Skip to main content

Home/ Dr. Goodyear/ Group items tagged practice guidelines

Rss Feed Group items tagged

Filter: All | Bookmarks | Topics Simple Middle
Nathan Goodyear

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guidel... - 0 views

press.endocrine.org/...jc.2014-2260

T Testosterone women therapy hormone hormones

shared by Nathan Goodyear on 07 Oct 14 - No Cached
  • Nathan Goodyear on 07 Oct 14
     
    data on androgen therapy in women is sparse at best.  The conclusion here is suspect: "evidence supports the short-term efficacy and safety of high physiological doses of T" for women with with hypoactive sexual desire, yet the same authors recommend against long-term therapy.  How do those 2 go together???  They don't.  Support with physiologic Testosterone when appropriate testing reveals low T and symptoms support the same.  This is a practice guideline that lacks evidence to strongly back it up because so little evidence exists.  Practice guidelines are for lazy physicians.
Nathan Goodyear

Guidelines have done more harm than good. [Blood Purif. 2008] - PubMed result - 0 views

www.ncbi.nlm.nih.gov/...18182801

medical practice medicine guidelines standard of care

shared by Nathan Goodyear on 12 May 11 - No Cached
  • Guidelines certainly do not encourage clinicians to consider and treat each patient as an individual
  • This all but guarantees many guidelines are obsolete by the time they are published
  • unlikely to stimulate original research
  • ...2 more annotations...
  • reated by a process that is artificial, laborious and cumbersome
  • uidelines are produced with industry support and recommendations often have a major impact on sales of industry products
  • Nathan Goodyear on 12 May 11
     
    Medical guidelines likely do more harm than good
Nathan Goodyear

Testosterone deficiency: Practical guidelines for diagnosis and treatment | BC Medical ... - 0 views

www.bcmj.org/...elines-diagnosis-and-treatment

low T low Testosterone hypogonadism men male hormone hormones

shared by Nathan Goodyear on 12 Aug 14 - No Cached
  • Nathan Goodyear on 12 Aug 14
     
    I am not a fan of guideline medicine, but this review of the literature on low T is worth while.
Nathan Goodyear

Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Cli... - 0 views

jcem.endojournals.org/...1911.abstract

vitamin vitamin d deficiency

shared by Nathan Goodyear on 10 Sep 11 - No Cached
  • Nathan Goodyear on 10 Sep 11
     
    the Endocrine Society clinical practice guideline to not screen for vitamin D deficiency, proves that this organization cannot be looked to for reliable analysis of scientific data
Nathan Goodyear

Best practice in the treatment of nonmuscle invasive bladder cancer - 0 views

www.ncbi.nlm.nih.gov/...PMC3263923

bladder cancer bladder cancer

shared by Nathan Goodyear on 05 Jan 15 - No Cached
  • Nathan Goodyear on 05 Jan 15
     
    2 year old "best practice" guidelines for bladder cancer.
Nathan Goodyear

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Cl... - 0 views

jcem.endojournals.org/...2536.full

testosterone therapy deficiency low T androgen

shared by Nathan Goodyear on 31 Jan 12 - No Cached
  • Nathan Goodyear on 31 Jan 12
     
    androgen deficiency and guidelines for Testosterone therapy.  Nice review of statistics and symptoms.  Many symptoms of low T go unrecognized.
Nathan Goodyear

Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH... - 0 views

www.ncbi.nlm.nih.gov/...PMC6482353

cancer anemia

shared by Nathan Goodyear on 08 Jun 19 - No Cached
  • Nathan Goodyear on 08 Jun 19
     
    New "guidelines" for management of anemia in cancer.
Nathan Goodyear

The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline - 0 views

jcem.endojournals.org/...1526.long

cortisol saliva salivary hormone hormones test testing evaluation Cushing's syndrome practice guidelines

shared by Nathan Goodyear on 07 Feb 12 - No Cached
  • late night salivary cortiso
  • high diagnostic accuracy
  • Nathan Goodyear on 07 Feb 12
     
    salivary cortisol testing recommended as first-line test for Cushing's syndrome due to "high diagnostic accuracy".  So, I wonder why so many state medical boards and insurance companies have missed this one?
Nathan Goodyear

https://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20... - 0 views

www.endocrine.org/...-Practice-Guideline-NonCME.pdf

HGH GH human growth hormone growth hormone

shared by Nathan Goodyear on 04 Nov 14 - No Cached
  • Nathan Goodyear on 04 Nov 14
     
    Current recommendations on HGH origin, evaluation, and therapy.
Nathan Goodyear

Platelet Transfusion: A Clinical Practice Guideline From the AABB | Annals of Internal ... - 0 views

annals.org/...l-practice-guideline-from-aabb

platelets

shared by Nathan Goodyear on 10 Jan 19 - No Cached
  • Nathan Goodyear on 10 Jan 19
     
    Platelets and "recommended" indications for transfusion.
spineneuro

Dr Paresh Doshi Helps Creating Guidelines for Neurodegenerative Disorders - 0 views

www.briefingwire.com/...or-neurodegenerative-disorders

Dr. Paresh Doshi Best Deep Brain Stimulation Neurosurgeon in India Top 10 Neurosurgeons for DBS in India Top Neurosurgeon at Jaslok Hospital Mumbai Dr Paresh Doshi Jaslok Mumbai

shared by spineneuro on 17 Aug 21 - No Cached
  • spineneuro on 17 Aug 21
     
    Dr. Paresh Doshi top neurosurgeon at Jaslok Hospital Mumbai outlines best practices in the control of these difficult-to-treat disorders.
Nathan Goodyear

The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline - 1 views

www.ncbi.nlm.nih.gov/...PMC2605410

salivary saliva cortisol testing cushing's disease syndrome

shared by Nathan Goodyear on 27 Nov 11 - No Cached
  • the diagnostic sensitivity and specificity is said to be excellent (92–100%)
  • Measurement of salivary cortisol by ELISA and LC-MS/MS has been well validated in the United States
  • Nathan Goodyear on 27 Nov 11
     
    Endocrine society clinical  practice guideline's state proves validity of salivary cortisol testing.  Statement: "the diagnostic sensitivity and specificity is said to be excellent (92-100%)" and " Measurement of salivary cortisol by ELISA and LC-MS/MS has been well validated in the United States"
Nathan Goodyear

Testosterone and glucose metabolism in men: current concepts and controversies - 0 views

joe.endocrinology-journals.org/...R37.full

Low T Testosterone metabolic syndrome MetS Diabetes men male glucose hormone hormones g

shared by Nathan Goodyear on 04 Feb 14 - No Cached
  • Around 50% of ageing, obese men presenting to the diabetes clinic have lowered testosterone levels relative to reference ranges based on healthy young men
  • The absence of high-level evidence in this area is illustrated by the Endocrine Society testosterone therapy in men with androgen deficiency clinical practice guidelines (Bhasin et al. 2010), which are appropriate for, but not specific to men with metabolic disorders. All 32 recommendations made in these guidelines are based on either very low or low quality evidence.
  • A key concept relates to making a distinction between replacement and pharmacological testosterone therapy
  • ...59 more annotations...
  • The presence of symptoms was more closely linked to increasing age than to testosterone levels
  • Findings similar to type 2 diabetes were reported for men with the metabolic syndrome, which were associated with reductions in total testosterone of −2.2 nmol/l (95% CI −2.41 to 1.94) and in free testosterone
  • low testosterone is more predictive of the metabolic syndrome in lean men
  • Cross-sectional studies uniformly show that 30–50% of men with type 2 diabetes have lowered circulating testosterone levels, relative to references based on healthy young men
  • In a recent cross-sectional study of 240 middle-aged men (mean age 54 years) with either type 2 diabetes, type 1 diabetes or without diabetes (Ng Tang Fui et al. 2013b), increasing BMI and age were dominant drivers of low total and free testosterone respectively.
  • both diabetes and the metabolic syndrome are associated with a modest reduction in testosterone, in magnitude comparable with the effect of 10 years of ageing
  • In a cross-sectional study of 490 men with type 2 diabetes, there was a strong independent association of low testosterone with anaemia
  • In men, low testosterone is a marker of poor health, and may improve our ability to predict risk
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      probably the most important point made in this article
  • low testosterone identifies men with an adverse metabolic phenotype
  • Diabetic men with low testosterone are significantly more likely to be obese or insulin resistant
  • increased inflammation, evidenced by higher CRP levels
  • Bioavailable but not free testosterone was independently predictive of mortality
  • It remains possible that low testosterone is a consequence of insulin resistance, or simply a biomarker, co-existing because of in-common risk factors.
  • In prospective studies, reviewed in detail elsewhere (Grossmann et al. 2010) the inverse association of low testosterone with metabolic syndrome or diabetes is less consistent for free testosterone compared with total testosterone
  • In a study from the Framingham cohort, SHBG but not testosterone was prospectively and independently associated with incident metabolic syndrome
  • low SHBG (Ding et al. 2009) but not testosterone (Haring et al. 2013) with an increased risk of future diabetes
  • In cross-sectional studies of men with (Grossmann et al. 2008) and without (Bonnet et al. 2013) diabetes, SHBG but not testosterone was inversely associated with worse glycaemic control
  • SHBG may have biological actions beyond serving as a carrier protein for and regulator of circulating sex steroids
  • In men with diabetes, free testosterone, if measured by gold standard equilibrium dialysis (Dhindsa et al. 2004), is reduced
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      expensive, laborious process filled with variables
  • Low free testosterone remains inversely associated with insulin resistance, independent of SHBG (Grossmann et al. 2008). This suggests that the low testosterone–dysglycaemia association is not solely a consequence of low SHBG.
  • Experimental evidence reviewed below suggests that visceral adipose tissue is an important intermediate (rather than a confounder) in the inverse association of testosterone with insulin resistance and metabolic disorders.
  • testosterone promotes the commitment of pluripotent stem cells into the myogenic lineage and inhibits their differentiation into adipocytes
  • testosterone regulates the metabolic functions of mature adipocytes (Xu et al. 1991, Marin et al. 1995) and myocytes (Pitteloud et al. 2005) in ways that reduce insulin resistance.
  • Pre-clinical evidence (reviewed in Rao et al. (2013)) suggests that at the cellular level, testosterone may improve glucose metabolism by modulating the expression of the glucose-transported Glut4 and the insulin receptor, as well as by regulating key enzymes involved in glycolysis.
  • More recently testosterone has been shown to protect murine pancreatic β cells against glucotoxicity-induced apoptosis
  • Interestingly, a reciprocal feedback also appears to exist, given that not only chronic (Cameron et al. 1990, Allan 2013) but also, as shown more recently (Iranmanesh et al. 2012, Caronia et al. 2013), acute hyperglycaemia can lower testosterone levels.
  • There is also evidence that testosterone regulates insulin sensitivity directly and acutely
  • In men with prostate cancer commencing androgen deprivation therapy, both total as well as, although not in all studies (Smith 2004), visceral fat mass increases (Hamilton et al. 2011) within 3 months
  • More prolonged (>12 months) androgen deprivation therapy has been associated with increased risk of diabetes in several large observational registry studies
  • Testosterone has also been shown to reduce the concentration of pro-inflammatory cytokines in some, but not all studies, reviewed recently in Kelly & Jones (2013). It is not know whether this effect is independent of testosterone-induced changes in body composition.
  • the observations discussed in this section suggest that it is the decrease in testosterone that causes insulin resistance and diabetes. One important caveat remains: the strongest evidence that low testosterone is the cause rather than consequence of insulin resistance comes from men with prostate cancer (Grossmann & Zajac 2011a) or biochemical castration, and from mice lacking the androgen receptor.
  • Several large prospective studies have shown that weight gain or development of type 2 diabetes is major drivers of the age-related decline in testosterone levels
  • there is increasing evidence that healthy ageing by itself is generally not associated with marked reductions in testosterone
  • Circulating testosterone, on an average 30%, is lower in obese compared with lean men
  • increased visceral fat is an important component in the association of low testosterone and insulin resistance
  • The vast majority of men with metabolic disorders have functional gonadal axis suppression with modest reductions in testosterone levels
  • obesity is a dominant risk factor
  • men with Klinefelter syndrome have an increased risk of metabolic disorders. Interestingly, greater body fat mass is already present before puberty
  • Only 5% of men with type 2 diabetes have elevated LH levels
  • inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion from GNRH neurons situated in the preoptic area
  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • suppression of the diabesity-associated HPT axis is functional, and may hence be reversible
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Modifiable risk factors such as obesity and co-morbidities are more strongly associated with a decline in circulating testosterone levels than age alone
  • 55% of symptomatic androgen deficiency reverted to a normal testosterone or an asymptomatic state after 8-year follow-up, suggesting that androgen deficiency is not a stable state
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • Leptin treatment resolves hypogonadism in leptin-deficient men
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • change in BMI was associated with the change in testosterone (Corona et al. 2013a,b).
  • weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in men who improved their glycaemic control over time, testosterone levels increased. By contrast, in those men in whom glycaemic control worsened, testosterone decreased
  • testosterone levels should be measured after successful weight loss to identify men with an insufficient rise in their testosterone levels. Such men may have HPT axis pathology unrelated to their obesity, which will require appropriate evaluation and management.
  • Nathan Goodyear on 04 Feb 14
     
    Article discusses the expanding evidence of low T and Metabolic syndrome.
Nathan Goodyear

Endocrinology of the Aging Male - 0 views

www.ncbi.nlm.nih.gov/...PMC3073592

aging male hormone hormones

shared by Nathan Goodyear on 30 Apr 13 - No Cached
  • All steps beyond the formation of pregnenolone take place in the smooth endoplasmic reticulum
  • Cytochrome P450 enzyme, CYP11A is located on the inner mitochondrial membrane and catalyses the rate limiting step of pregnenolone synthesis
  • Estrogen and related steroids, thyroid hormone and insulin increase SHBG levels.
  • ...21 more annotations...
  • SHBG decreases in response to androgens, and in the presence of hypothyroidism, and insulin resistance.
  • Plasma SHBG levels tend to increase with increasing age
  • The apparent metabolic clearance rate of testosterone is decreased in elderly as compared to younger men
  • Testosterone circulates predominantly bound to the plasma proteins SHBG and albumin, with high and low affinity respectively
  • Testosterone is secreted in a pulsatile fashion
  • Current clinical guidelines suggest at least two measurements
  • In adult men, there is a well-documented diurnal variation (particularly in younger subjects) in testosterone levels, which are highest in the early morning and progressively decline throughout the day to a nadir in the evening
  • In older men, the diurnal variation is blunted
  • it is standard practice for samples to be obtained between 0800 and 1100 h.
  • Testosterone and DHEA decline, whereas LH, FSH, and SHBG rise
  • DHT remains constant despite the decline of its precursor testosterone
  • Longitudinal studies show an average annual decline of 1–2% total testosterone levels, with decline in free testosterone more rapid because of increases in SHBG with aging
  • Massachusetts Male Aging Study (MMAS) data show DHEA, DHEAS, and Ae declining at 2–3% per year
  • DHT showed no cross-sectional age trend
  • Androstanediol glucuronide (AAG) declined cross-sectionally with age in the MMAS sample, at 0.6% per year
  • The EMAS data show that, consistent with the longitudinal findings of MMAS (Figure 1), the core hormonal pattern with increasing age is suggestive of incipient primary testicular dysfunction with maintained total testosterone and progressively blunted free testosterone associated with higher LH
    • Nathan Goodyear
      Nathan Goodyear on 01 May 13
       
      This author proves the point in the review of these two studies, that TT may remain constant in aging men, however, FT drops.
  • obesity impairs hypothalamic/pituitary function
  • Androgen deprivation in men with prostate cancer has been associated with increased insulin resistance, worse glycemic control, and a significant increase in risk of incident diabetes
  • Low serum testosterone is associated with the development of metabolic syndrome 116, 117 and type 2 diabetes. 118 SHBG has been inversely correlated with type 2 diabetes
  • Improvement in insulin sensitivity with testosterone treatment has been reported in healthy 121 and diabetic 122 adult men
  • In studies conducted in men with central adiposity, testosterone has been shown to inhibit lipoprotein lipase activity in abdominal adipose tissue leading to decreased triglyceride uptake in central fat depots. 123
  • Nathan Goodyear on 30 Apr 13
     
    great review of hormone changes associated with aging in men.
Nathan Goodyear

SOGC Clinical Practice Guideline. Magn... [J Obstet Gynaecol Can. 2011] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...21639972

IV magnesium nutritional therapy cerebral palsy CP neuroprotection IV magnesium

shared by Nathan Goodyear on 07 Feb 13 - No Cached
  • Nathan Goodyear on 07 Feb 13
     
    IV magnesium shown to be neuroprotective in those at risk for cerebral palsy.  How?  NMDA inhibition.
Nathan Goodyear

The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic ... - 0 views

cid.oxfordjournals.org/...1089.full

lyme CDC treatment disease

shared by Nathan Goodyear on 23 Sep 13 - No Cached
  • Nathan Goodyear on 23 Sep 13
     
    CDC recommendations on lyme treatment
Nathan Goodyear

Clinical controversies in screening women for thyr... [J Midwifery Womens Health. 2006 ... - 0 views

www.ncbi.nlm.nih.gov/...16647667

TSH screening

shared by Nathan Goodyear on 16 Dec 10 - No Cached
  • In November 2002, the American Association of Clinical Endocrinologists (AACE) released new guidelines for clinical practice for the diagnosis and treatment of hyperthyroidism and hypothyroidism, which includes a new thyroid-stimulating hormone (TSH) reference range of 0.3 to 3.0 mIU/
  • Nathan Goodyear on 16 Dec 10
     
    TSH "screening" needs to be between 0.3 and 3 according to American Association of Clinical Endocrinologists
Nathan Goodyear

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Te... - 0 views

onlinelibrary.wiley.com/...full

CVD cholesterol mortality norwegian hunt study 2

shared by Nathan Goodyear on 26 Oct 11 - No Cached
  • Nathan Goodyear on 26 Oct 11
     
    here is the full article on the need for change in how we view cholesterol.  This is from the Norwegian HUNT 2 study that showed that cholesterol up to 270 reduced cardiovascular disease mortality
Nathan Goodyear

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Te... - 0 views

onlinelibrary.wiley.com/...abstract

cholesterol heart disease risk CVD atherosclerosis hyperlipidemia mortality

shared by Nathan Goodyear on 26 Oct 11 - No Cached
  • Nathan Goodyear on 26 Oct 11
     
    new study of 52,087 shows cholesterol up to 270 actually lowers heart disease mortality
Nathan Goodyear

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guidel... - 0 views

press.endocrine.org/...jc.2014-2260

Testosterone women female hormone hormones

shared by Nathan Goodyear on 05 Nov 14 - No Cached
  • Nathan Goodyear on 05 Nov 14
     
    A recommendation that I agree with: Very little data available for Testosterone in women requires significant restraint and recommendation to limit use of Testosterone in women.
1 - 20 of 22 Next ›
Showing 20▼ items per page