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Nathan Goodyear

Testosterone deficiency: A determinant of ao... [Atherosclerosis. 2014] - PubMed - NCBI - 0 views

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    low Total Testosterone associated with CAD, particularly aortic.  Obviously, Testosterone, when low, is a marker of poor health in men.  However, low Testosterone can likely play a role in disease development, especially when age is factored in--low Testosterone in younger men likely plays an etiology versus a lesser impact in the elder.
Nathan Goodyear

Prevalence and Correlates of Late-Onset Hypogonadism Among Korean Men Aged 40 Years or ... - 0 views

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    Study of Korean men finds late onset of hypogonadism to be 16.8% in their study of 1,235 men older than 40.  This is a higher rate than other studies, but lower than others (38.7% in American men).  The test definition of low T was set at 3.2 ng/ml.  Abdominal obesity, metabolic syndrome, diabetes, and increasing age were associated with low T. Low T is clearly not a problem unique to America.  It definitely appears that a decreasing Testosterone level is a marker of poor health in men.  
Nathan Goodyear

Testosterone Levels Increase 50% with Weight Loss, Exercise - 0 views

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    Weight loss increases Testosterone levels.  This author points to low Testosterone as merely a biomarker of poor health.  In some this is correct, but Testosterone can have significant positive effects.
Nathan Goodyear

Gonadal dysfunction in systemic diseases - 0 views

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    Systemic illness i.e. inflammation is associated with impaired HPA function and gonadal function.  This can be translated as low T.  Low Testosterone is a biomarker of poor health in men.
Nathan Goodyear

http://press.endocrine.org/doi/pdf/10.1210/jc.2014-1872 - 0 views

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    New study finds Testosterone therapy provides less than statistical significant improvement in constitutional/sexual symptoms, in obese men with type II diabetes with symptoms classified as mild-moderate with modest reductions in Total Testosterone.  This study highlights that low Testosterone is a biomarker of poor health and multiple comorbidities and that simply adding in Testosterone therapy will not cure all male woes.  The authors did state that ED and low T are separate issues and I will differ with them on this--they are in fact link.  This association may vary between individuals, but to flatly state they are completely separate issues is devoid of the fact that testosterone has been shown to reduce inflammatory cytokines and improve PDE5 therapy.  
Nathan Goodyear

Total and free testosterone concentrat... [Clin Endocrinol (Oxf). 2012] - PubMed - NCBI - 0 views

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    Testosterone levels appear to be more of a biomarker of poor health in older men that are obese with diabetes.  More of these men had low free Testosterone (calc) versus Total Testosterone.  Using QOL questionnaires, weak correlation (not statistically significant) with androgen deficiency symptoms and ED were found.
Nathan Goodyear

International Journal of Impotence Research - Clomiphene increases free testosterone le... - 0 views

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    Nice study that looked at climid to restore HPA function and increase Testosterone stimulation and production.  This study also does a good job of reviewing the mechanisms of low T.  Low T is really a biomarker of poor health in men.
Nathan Goodyear

Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MI... - 0 views

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    muscle loss, sarcopenia is a significant marker of poor health in men.  This study of 845 men age 45-85 finds that low Testosterone, low vitamin D, low physical activity, smoking, and thin body build are associated with sarcopenia in men.
Nathan Goodyear

Androgen Therapy Improves Insulin Sensitivity and Decreases Leptin Level in Healthy Adu... - 0 views

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    Three month study of men with low T, found that Testosterone therapy improved insulin sensitivity and reduced leptin levels.  The group of men here were described as "healthy, non-obese men".   Remember, low T is a biomarker of poor health in men, so the authors statement about the study group is inaccurate.  This also points to a relatively quick metabolic effect by Testosterone and a direct effect on insulin receptor effect and adipocyte leptin release.
harshitatyagi

What is the Procedure of IVF with Donor Embryos... - 0 views

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    The embryo is the combined form of a matured egg and sperm. It is generally known as the most critical stage of IVF treatment. Despite that, successful embryo implantation only decides the achievement of pregnancy, and when it fails, it obstructs the entire IVF process. It extensively occurs when a couple fails to develop a healthy embryo using their eggs and sperm because of poor health conditions.
harshitatyagi

Why is getting pregnant so difficult? - 0 views

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    Usually, when getting pregnant becomes difficult, it leads to a situation where a woman faces infertility issues. As infertility is a never-ending illness in which conceiving becomes impossible either due to health conditions or a poor environment. Here find out the reasons why it becomes challenging to become pregnant?
harshitatyagi

Why Does IVF Fails, and how can you deal with it? - 0 views

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    There are various reasons why their IVF treatment was unsuccessful or failed such as Female Age, Poor egg quality, Lower sperm health, Chromosomal abnormalities read more...
Nathan Goodyear

Higher Free Thyroxine Levels Predict Increased Incidence of Dementia in Older Men: The ... - 0 views

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    what a silly study!  They look at free T4, the weakest thyroid hormone and found high levels to be associated with dementia.  However, they failed to assess free T3, the most biologically active, and reverse T3, inactive.  This study was like they intentionally blinded themselves of the body's physiology to study dementia.  This is the problem with a lot of research today: they have forgotten their foundation. Many older adults struggle with poor free T4 to free T3 conversion and high reverse T3 conversion.  So, without knowing what these clients were doing in these pathways makes their conclusion obsolete.
Nathan Goodyear

Testosterone, SHBG and cardiovascular health in postmenopausal women - 0 views

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    Master's thesis reviews Testosterone therapy in women.  The evidence is poor.  What is seen is that low SHBG and increasing Testosterone in the long term appears to be associated with adverse CV effects. Otherwise, the effects of Testosterone are negligible if negative at all.   High dose studies did find increased CVD in women. The dosing here was at 40 mg.
Nathan Goodyear

Elderly men over 65 years of age with late-onset hypogonadism benefit as much from test... - 0 views

  • The benefits of restoring serum testosterone in men with LOH were not significantly different between men older than 65 years of age and younger men. There were no indications that side effects were more severe in elderly men. The effects on prostate and urinary function and hematocrit were within safe margins.
  • obesity, but also impaired general health, are the more common causes of low testosterone in aging men
  • Severe LOH is associated with substantially higher risks of all-cause and cardiovascular mortality,
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  • advanced age, obesity, a diagnosis of metabolic syndrome, and poor general health status were predictors of LOH
  • Diabetes mellitus was correlated with hypogonadism in most studies
  • coronary heart disease, hypertension, stroke, and peripheral arterial disease did not predict hypogonadism, they did correlate with the incidence of low testosterone
  • LOH can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol/L (3.2 ng/mL) and a free testosterone level of less than 220 pmol/L (64 pg/mL)
    • Nathan Goodyear
       
      the European Male Aging study defined low T as total < 320 ng/dl and free < 64 pg/ml.  
  • Mean weight decreased
  • Waist circumference decreased
  • Total cholesterol decreased
  • Low-density lipoprotein decreased
  • Triglycerides decreased
  • High-density lipoprotein (HDL) increased
  • ratio of total cholesterol to HDL improved
  • Prostate volume increased
  • PSA increased
  • The benefits for men older than 65 years of age were compared with those of younger men, and the improvements in body weight, metabolic factors, psychological functioning, and sexual functioning were of the same magnitude in both age groups
  • weight loss was progressive over the 6-year period, effects of testosterone on lipids and on psychological and sexual functioning reached a plateau after approximately 3 years and these effects were sustained
  • Effects of testosterone on hematopoiesis, on the prostate, and on bladder function were not more severe in older men than in younger men
  • observe a mild increase in prostate volume and serum PSA over time, which is a normal finding in aging men. Maybe somewhat surprising, postvoiding residue and the IPSS did not deteriorate with aging but showed a degree of improvement
  • the severity of the metabolic syndrome is associated with the severity of lower urinary tract symptoms
  • The symptoms of the metabolic syndrome improve upon testosterone treatment and testosterone may thus have a favorable effect on lower urinary tract symptoms
  • it seems reasonable to conclude that the risks of testosterone administration to elderly men are not disproportionately higher in elderly men than in younger men.
  • Despite evidence to the contrary, physicians still harbor a wrongful association between testosterone and the development of prostate pathology (prostate cancer and benign prostate hyperplasia)
  • Not surprisingly, the incidence of prostate cancer was higher in older men; however, it was lower than expected in both groups
  • These observations suggest that the incidence of prostate cancer in patients receiving testosterone therapy, both in the younger and in the older group, was not greater than in the general population not receiving testosterone treatment
  • The historical fear that raising testosterone levels will result in more prostate cancer has been dispelled, particularly by the work of Abraham Morgentaler
  • Higher serum testosterone levels fail to show an increased risk of prostate cancer, and supraphysiological testosterone does not increase prostate volume or PSA in healthy men
  • This apparent paradox is explained by the "saturation model,"
  • Recent studies indicate no increased risk of prostate cancer among men with serum testosterone in the therapeutic range
  • In the present observational study, no cases of major adverse cardiovascular events occurred.
  • the benefits of testosterone therapy are fully achieved only by long-term treatment
  • To achieve maximal benefits, good patient adherence is a prerequisite
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    Study finds new difference in Testosterone benefits and/or side effects between men < 65 with low T and men > 65 with low T.
Nathan Goodyear

Selenium and human health : The Lancet - 0 views

  • Low selenium status has been associated with increased risk of mortality, poor immune function, and cognitive decline
  • Higher selenium status or selenium supplementation has antiviral effects, is essential for successful male and female reproduction, and reduces the risk of autoimmune thyroid disease.
  • Prospective studies have generally shown some benefit of higher selenium status on the risk of prostate, lung, colorectal, and bladder cancers, but findings from trials have been mixed, which probably emphasises the fact that supplementation will confer benefit only if intake of a nutrient is inadequate
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    Selenium is a "U" shaped curve.  Abstract only available here.
Nathan Goodyear

Prior Dietary Practices and Connections to a Human Gut Microbial Metacommunity Alter Re... - 0 views

  • Long-term DPs play a large role in determining the selective environment that the gut microbiota faces, ultimately influencing the composition and diversity of taxa maintained within the gut microbial community
  • Americans consuming unrestricted diets maintained less diverse fecal microbiota than those of individuals adhering to a plant-rich diet with restricted caloric intake
  • Experiments in mice have shown that multigenerational exposure to a Western diet poor in “microbiota-accessible carbohydrates” can lead to extirpation of specific bacterial lineages
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    Diet is the key to gut microbe diversity.  Gut microbes are key to maintaining optimal cellular metabolism.  Nutrition can be a prescription for improving and reprogramming gut bacteria.
Nathan Goodyear

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

  • 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
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  • 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
       
      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
       
      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 (&gt;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 &amp; 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 &amp; 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.
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    Article discusses the expanding evidence of low T and Metabolic syndrome.
Nathan Goodyear

Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer a... - 0 views

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    intake of sugar drinks i.e. coke associated with increased risk of type I endometrial cancer in postmenopausal women.
Nathan Goodyear

Testosterone and the Cardiovascular System: A Comprehensive Review of the Clinical Lite... - 0 views

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    Some startling statistics in this 2013 review on Testosterone in men.  Studies reflect an inverse relationship between Testosterone and CAD severity.  That is, the lower the Testosterone levels, the increase in severity of CAD. This same association was also found with CHF.  Low Testosterone is common in those with CAD, CHF, type II diabetes, increased IMT in carotids and aorta, and obesity when compared to "healthy" individuals.  Testosterone therapy in those with CAD found benefits: prolongation of ST segment depression, coronary vasodilation, improved exercise capacity in those with CHF, shift to type I muscle fibers, shorten the QTc interval.  Testosterone therapy has been shown to improve insulin resistance, improve HgbA1c and decrease waist circumference and fat loss in obese individuals.  Otherwise, a good review of the association between a declining Testosterone and cardiovascular disease.
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