychological well-being and promote a healthy distribution of fat. When the average man hits 30, his testosterone levels begin falling by about 1 percent each year. As the hormones decline, the body becomes less efficient. Sometimes the side effects aren’t imagined, they’re real.

Read more here

Do men really have higher sex drives than women?

SOURCE:

http://io9.com/5977668/do-men-really-have-higher-sex-drives-than-women

• Several studies show that men desire significantly more sex partners than women. (One survey found that, uninhibited by factors like disease or laws, college age females would ideally like to have 2.7 sex partners over the entire rest of their lives. College age males, on the other hand, desired an average of 64 lifetime sex partners.)
• Men masturbate more. A meta-analysis of 26 studies on gender differences in sexual behavior found that "masturbation was the largest difference of all the variables they examined, with men nearly a full standard deviation higher than women."
• Several studies to date indicate that women have an easier time than men going without sexual gratification. For a particularly interesting (if unsettling, given the long and sordid history of sexual abuse in the Catholic church) look at the ability and willingness to forego sex, see this investigation on clerical celibacy among Catholic men and women.

Men also spend way more money on porn, are less likely to report a pathological lack of sexual desire, and tend to rate their genitals — and the genitals of their partners — as more inherently lovable and attractive than women.

The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men

ABSTRACT

Introduction.  Testosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).

Aim.  To quantify the incremental cost burden imposed by TD's cardiometabolic sequelae.

Method.  Incidence, prevalence, and mortality of these conditions were collected for men ages 45–74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.

Main Outcome Measures.  Adjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.

Results.  Actual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45–74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately $8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately $190–$525 billion in inflation-adjusted U.S. health care expenditures.

Conclusion.  TD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care. Moskovic DJ, Araujo AB, Lipshultz LI, and Khera M. The 20-year public health impact and direct cost of testosterone deficiency in U.S. men. J Sex Med

Male hypogonadism: More than just a low testosterone

This is a must read and great paper from the Cleveland Clinic.


Confronted with a low serum testosterone level, physicians should not jump to the diagnosis of hypogonadism, as confirmation and thorough evaluation are warranted before making the diagnosis or starting therapy. This review discusses how to approach the finding of a low testosterone value, stressing the need to confirm the finding, the underlying pathophysiologic processes, drugs that can be responsible, and the importance of determining whether the cause is primary (testicular) or secondary (hypothalamic-pituitary).

Read more here: http://www.ccjm.org/content/79/10/717.full

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

How to Avoid Getting Man Boobs

From the book: Testosterone: A Man's Guide

Avoiding Enlarged Breast (Gynecomastia)

Yes, I am talking about breast appearance in men, not women. Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Men who start experiencing this problem complain of pain and tenderness around the nipple area. Gynecomastia is caused by higher than normal blood levels of estradiol, a metabolite of estrogen. As discussed earlier in the book, testosterone can convert into estradiol, DHT, and other metabolites. Men with higher amounts of the enzyme aromatase usually have this problem even at lower doses of testosterone. Growth of this glandular tissue is influenced by a higher fat percentage, older age, excessive alcohol intake, and the use of certain medications. Gynecomastia usually occurs early in testosterone replacement in those who experience this side effect.

In several studies on testosterone replacement, only a very small percentage of people receiving testosterone experience growth of breast tissue. In one HIV-specific study conducted by Dr. Judith Rabkin in New York, she reported that out of 150 men enrolled in the study, two men experienced this adverse reaction. Gynecomastia is much more common among those who use high testosterone doses, such as bodybuilders (they call this "gyno" or "bitch-tits").

How do you manage gynecomastia if it does occur? Lowering the testosterone dose had not proven helpful for the two patients in Dr. Rabkin’s study. The use of antiestrogens, such as tamoxifen 10 mg twice daily, with lower doses of testosterone has been effective. Gynecomastia can become permanent if the condition lasts very long although it may reduce in size when the androgen use is discontinued. In the absence of resolution, surgical correction may be necessary in severe cases.

For men who experience enlarged breast size, doctors usually check estradiol levels to determine whether too much testosterone is being converted into estrogen. I do not believe that routine measurement of estrogen is needed for men who have no symptoms of high estrogen (mainly breast tissue enlargement and water retention). For those who have higher than normal estrogen, doctors usually prescribe an antiestrogen medication. One such regimen is anastrozole at 1 mg/day during the first week until nipple soreness and breast enlargement disappear. The dose is then lowered to 0.25 mg a day, or 1 mg twice a week.

A warning: Bringing estrogen down to very low levels could cause health problems in men in the long run. Hair/skin quality and health, brain function, bone density, and other important factors may be greatly influenced by estrogen. However a 12-week study in men using anastrozole at 1 mg a day and 1 mg twice a week found no changes in bone metabolism markers.

The normal production ratio of testosterone to estrogen is approximately 100:1. The normal ratio of testosterone to estrogen in the circulation is approximately 300:1. Estrogen (measured as estradiol) should be kept at 30 picograms per milliliter (pg/mL) or lower. As men grow older or as they gain a lot of fat mass, their estrogen blood levels increase, even to levels higher than that of postmenopausal women.

Medications and Products That Can Cause Gynecomastia

A number of medications have been reported in the medical literature to cause gynecomastia due to decreases in testosterone, increases in estradiol, or both. These include:

• Antiandrogens. These include cyproterone, flutamide, and finasteride.used to treat prostate cancer and some other conditions.
• HIV medications. Sustiva, Atripla, and Videx have been associated with gynecomastia.
• Anti-anxiety medications such as diazepam (Valium).
• Tricyclic antidepressants. These include amitriptyline.
• Glucocorticoid steroids.
• Antibiotics.
• Ulcer medication such as cimetidine (Tagamet).
• Cancer treatment (chemotherapy).
• Heart medications such as digitalis and calcium channel blockers.
• Anabolic steroids

Substances that have been reported to cause gynecomastia include:

• Alcohol
• Amphetamines
• Marijuana
• Heroin
• Soy and flaxseed- There are conflicting studies but it is something to keep in mind
• Exposure to pesticides and byproducts of plastic processing has also been linked to increased estrogen and decreased sperm count in men.

Fore more information

For more information on anastrozole pricing by prescription, fill out this form: Click Here

Testosterone: A Man's Guide- Why You Should Read This Book

How to Prevent Heart Attacks if You are Using Testosterone

Testosterone and anabolics can increase red blood cells.  The proportion of red blood cells in the blood is called hematocrit.  High hematocrit (polycythemia) can make blood viscous and increase the work load on the heart, which can cause serious cardiovascular problems and even heart attacks and strokes.  So, it is important to monitor hematocrit and know how to manage it if it is high.

Preventing and Managing Polycythemia

From:Testosterone: A Man's Guide

It's important to check patients' hemoglobin and hematocrit blood levels while on testosterone replacement therapy. As we all know, hemoglobin is the substance that makes blood red and helps transport oxygen in the blood. Hematocrit reflects the proportion of red cells to total blood volume. A hematocrit of over 52 percent or a hemoglobin value over 19 g/dl should be evaluated. Decreasing testosterone dose or stopping it are options that may not be the best for assuring patients' best quality of life, however. Switching from injectable to transdermal testosterone may decrease hematocrit, but in many cases not to the degree needed.

The following table shows the different guideline groups that recommend monitoring for testosterone replacement therapy.  Since hematocrit increases usually happen during the first few months of testosterone replacement, all guideline groups agree on measuring hematocrit at month 3, and then annually, with some also recommending measurements at month 6 after starting testosterone.


Many patients on testosterone replacement who experience polycythemia do not want to stop the therapy due to fears of re-experiencing the depression, fatigue and low sex-drive they had before starting treatment. For those patients, therapeutic phlebotomy may be the answer. Therapeutic phlebotomy is very similar to what happens when donating blood, but this procedure is prescribed by physicians as a way to bring down blood hematocrit and viscosity.

A phlebotomy of one pint of blood will generally lower hematocrit by about 3 percent. I have seen phlebotomy given weekly for several weeks bring hematocrit from 56 percent to a healthy 46 percent. I know physicians who prescribe phlebotomy once every 8-12 weeks because of an unusual response to testosterone replacement therapy. This simple procedure is done in a hospital blood draw or a blood bank facility and can reduce hematocrit, hemoglobin, and blood iron easily and in less than one hour. Unfortunately, therapeutic phlebotomy can be a difficult option to get reimbursed or covered by insurance companies. The reimbursement codes for therapeutic phlebotomy are CPT 39107, icd9 code 289.0.

Unless a local blood bank is willing to help, some physicians may need to write a letter of medical necessity for phlebotomy if requested by insurance companies. If the patient is healthy and without HIV, hepatitis B, C, or other infections, they could donate blood at a blood bank (it is good to remember that there is a ban on gay blood donors in the United States, however).

The approximate amount of blood volume that needs to be withdrawn to restore normal values can be calculated by the following formula, courtesy of Dr. Michael Scally, an expert on testosterone side effect management. The use of the formula includes the assumption that whole blood is withdrawn. The duration over which the blood volume is withdrawn is affected by whether concurrent fluid replacement occurs.

Volume of Withdrawn Blood (cc)=
Weight (kg) × ABV×[Hgbi - Hgbf]/[(Hgbi +Hgbf)/2]


Where:
ABV = Average Blood Volume (default = 70)
Hgbi (Hcti) = Hemoglobin initial
Hgbf (Hctf) = Hemoglobin final (desired);

So, for a 70 kg (154 lbs) man (multiply lbs x 0.45359237 to get kilogram) with an initial high hemoglobin of 20 mg/mL who needs to have it brought down to a normal hemoglobin of 14 mg/mL, the calculation would be:

CC of blood volume to be withdrawn = 75 x 70 x [20 - l4]/[(20 + l4)/2] = 75 x 70 x (6/17) = approximately 1850 cc;

One unit of whole blood is around 350 to 450 cc; approximately 4 units of blood need to be withdrawn to decrease this man's hemoglobin from 20 mg/mL to 14 mg/mL.

The frequency of the phlebotomy depends on individual factors, but most men can do one every two to three months to manage their hemoglobin this way. Sometimes red blood cell production normalizes without any specific reason. It is impossible to predict exactly who is more prone to developing polycythemia, but men who use higher doses, men with higher fat percentage, and older men may have a higher incidence.

Some doctors recommend the use of a baby aspirin (81 mg) a day and 2,000 to 4,000 mg a day of omega-3 fatty acids (fish oil capsules) to help lower blood viscosity and prevent heart attacks. These can be an important part of most people's health regimen but they are not alternatives for therapeutic phlebotomy if the patient has polycythemia and does not want to stop testosterone therapy. It is concerning that many people assume that they are completely free of stroke/heart attack risks by taking aspirin and omega-3 supplements when they have a high hematocrit.

Although some people may have more headaches induced by high blood pressure or get extremely red when they exercise, most do not feel any different when they have polycythemia. This does not make it any less dangerous. It may be a silent killer that is easy to prevent.

Propecia and Proscar Cause Sexual Dysfunction, the FDA says

The FDA made a few changes to Propecia and Proscar which include:

• a revision to the Propecia label to include libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug,
• a revision to the Proscar label to include decreased libido that continued after discontinuation of the drug, and
• a revision to both the Propecia and Proscar labels to include a description of reports of male infertility and/or poor semen quality that normalized or improved after drug discontinuation.

More : Finasteride causes sexual problems in men

How to Find a Good Doctor that Prescribes Testosterone?

Many  primary care doctors in the United States feel comfortable prescribing testosterone in the present.  Unfortunately, there are many doctors who still do not know much about the proper management of testosterone replacement or are afraid to prescribe it.

Here are several resources that can help you if you need to search for one:

Life Extension Foundation, List of Innovative Doctors:http:www.lef.org/Health-Wellness/InnovativeDoctors/

        APS Pharmacy: Email Anthony@APSMeds.com and ask if they have a
        doctor in your area

Women’s International Pharmacy: They refer doctors here http://www.womensinternational.com/request_referral.html

College Pharmacy (Colorado Springs, CO): http://www.collegepharmacy.com/

Click “Find a Health Care Provider.” There is a form to fill out. Submit the form and they will e-mail a list of doctors nearest you who use their compounding services.

       

Medibolics.com, a HIV-related web site:

Doctors in this list also treat people who are not HIV positive (but they also treat HIV-. These docs have been using TRT for longer than most regular docs): http://www.medibolics.com/physic2.htm

Directory of “anti-aging” worldwide doctors:

         http://www.a4m.com/directory.html

You can also google “compounding pharmacy YOUR CITY” to find out which compounding pharmacies are in your area. You can call them to find out if they can refer you to a doctor who uses their services.

     

After you find a potential doctor, ask some basic questions to determine their level of knowledge about testosterone.  Some may feel insulted to be asked questions like these, but if they are it’s probably not going to be a good match for you (of course, be nice and diplomatic when asking questions!)

1. How many men does he/she treat for hypogonadism?
2. Does he/she offer HCG therapy, in addition to testosterone for testicular atrophy? (Many doctors do not know how to use HCG.)
3. Does he/she use Arimidex  (generic: anastrozole) to keep estrogen down in case of gynecomastia (enlarged breasts) or other high estradiol related issues?
4. Do they provide other therapies that can complement testosterone replacement?
5. Does he/she allow patients to self-inject at home?
6. Does he/she work with any compounding pharmacies to access cheaper and customized hormonal products? (Some doctors worry com­pounding pharmacies have poor quality control)
7. How many times do you have to go see him or her?
8. Do they share blood work results with you?
9. What is the set-up lab/doctor fee and approximate drug costs?

 I invite anyone who hates to read but wants to watch a video before they call a potential doctor so that they know what to ask to take some minutes to watch this:

Another option could be getting services from a clinic with national reach. 

 After my frustration to find physicians around the country that not only prescribe testosterone but also know how to prevent and manage potential side effects, I searched for a way to help people who read my book no matter where they live.   I finally was able to find a great and reasonably priced clinic that can do so.  

I consult with a national clinic called Defy Medical which uses the principles described in my book. They can treat you in your city with a local lab and a phone/skype consult.  They are very reasonably priced compared to all men's health clinics out there.  They not only diagnose hypogonadism and prescribe several testosterone products but also believe in the principles outlined in my book that detail side effect prevention and management.  For this reason, they provide other adjunctive therapies like HCG, anastrozole, sublingual ED drugs, injectable and oral aminoacids/vitamins, Sermorelin, TRIMIX, etc  They can also help people who want to lose weight with a comprehensive program.

You can find more information in their last newsletter :

http://defymedical.com/in-the-news/49

If you are interested, please email Matt Castleberry from Defy for him to provide you details on the different programs. His email is matt@defymedical.com

I also provide 1 hour coaching sessions for those who need more detailed assistance before starting TRT or to maximize benefits/minimize potential side effects after they start.  You can set it up here:  http://www.testosteronewisdom.com/     After the set up, I can email you a health questionnaire that will list blood work needed for best coaching results (you can wait until you get them done through Defy Medical)

I also encourage people who read my book to subscribe to my  facebook testosterone group since there are so many things always coming up in this field.  Over 900 people belong to the Facebook group including more than 5 doctors who answer questions:

https://www.facebook.com/groups/testosteronereplacement/?fref=ts

I hope this helps you empower yourself to find the right doctor!

Nelson Vergel
http://www.testosteronewisdom.com/

Evidence review places benefits, drawbacks of testosterone therapy in context for physicians

Testosterone replacement remains controversial due to a shortage of large clinical trials demonstrating the benefits and adverse effects of treatment in boys and men of all ages. However, available evidence and published clinical experience may help physicians determine for whom this therapy is appropriate. “Treatment of testosterone deficiency due to classical diseases affecting the hypothalamus, pituitary and/or testes has been accepted for decades, although there were no multicenter trials,”Glenn R. Cunningham, MD, and Shivani M. Toma, MD, both of the Baylor College of Medicine and St. Luke’s Episcopal Hospital in Houston, wrote in a recent review. Cunningham, who is also an Endocrine Today editorial board member, and Toma analyzed the currently available data more closely to gain better insight into the treatment’s use. “Most clinicians do not have the time or the expertise to critically review the literature on a complicated medical issue,” Cunningham said in an interview. “A review of this type in a reputable journal should highlight the issues and address them in an informative manner.” Challenges of diagnosis, age Physicians may have trouble determining whether testosterone therapy is appropriate because diagnosing androgen deficiency is complicated, according to the authors. Although several symptoms, including incomplete sexual development and loss of body hair, are apparent, others, such as fatigue, are nonspecific. Serum testosterone levels are also not necessarily reliable as thresholds for different tests vary widely. Moreover, these levels naturally decline with age. “The assumption is that older men who fall below this reference range for younger men will also benefit from replacement testosterone treatment. This argument ignores the fact that we have limited data to assess relative benefit at specific serum testosterone windows,” Ronald Swerdloff, MD, and Christina Wang, MD, both of Harbor-UCLA Medical Center, wrote in an accompanying editorial published in The New England Journal of Medicine. Generally, physicians deem testosterone treatment suitable for boys aged 14 years with delayed puberty and men aged 20 to 49 years as benefits outweigh the risks in these populations. In men aged 50 to 60 years, however, true androgen deficiency is difficult to detect due to common comorbidities, such as obesity and type 2 diabetes, that may lower testosterone levels. For men aged older than 60 years, the debate revolves around whether aging organs are as responsive to testosterone therapy, the researchers said. Benefits, risks Cunningham and Toma said several randomized, placebo-controlled trials back well-known advantages of testosterone therapy, including improvements in body composition, bone mineral density, libido and sexual function. Although linked with various side effects, increased risk for prostate cancer and benign prostatic hyperplasia, and cardiovascular issues are most concerning, Cunningham and Toma said. Current clinical trials indicate little risk for prostate cancer, but the researchers noted that exposure time to testosterone was limited in these studies. Similarly, two meta-analyses suggest no increased risk for CV events, but one study of testosterone use in men aged 65 and older yielded data to the contrary. “An ongoing National Institute of Aging-sponsored clinical trial should provide definitive answers regarding potential benefits [of testosterone replacement therapy],” Cunningham said, noting that if the results confirm benefits, then a larger more expensive trial that can better assess the risks, as well as benefits, will be warranted. Currently, however, Cunningham and Toma advise physicians to proceed with caution. “For now, clinicians should discuss the available efficacy and risk data for testosterone replacement and should help each patient make the decision that is best for him,” they wrote. For more information: Cunningham GR. J Clin Endocrinol Metab. 2011;96:38-52. Swerdloff R. J Clin Endocrinol Metab. 2011;96:62-65.

Boosting Sexual Function in Aging Men- A Handout

This is a handout of a lecture I am giving this week in Fort Lauderdale

http://pozitiveattitudes.files.wordpress.com/2011/03/nelsonvergelmarch2011.pdf

Testosterone Therapy Safe for the Prostate

http://www.renalandurologynews.com/testosterone-therapy-safe-for-the-prostate/article/198763/

Estradiol, NOT testosterone, was linked to coronary artery disease in men

Keywords:

• Oestradiol;
• testosterone;
• men;
• coronary artery disease

Summary

Objectives:  Men die of coronary artery disease more often (CAD) than women. There is evidence that testosterone is either neutral or has a beneficial effect on male cardiovascular disease. The role of oestrogens in male CAD has been less studied. This study was carried out with the purpose of evaluating the relationship between sex hormones levels and coronary artery disease.

Designer:  Case-control study.

Participants:  Men (aged 40-70) submitted to coronary angiography. A 70% occlusion of at least one major coronary artery defined the cases; subjects with ≤ 50% occlusion constituted the control group.

Measurements:  Blood samples were collected for total testosterone, oestradiol, LH, FSH, SHBG, lipid profile and albumin measurements. Bioavailable and free testosterone, FAI and FEI were calculated. Oestradiol and total testosterone levels were examined as terciles, based on the whole study population.

Results:  Of the 140 patients included, 72 were cases and 68 were controls. The baseline characteristics of the two groups were similar, except for the older age and lower LDL-C in the cases. Oestradiol and free estrogen index (FEI )but not total, bioavailable and free testosterone and free androgen index (FAI ) correlated positively with CAD. After adjustments for potential confounders oestradiol remained statistically significant. The prevalence of CAD was significantly higher in the 3^rd than in the 1^st tercile of oestradiol.

Conclusion:  In this study, men with CAD had higher oestradiol and FEI levels. Additional studies are needed to clarify the direction of causality and possible underlying mechanisms.

Source: 

Artery Disease in Men- Sex hormones and coronary artery disease

1. Emmanuela Quental Callou de Sá¹,
2. Francisco Carleial Feijó de Sá², 
3. Rebeca de Souza e Silva³, 
4. Kelly Cristina de Oliveira¹,
5. Alexis Dourado Guedes¹, 
6. Fausto Feres², 
7. Ieda Therezinha do Nascimento Verreschi¹

DOI: 10.1111/j.1365-2265.2011.04017.x

Copyright © 2011 Blackwell Publishing Ltd