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Nathan Goodyear

JAMA Network | JAMA | Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Dia... - 0 views

  • lack of reliable data on levels of free hormones
  • endogenous levels of testosterone and SHBG each exhibit sex-dependent relations with risk of type 2 diabetes
  • high testosterone levels were associated with greater type 2 diabetes risk in women but lower risk in men
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  • the inverse association of SHBG was stronger in women than in men
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    No surprise, testosterone in men and women have different effects.  I just wrote a post on this.  Testosterone is positively associated with increased risk of diabetes in women, but inversely with men.  That is increased T in women equals increased Diabetes in women; contrast with increased T associated with decreased Diabetes in men.   But the interesting point is SHBG.  This study found a strong inverse association between SHBG with diabetes in women when compared to men.  Meaning: low SHBG is associated with an increased risk of type II Diabetes.  This is at the same time that testosterone is associated with an increased risk.
Nathan Goodyear

Gut microbe levels are linked to type 2 diabetes and obesity -- ScienceDaily - 0 views

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    Individuals with obesity and type II Diabetes been found to have significantly different gut bacteria populations compared to healthy individuals.  This is not new information.  The firmicutes:bacteroidetes ratio has been long known to be elevated in obese individuals vs those that are lean.  The question here is cause and effect.  Is the change in the bacterial population leading to obesity and type II diabetes?  Or is diabetes and obesity leading to changes in the bacterial population?  A heavy-laden carb diet is know to lead to a change to a more unhealthy gut bacterial population--maybe it is just a product of diet?  Maybe it is effected by vaginal delivery vs cesarean delivery?  Maybe breast feeding plays a role.  Maybe, all the above is required. The point is that the cause of obesity and type II diabetes may have its origins deep, deep in the...well you know. http://ow.ly/yqDML 
Nathan Goodyear

Endogenous Sex Hormones and the Development of Type 2 Diabetes in Older Men and Women: ... - 0 views

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    A prospective study of aging men and women in the development risk of type II diabetes.  The sexes bring significant differences.  In men, low Testosterone predicts the development of type II diabetes.  In women, just the opposite is seen--high Testosterone levels and low SHBG are most predictive of type II diabetes risk.
Nathan Goodyear

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

  • Low endogenous bioavailable testosterone levels have been shown to be associated with higher rates of all‐cause and cardiovascular‐related mortality.39,41,46–47 Patients suffering from CAD,13–18 CHF,137 T2DM,25–26 and obesity27–28
  • have all been shown to have lower levels of endogenous testosterone compared with those in healthy controls. In addition, the severity of CAD15,17,29–30 and CHF137 correlates with the degree of testosterone deficiency
  • In patients with CHF, testosterone replacement therapy has been shown to significantly improve exercise tolerance while having no effect on LVEF
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  • testosterone therapy causes a shift in the skeletal muscle of CHF patients toward a higher concentration of type I muscle fibers
  • Testosterone replacement therapy has also been shown to improve the homeostatic model of insulin resistance and hemoglobin A1c in diabetics26,68–69 and to lower the BMI in obese patients.
  • Lower levels of endogenous testosterone have been associated with longer duration of the QTc interval
  • testosterone replacement has been shown to shorten the QTc interval
  • negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries, abdominal aorta, and thoracic aorta
  • These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk of developing atherosclerosis.
  • Current guidelines from the Endocrine Society make no recommendations on whether patients with heart disease should be screened for hypogonadism and do not recommend supplementing patients with heart disease to improve survival.
  • The Massachusetts Male Aging Study also projects ≈481 000 new cases of hypogonadism annually in US men within the same age group
  • since 1993 prescriptions for testosterone, regardless of the formulation, have increased nearly 500%
  • Testosterone levels are lower in patients with chronic illnesses such as end‐stage renal disease, human immunodeficiency virus, chronic obstructive pulmonary disease, type 2 diabetes mellitus (T2DM), obesity, and several genetic conditions such as Klinefelter syndrome
  • A growing body of evidence suggests that men with lower levels of endogenous testosterone are more prone to develop CAD during their lifetimes
  • There are 2 major potential confounding factors that the older studies generally failed to account for. These factors are the subfraction of testosterone used to perform the analysis and the method used to account for subclinical CAD.
  • The biologically inactive form of testosterone is tightly bound to SHBG and is therefore unable to bind to androgen receptors
  • The biologically inactive fraction of testosterone comprises nearly 68% of the total testosterone in human serum
  • The biologically active subfraction of testosterone, also referred to as bioavailable testosterone, is either loosely bound to albumin or circulates freely in the blood, the latter referred to as free testosterone
  • It is estimated that ≈30% of total serum testosterone is bound to albumin, whereas the remaining 1% to 3% circulates as free testosterone
  • it can be argued that using the biologically active form of testosterone to evaluate the association with CAD will produce the most reliable results
  • English et al14 found statistically significant lower levels of bioavailable testosterone, free testosterone, and free androgen index in patients with catheterization‐proven CAD compared with controls with normal coronary arteries
  • patients with catheterization‐proven CAD had statistically significant lower levels of bioavailable testosterone
  • In conclusion, existing evidence suggests that men with CAD have lower levels of endogenous testosterone,13–18 and more specifically lower levels of bioavailable testosterone
  • low testosterone levels are associated with risk factors for CAD such as T2DM25–26 and obesity
  • In a meta‐analysis of these 7 population‐based studies, Araujo et al41 showed a trend toward increased cardiovascular mortality associated with lower levels of total testosterone, but statistical significance was not achieved (RR, 1.25
  • the authors showed that a decrease of 2.1 standard deviations in levels of total testosterone was associated with a 25% increase in the risk of cardiovascular mortality
  • the relative risk of all‐cause mortality in men with lower levels of total testosterone was calculated to be 1.35
  • higher risk of cardiovascular mortality is associated with lower levels of bioavailable testosterone
  • Existing evidence seems to suggest that lower levels of endogenous testosterone are associated with higher rates of all‐cause mortality and cardiovascular mortality
  • studies have shown that lower levels of endogenous bioavailable testosterone are associated with higher rates of all‐cause and cardiovascular mortality
  • It may be possible that using bioavailable testosterone to perform mortality analysis will yield more accurate results because it prevents the biologically inactive subfraction of testosterone from playing a potential confounding role in the analysis
  • The earliest published material on this matter dates to the late 1930s
  • the concept that testosterone replacement therapy improves angina has yet to be proven wrong
  • In more recent studies, 3 randomized, placebo‐controlled trials demonstrated that administration of testosterone improves myocardial ischemia in men with CAD
  • The improvement in myocardial ischemia was shown to occur in response to both acute and chronic testosterone therapy and seemed to be independent of whether an intravenous or transdermal formulation of testosterone was used.
  • testosterone had no effect on endothelial nitric oxide activity
  • There is growing evidence from in vivo animal models and in vitro models that testosterone induces coronary vasodilation by modulating the activity of ion channels, such as potassium and calcium channels, on the surface of vascular smooth muscle cells
  • Experimental studies suggest that the most likely mechanism of action for testosterone on vascular smooth muscle cells is via modulation of action of non‐ATP‐sensitive potassium ion channels, calcium‐activated potassium ion channels, voltage‐sensitive potassium ion channels, and finally L‐type calcium ion channels
  • Corona et al confirmed those results by demonstrating that not only total testosterone levels are lower among diabetics, but also the levels of free testosterone and SHBG are lower in diabetic patients
  • Laaksonen et al65 followed 702 Finnish men for 11 years and demonstrated that men in the lowest quartile of total testosterone, free testosterone, and SHBG were more likely to develop T2DM and metabolic syndrome.
  • Vikan et al followed 1454 Swedish men for 11 years and discovered that men in the highest quartile of total testosterone were significantly less likely to develop T2DM
  • authors demonstrated a statistically significant increase in the incidence of T2DM in subjects receiving gonadotropin‐releasing hormone antagonist therapy. In addition, a significant increase in the rate of myocardial infarction, stroke, sudden cardiac death, and development of cardiovascular disease was noted in patients receiving antiandrogen therapy.67
  • Several authors have demonstrated that the administration of testosterone in diabetic men improves the homeostatic model of insulin resistance, hemoglobin A1c, and fasting plasma glucose
  • Existing evidence strongly suggests that the levels of total and free testosterone are lower among diabetic patients compared with those in nondiabetics
  • insulin seems to be acting as a stimulant for the hypothalamus to secret gonadotropin‐releasing hormone, which consequently results in increased testosterone production. It can be argued that decreased stimulation of the hypothalamus in diabetics secondary to insulin deficiency could result in hypogonadotropic hypogonadism
  • BMI has been shown to be inversely associated with testosterone levels
  • This interaction may be a result of the promotion of lipolysis in abdominal adipose tissue by testosterone, which may in turn cause reduced abdominal adiposity. On the other hand, given that adipose tissue has a higher concentration of the enzyme aromatase, it could be that increased adipose tissue results in more testosterone being converted to estrogen, thereby causing hypogonadism. Third, increased abdominal obesity may cause reduced testosterone secretion by negatively affecting the hypothalamus‐pituitary‐testicular axis. Finally, testosterone may be the key factor in activating the enzyme 11‐hydroxysteroid dehydrogenase in adipose tissue, which transforms glucocorticoids into their inactive form.
  • increasing age may alter the association between testosterone and CRP. Another possible explanation for the association between testosterone level and CRP is central obesity and waist circumference
  • Bai et al have provided convincing evidence that testosterone might be able to shorten the QTc interval by augmenting the activity of slowly activating delayed rectifier potassium channels while simultaneously slowing the activity of L‐type calcium channels
  • consistent evidence that supplemental testosterone shortens the QTc interval.
  • Intima‐media thickness (IMT) of the carotid artery is considered a marker for preclinical atherosclerosis
  • Studies have shown that levels of endogenous testosterone are inversely associated with IMT of the carotid artery,126–128,32,129–130 as well as both the thoracic134 and the abdominal aorta
  • 1 study has demonstrated that lower levels of free testosterone are associated with accelerated progression of carotid artery IMT
  • another study has reported that decreased levels of total and bioavailable testosterone are associated with progression of atherosclerosis in the abdominal aorta
  • These findings suggest that normal physiologic testosterone levels may help to protect men from the development of atherosclerosis
  • Czesla et al successfully demonstrated that the muscle specimens that were exposed to metenolone had a significant shift in their composition toward type I muscle fibers
  • Type I muscle fibers, also known as slow‐twitch or oxidative fibers, are associated with enhanced strength and physical capability
  • It has been shown that those with advanced CHF have a higher percentage of type II muscle fibers, based on muscle biopsy
  • Studies have shown that men with CHF suffer from reduced levels of total and free testosterone.137 It has also been shown that reduced testosterone levels in men with CHF portends a poor prognosis and is associated with increased CHF mortality.138 Reduced testosterone has also been shown to correlate negatively with exercise capacity in CHF patients.
  • Testosterone replacement therapy has been shown to significantly improve exercise capacity, without affecting LVEF
  • the results of the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not cause an increase in the rate of adverse cardiovascular events
  • Data from 3 meta‐analyses seem to contradict the commonly held belief that testosterone administration may increase the risk of developing prostate cancer
  • One meta‐analysis reported an increase in all prostate‐related adverse events with testosterone administration.146 However, when each prostate‐related event, including prostate cancer and a rise in PSA, was analyzed separately, no differences were observed between the testosterone group and the placebo group
  • the existing data from the 3 meta‐analyses seem to indicate that testosterone replacement therapy does not increase the risk of adverse cardiovascular events
  • the authors correctly point out the weaknesses of their study which include retrospective study design and lack of randomization, small sample size at extremes of follow‐up, lack of outcome validation by chart review and poor generalizability of the results given that only male veterans with CAD were included in this study
    • Nathan Goodyear
       
      The authors here present Total Testosterone as a "confounding" value
    • Nathan Goodyear
       
      This would be HSD-II
  • the studies that failed to find an association between testosterone and CRP used an older population group
  • low testosterone may influence the severity of CAD by adversely affecting the mediators of the inflammatory response such as high‐sensitivity C‐reactive protein, interleukin‐6, and tumor necrosis factor–α
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    Good review of Testosterone and CHD.  Low T is associated with increased all cause mortality and cardiovascular mortality, CAD, CHF, type II diabetes, obesity, increased IMT,  increased severity of CAD and CHF.  Testosterone replacement in men with low T has been shown to improve exercise tolerance in CHF, improve insulin resistance, improve HgbA1c and lower BMI in the obese.
Nathan Goodyear

Testosterone deficiency is associated with increased risk of mortality and testosterone... - 0 views

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    Men with type II diabetes have lower Testosterone levels when compared to none diabetics.  This study found an increased mortality with low T in those with type II Diabetes.  The main association was found with bioavailable Testosterone.  Total Testosterone is proving useless as a functional tool.  Additionally, Testosterone therapy reduced mortality in those with Diabetes.
Nathan Goodyear

Unintended effects of statins from observational studies in the general population: sys... - 0 views

  • A markedly increased risk of myopathy was observed
  • One cohort study (Women’s Health Initiative) of higher quality and larger sample size found stronger evidence of an increased risk of self-reported T2DM (OR=1.47; 95% CI 1.32 to 1.64) for the groups of women who reported statin use at baseline and three years later
  • Hippisley-Cox et al. found an increased risk of liver enzyme changes
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  • weak evidence of an increased risk of type 2 diabetes mellitus (T2DM) was observed
  • Smeeth et al. found an increased risk of incident liver disease in the first year after the index date
  • The cumulative incidence of T2DM after three years of statin treatment was 6.25%, corresponding to an excess risk of 2.25%
  • We found no increased risk of peripheral neuropathy, depression, common eye diseases, renal disorders or arthritis associated with taking statins. Studies of higher quality did not show previously reported protective effects of statins on fractures, venous thrombo-embolism or pneumonia
  • There was evidence of an increase in myopathy, raised liver enzymes and diabetes.
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    Statin use associated with increased myopathy, liver dysfunction, and type II Diabetes.  The authors conclude that the absolute risk is very low, yet OR was 1.47 for type II Diabetes (translated 47% increased odds of developing Diabetes as a result of statins) and OR of 2.63 in risk of myopathy (translated 163% increased odds of developing myopathy as a result of statins).  Seems the authors "low risk" statement is just applies to those without symptoms/side effects.  Physicians need to do a better job of understanding risks and customizing therapies.
Nathan Goodyear

Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyper... - 0 views

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    Insulin therapy in people with type II diabetes shown to increase complications, cancer, and mortality.  The reason?  Insulin is not the problem.  Treat the cause.  Diabetes can not be properly managed without dietary changes and weight loss.
Nathan Goodyear

Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyper... - 0 views

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    not sure if I posted this previously, but new study finds that insulin should be the last thing given to a type II diabetic.  Insulin doubles mortality rate.
Nathan Goodyear

Colonic Microbiota Encroachment Correlates With Dysglycemia in Humans - Cellular and Mo... - 0 views

  • most (86%) were overweight, many (45%) were obese
  • third (14 out of 42) had diabetes
  • in obese persons with diabetes, bacteria could be found in the dense inner mucus and in close proximity to the epithelium
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    Gut bacteria proximity, not just balance and diversity, to mucosa lining linked to systemic inflammation and insulin resistance in type II diabetes.  The role of type II diabetes may simply be the gut.  This has been called metabolic endotoxemia.
Nathan Goodyear

Effect of Testosterone Treatment on Glucose Metabolism in men With Type 2 Diabetes: A R... - 0 views

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    Study finds no improvement with glucose control in diabetics.  This study looked at moderately controlled diabetes. Studies have previously shown that poorly controlled diabetes definitely benefits more than those with more mild glucose control problems.  Additionally, the Testosterone levels in this study would not have met the definition of low T by other studies.  So, the question is did these men need T?  Second, did the authors design the study long enough to see changes in the insulin sensitivity and glucose control?  Abstract only available and thus I don't have access to that information.  Third, and this might support the 2nd point, increased lean mass and decreased fat mass was found.  This points to positive metabolic change.  Would this have, given more time, resulted in improved glucose control? No change in visceral adiposity was seen.  This finding, also, is not new.  Testosterone therapy does not improve visceral adiposity.  Though, increasing fat adiposity, low Testosterone, and associated increase in systemic inflammatory cytokine production results in visceral adiposity, Testosterone therapy does reverse the visceral adiposity.  
Nathan Goodyear

Hypogonadism and Metabolic Syndrome in Nigerian Male Patients With Both Type 2 Diabetes... - 0 views

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    Asian study finds Testosterone is inversely associated with increased central obesity, increased dyslipidemia, and metabolic syndrome in me with new diagnosis of type II diabetes and hypertension.  Men with metabolic syndrome, type II diabetes, and CVD must have appropriate hormone evaluation.
Nathan Goodyear

Effect of Testosterone Treatment on Glucose Metabolism in Men With Type 2 Diabetes: A R... - 0 views

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    Only the abstract available in this publication.  Good study design.  No improvement in insulin resistance, glycemic control or visceral adiposity in obese men with type II diabetes.  The levels of inclusion were TT < 346, which would not meet the criteria put forth by other studies.  This study appeared to look at border line "low T" men with obesity and type II diabetes and found no direct glycemic control improvement.  An increase in lean muscle mass and decrease in subcutaneous fat was found.
Nathan Goodyear

The Evaluation of Serum Levels of Testosterone in Type 2 Diabetic Men and Its Relation ... - 0 views

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    Small study of 2 men with type II diabetes finds fasting glucose levels negatively correlate with total and free Testosterone levels, HgbA1c negatively correlated with SHBG only, total cholesterol and LDL negatively correlated with SHBG and total testosterone.  The prevalence of type II diabetes was higher with low free Testosterone than total Testosterone, but both were statistically significant.
Nathan Goodyear

[Evaluation of relationships between pla... [Pol Merkur Lekarski. 2014] - PubMed - NCBI - 0 views

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    Men with Metabolic Syndrome have lower Total Testosterone values.  Symptoms correlated with age: older men associated with increased symptoms.  This study only found lot T at 6.5%.  The authors in this study have come up with a new box--andropenia.  I don't know what the heck that is and how that helps clients.  If symptoms are present and if levels are on the decline, then symptomatic hypogonadism is present.  I know the logic seems simple, but it appears hard to follow in the science.  I don't see this any different then type II diabetes.  At 126 you have diabetes, but at 125, we don't know what to do with you but see us next year and you will have diabetes and we will know what to do because you are in the box of diabetes.
Nathan Goodyear

Circulating Estrone Levels Are Associated Prospectively With Diabetes Risk in Men of th... - 0 views

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    A cross-sectional study of 1,458 men over a 13 years found an increase risk of diabetes incidence with elevated Estradiol and Estrone levels.  The greatest association was found with Estrone.  This should come as no surprise to anybody as type II diabetes is clearly associated with increasing weight and this is the source of 80% of estrogen production in men.
Nathan Goodyear

[Plasma testosterone, obesity, metabolic syndrome and diabetes]. - Abstract - Europe Pu... - 0 views

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    Androgen deprivation therapy leads to insulin resistance, metabolic syndrome, and type II diabetes in men. Testosterone therapy in men with IR, obesity, metabolic syndrome, and type II Diabetes will result in improved cardiovascular risk.  
Nathan Goodyear

Hypoadiponectinemia in Obesity and Type 2 Diabetes: Close Association with Insulin Resi... - 0 views

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    obesity and type II diabetes found to be associated with low adiponectin and elevated insulin as found in insulin resistance.  This study revealed the inverse relationship of adiponectin and insulin resistance.  The interesting thing is that inflammation causes insulin resistance.  Here you can see the inflammation-insulin resistance-low adiponectin-obesity-diabetes link.
Nathan Goodyear

ScienceDirect.com - Environmental Research - Adipose tissue concentrations of persisten... - 0 views

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    PCBs and organochlorine pesticides associated with increased risk of type II diabetes
Nathan Goodyear

Caffeinated and Decaffeinated Coffee Consumption and Risk of Type 2 Diabetes: A Systema... - 0 views

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    Coffee, whether caffeinated or decaffeinated, is found to reduce the risk of type II diabetes in meta-analysis.  According to the authors, it is the polyphenols that provide the benefits.
Nathan Goodyear

Testosterone Deficiency, Cardiac Health, and Older Men - 0 views

  • Studies have shown pharmacological doses of testosterone to relax coronary arteries when injected intraluminally [39] and to produce modest but consistent improvement in exercise-induced angina and reverse associated ECG changes [40]. The mechanism of action is via blockade of calcium channels with effect of similar magnitude to nifedipine
    • Nathan Goodyear
       
      This directly refutes the recent studies (3) that Testosterone therapy increases cardiovascular events.
    • Nathan Goodyear
       
      Testosterone acts as a calcium channel blocker inducing vasodilation.
  • men with chronic stable angina pectoris, the ischaemic threshold increased after 4 weeks of TRT and a recent study demonstrates improvement continuing beyond 12 months [
  • Exercise capacity in men with chronic heart failure increased after 12 weeks
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  • Studies have shown an inverse relationship between serum testosterone and fasting blood glucose and insulin levels
  • Medications such as chronic analgesics, anticonvulsants, 5ARIs, and androgen ablation therapy are associated with increased risk of testosterone deficiency and insulin resistance
  • Women with T2D or metabolic syndrome characteristically have low SHBG and high free testosterone
    • Nathan Goodyear
       
      This stands in polar opposite of that with men.
  • Hypogonadism is a common feature of the metabolic syndrome
  • The precise interaction between insulin resistance, visceral adiposity, and hypogonadism is, as yet, unclear but the important mechanisms are through increased aromatase production, raised leptin levels, and increase in inflammatory kinins
  • levels of testosterone are reduced in proportion to degree of obesity
  • Men should be encouraged to combine aerobic exercise with strength training. As muscle increases, glucose will be burned more efficiently and insulin levels will fall. A minimum of 30 minutes exercise three times weekly should be advised
  • Testosterone increases levels of fast-twitch muscle fibres
  • By increasing testosterone, levels of type 2 fibres increase and glucose burning improves
  • Weight loss will increase levels of testosterone
  • studies now clearly show that low testosterone leads to visceral obesity and metabolic syndrome and is also a consequence of obesity
  • In the case of MMAS [43], a baseline total testosterone of less than 10.4 nmol/L was associated with a greater than 4-fold incidence of type 2 diabetes over the next 9 years
  • There is high level evidence that TRT improves insulin resistance
  • Low testosterone predicts increased mortality and testosterone therapy improves survival in 587 men with type 2 diabetes
  • A similar retrospective US study involved 1031 men with 372 on TRT. The cumulative mortality was 21% in the untreated group versus 10% ( ) in the treated group with the greatest effect in younger men and those with type 2 diabetes
  • the presence of ED has been shown to be an independent risk factor, particularly in hypogonadal men, increasing the risk of cardiac events by over 50%
  • A recent online publication on ischaemic heart disease mortality in men concluded optimal androgen levels are a biomarker for survival
  • inverse associations between low TT or FT (Table 2) and the severity of CAD
  • A recent 10 year study from Western Australia involving 3690 men followed up from 2001–2010 concluded that TT and FT levels in the normal range were associated with decreased all-cause and cardiovascular mortality, for the first time suggesting that both low and DHT are associated with all-cause mortality and higher levels of DHT reduced cardiovascular risk
  • TDS is associated with increased cardiovascular and all-cause mortality
  • The effect of treatment with TRT reduced the mortality rate of treated cohort (8.4%) to that of the eugonadal group whereas the mortality for the untreated remained high at 19.2%
  • hypogonadal men had slightly increased triglycerides and HDL
  • Men with angiographically proven CAD (coronary artery disease) have significantly lower testosterone levels [29] compared to controls ( ) and there was a significant inverse relationship between the degree of CAD and TT (total testosterone) levels
  • TRT has also been shown to reduce fibrinogen to levels similar to fibrates
  • men treated with long acting testosterone showed highly significant reductions in TC, LDL, and triglycerides with increase in HDL, associated with significant reduction in weight, BMI, and visceral fat
  • Low androgen levels are associated with an increase in inflammatory markers
  • In the Moscow study, C-reactive protein was reduced by TRT at 30 weeks versus placebo
  • In some studies, a decline in diastolic blood pressure has been observed, after 3–9 months [24, 26] and in systolic blood pressure
  • A decline was noted in IL6 and TNF-alpha
  • No studies to date show an increase in LUTS/BPH symptoms with higher serum testosterone levels
  • TRT has been shown to upregulate PDE5 [65] and enhance the effect of PDE5Is (now an accepted therapy for both ED and LUTS), it no longer seems logical to advice avoidance of TRT in men with mild to moderate BPH.
    • Nathan Goodyear
       
      What about just starting with normalization of Testosterone levels first.
  • Several meta-analyses have failed to show a link between TRT and development of prostate cancer [66] but some studies have shown a tendency for more aggressive prostate cancer in men with low testosterone
    • Nathan Goodyear
       
      And if one would have looked at their estrogen levels, I guarantee they would have been found to be elevated.
  • low bioavailable testosterone and high SHBG were associated with a 4.9- and 3.2-fold risk of positive biopsy
  • Current EAU, ISSAM, and BSSM guidance [1, 2] is that there is “no evidence TRT is associated with increased risk of prostate cancer or activation of subclinical cancer.”
  • Men with prostate cancer, treated with androgen deprivation, develop an increase of fat mass with an altered lipid profile
  • Erectile dysfunction is an established marker for future cardiovascular risk and the major presenting symptom leading to a diagnosis of low testosterone
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