Injectable testosterone shown to increase Estradiol production and negatively influence the E2:T ratio in older, obese men. This is no surprise as age and obesity are known to increase aromatase activity. I am really surprised that no discussion of aromatase inhibition was discussed.
only abstract available here. Mouse model finds possible explanation for low Testosterone and diabetes link. Actually, the link is between the metabolite DHT and the AR. The activity of AR from DHT binding induces beta cell insulin secretion in the presence of glucose. This is dependent on glucagon-like peptide 1 receptor activation also, which AR activation by DHT does in fact do.
highest concentration occurring at about 8:00 a.m. and the lowest at about 8:00 p.m.
Average serum concentrations and diurnal variation in testosterone diminish as men age
40% is sequestered with high affinity to sex hormone-binding globulin (SHBG)
almost 60% is bound with low affinity to albumin
2% as free, unbound hormone
5α-DHT has even greater binding affinity to sex hormone-binding globulin than does testosterone
5α-DHT is only about 5% as abundant in the blood as testosterone and is largely derived from peripheral metabolism of testosterone
Both 5α-reduction and aromatization are irreversible processes
Approximately 90% of an oral dose of testosterone is metabolized before it reaches the systemic circulation
there are three modes of action of testosterone. It may directly act through AR in target tissues where 5α-reductase is not expressed, be converted to 5α-DHT (5–10%) by 5α-reductase before binding to AR, or be aromatized to estrogen (0.2%) and act through the estrogen receptor
5α-DHT is a more potent AR ligand than testosterone
has 2–10-fold higher potency than testosterone in androgen-responsive tissues
estrogen plays a major role in regulating metabolic process,74,75 mood and cognition,76 cardiovascular disease,77,78 sexual function including libido,79 and bone turnover in men
Free testosterone is considered the most “biologically active” form
testosterone is the major androgen that acts in the “DHT-independent” tissues, such as skeletal muscle, where 5α-reductase is not expressed or is expressed at a very low level
Estradiol in men inhibits apoptosis. Testosterone promotes apoptosis. Thus the decreasing T:E2 ratio in men as they age is an important step in the development of prostate cancer.
P metabolites produced within breast tissues might be independently active hormones functioning as cancer-promoting
or -inhibiting regulatory agents
these P metabolites function as independent pro-or anti-cancer autocrine/paracrine
hormones that regulate cell proliferation, adhesion, apoptosis and cytoskeletal, and other cell status molecules via novel
receptors located in the cell membrane and intrinsically linked to cell signaling pathways
only a fraction of all breast cancer patients
respond to this estrogen-based therapy and the response is only temporary
P serves as the precursor for the major steroid hormones (androgens, estrogens,
corticosteroids) produced by the gonadal and adrenal cortical tissues.
5α-pregnane, 5β-pregnane, and 4-pregnene metabolites of P
These P-metabolizing enzymes included 5α-reductase, 5β-reductase, 3α-hydroxysteroid oxido-reductase (3α-HSO), 3β-HSO, 20α-HSO,
20β-HSO, 6α(β)-, 11β-, 17-, and 21-hydroxylase, and C17–20-lyase
Reduction
of P to 5α-pregnanes is catalyzed by 5α-reductase and the direct 5α-reduced metabolite of P is 5α-pregnane-3,20-dione (5αP).
The 5α-reductase reaction is irreversible
The two 4-pregnenes resulting from direct P conversion are 4-pregnen-3α-ol-20-one (3αHP) and 4-pregnen-20α-ol-3-one (20αHP),
catalyzed by the actions of 3α-HSO and 20α-HSO respectively
the P-metabolizing
enzyme activities identified in human breast tissues and cell lines were: 5α-reductase, 3α-HSO, 3β-HSO, 20α-HSO, and 6α-hydroxylase
In normal breast tissue, conversion to 4-pregnenes greatly exceeded the conversion to 5α-pregnanes,
whereas in tumorous tissue, conversion to 5α-pregnanes greatly exceeded that to 4-pregnenes
The results indicated that
P 5α-reductase activity is significantly higher, whereas P 3α-HSO and 20α-HSO activities are significantly lower in tumor
than in normal tissues
he results showed that production of 5α-pregnanes was higher and that of 4-pregnenes was lower in tumorigenic (e.g. MCF-7)
than in nontumorigenic (e.g. MCF-10A) cells (Fig. 3c⇑), while differences in ER/P status did not appear to play a role
The 5α-pregnane-to-4-pregnene ratios were 7- to 20-fold higher in the tumorigenic than in the nontumorigenic cell lines
altered direction in P metabolism, and hence in metabolite ratios, was due
to significantly elevated 5α-reductase and depressed 3α- and 20α-HSO activities in breast tumor tissues and tumorigenic cells.
It appeared, therefore, that changes in P-metabolizing enzyme activities might be related to the shift toward mammary cell
tumorigenicity and neoplasia
In vivo, changes in enzyme activity can result from changes in levels of the enzyme due to changes in expression of the mRNA coding
for the enzyme, or from changes in the milieu in which the enzyme operates (such as temperature and pH, and concentrations
of cofactors, substrates, products, competitors, ions, phospholipids, and other molecules)
Overall, the enzyme activity and expression studies strongly suggest that 5α-reductase stimulation and 3α- and 20α-HSO suppression
are associated with the transition from normalcy to cancer of the breast
The level of expression of 5α-reductase is up-regulated by estradiol and P in the uterus (Minjarez et al. 2001) and by 5α-dihydrotestosterone (DHT) in the prostate
Stimulation in cell numbers was also observed when cells were treated with other 5α-pregnanes, such as 5α-pregnan-3α-ol-20-one,
5α-pregnan-20α-ol-3-one, and 5α-pregnane-3α,20α-diol, whereas other 4-pregnenes such as 20α-HP and 4-pregnene-3α,20α-diol
resulted in suppression of cell proliferation
Stimulation of cell proliferation with 5αP and inhibition with 3αHP were also observed in all other breast cell lines examined,
whether ER/P-negative (MCF-10A, MDA-MB-231) or ER/P-positive (T47D, ZR-75-1) and whether requiring estrogen for tumorigenicity
(MCF-7, T47D) or not (MDA-MB-231), or whether they are nontumorigenic (
αHP resulted in significant increases in apoptosis and decreases in mitosis, leading to significant decreases in total
cell numbers. In contrast, treatment with 5αP resulted in decreases in apoptosis and increases in mitosis.
The opposing actions of 5αP and 3αHP on both cell anchorage and proliferation strengthen the hypothesis that the direction
of P metabolism in vivo toward higher 5α-pregnane and lower 4-pregnene concentrations could promote breast neoplasia and lead to malignancy.
he effects on proliferation and adhesion were not due to P, but
due to the 5α-reduced metabolites
The studies showed that binding of 5αP or 3αHP occurs in the plasma membrane fractions, but not in the nuclear or cytosolic
compartments
separate high-specificity, high-affinity, low- capacity receptors for 5αP and
3αHP that are distinct from each other and from the well-studied nuclear/cytosolic P, estrogen, and androgen and corticosteroid
receptors
The studies thus provided the first demonstration of the existence of specific P metabolite receptors
the receptor results suggest that
the putative tumorigenic actions of 5αP may be significantly augmented by the estradiol-induced increases in 5αP binding and
decreases in 3αHP binding.
Estradiol and 5αP resulted in significant dose-dependent increases, whereas 3αHP and 20αHP each resulted in dose-dependent
decreases in total ER
In combination, estradiol + 5αP or 3αHP
+ 20αHP resulted in additive increases or decreases respectively in ER numbers.
The data suggest that the action of 5αP on breast cancer cells
involves modulation of the MAPK signaling pathway
current evidence does not appear to support the notion that increased 5α-reductase activity/
expression might significantly alter androgen influences on breast tumor growth.
both testosterone and DHT inhibit cell growth more or less to the same extent
Fantastic read on the effects of progesterone metabolism on tumor and cancer growth. Tumorigenesis is not just about the hormone, hormone balance, but about the metabolism of hormones. This is why premarin is so carcinogenic: it is primarily metabolized by the 4-OH estrone pathway.
Men with BPH found to have higher levels of stromal Estradiol and Estrone. This is associated with aging. This elevation was not found in the prostate epithelium. No correlation with Testosterone and the stroma and epithelium were found. So, the point is that what is happening in the prostate appears to be related to increased aromatase activity in the prostate. Which this has been shown to be evident in the lateral lobes of the prostate in other studies. But DHT? The numbers here are slightly elevated. BUt the balance of DHT to Estradiol may be more important than the individual levels. This study was done in humans.
up to 40% of men with T2DM have testosterone deficiency
Among diabetic patients, a reduction in sex hormone binding globulin levels induced by insulin resistance leads to a further decline of testosterone levels
low bioavailable testosterone concentration was related to decreased lean body mass and muscle strength
Testosterone deficiency has a high prevalence in men with T2DM, and it is also associated with impaired insulin sensitivity, increased percentage body fat, central obesity, dyslipidemia, hypertension and cardiovascular diseases (CVD)
A meta-analysis of four randomized controlled trials (RCTs) showed that TRT seemed to improve glycemic control as well as fat mass in T2DM subjects with low testosterone levels and sexual dysfunction.
testosterone administration could increase muscle mass and strength
Insulin stimulates glucose uptake into muscle and adipose tissue via the Glut4 glucose transporter isoform. When insulin activates signaling via the insulin receptor, Glut4 interacts with insulin receptor substrate 1 to initialize intracellular signaling and facilitate glucose transportation into the cell
The benefits of TRT on glucose metabolism can mainly be explained by its influence on the insulin signaling pathway
Insulin resistance as assessed by, which is calculated from the equation (If*Gf/22.5, where If is fasting insulin and Gf is fasting glucose), was definitely improved by TRT after testosterone administration in three studies
Testosterone was observed to elevate the expression levels and stimulate translocation of Glut4 in cultured skeletal muscle cells and to upregulate Glut4 by activating insulin receptor signaling pathways in neonatal rats
These effects were inhibited by a dihydrotestosterone (DHT) blocker, indicating that glucose uptake may correlate with conversion of testosterone to DHT and activation of the androgen receptor.
TRT reduced triglyceride levels
TRT has been reported to have a positive effect in the decrease of total and LDL cholesterol levels and triglycerides in hypogonadal men
a recent meta-analysis showed that statins could significantly lower testosterone concentrations.
Epidemiological studies have found a negative relationship between testosterone levels and typical cardiovascular risk markers, such as body mass index, waist circumference, visceral adiposity and carotid intima-media thickness.
Testosterone treatment was shown to raise hemoglobin, hematocrit and thromboxane, all of which might give rise to CVD
Low Testosterone is a very significant problem in men with type II Diabetes. Estimated to reach 40%, likely much higher. They based these estimates only on T levels and sexual symptoms.
Testosterone improves glycemic control primarily through Increased transcription and transloction of GLUT4 insulin receptors to the cell surface. Inflammation reduction is also a mechanism. Testosteorne lowers Triglycerides in the traditional lipid profile. Studies are mixed on the other aspects of lipids.
diacylglycerol O-acyltransferase 2 (DGAT2), mechanistically implicated in this differential storage, [10] is regulated by dihydrotestosterone, [11] suggesting a potential role for androgens to influence the genetic predisposition to either the MHO or MONW phenotype.
bariatric surgery achieves 10%-30% long-term weight loss in controlled studies
The fact that obese men have lower testosterone compared to lean men has been recognized for more than 30 years
Reductions in testosterone levels correlate with the severity of obesity and men
epidemiological data suggest that the single most powerful predictor of low testosterone is obesity, and that obesity is a major contributor of the age-associated decline in testosterone levels.
healthy ageing by itself is uncommonly associated with marked reductions in testosterone levels
obesity blunts this LH rise, obesity leads to hypothalamic-pituitary suppression irrespective of age which cannot be compensated for by physiological mechanisms
Reductions in total testosterone levels are largely a consequence of reductions in sex hormone binding globulin (SHBG) due to obesity-associated hyperinsulinemia
although controversial, measurement of free testosterone levels may provide a more accurate assessment of androgen status than the (usually preferred) measurement of total testosterone in situations where SHBG levels are outside the reference range
SHBG increases with age
marked obesity however is associated with an unequivocal reduction of free testosterone levels, where LH and follicle stimulating hormone (FSH) levels are usually low or inappropriately normal, suggesting that the dominant suppression occurs at the hypothalamic-pituitary level
adipose tissue, especially when in the inflamed, insulin-resistant state, expresses aromatase which converts testosterone to estradiol (E 2 ). Adipose E 2 in turn may feedback negatively to decrease pituitary gonadotropin secretion
diabetic obesity is associated with decreases in circulatory E 2
In addition to E 2 , increased visceral fat also releases increased amounts of pro-inflammatory cytokines, insulin and leptin; all of which may inhibit the activity of the HPT axis at multiple levels
In the prospective Massachusetts Male Aging Study (MMAS), moving from a non-obese to an obese state resulted in a decline of testosterone levels
weight loss, whether by diet or surgery, increases testosterone levels proportional to the amount of weight lost
fat is androgen-responsive
low testosterone may augment the effects of a hypercaloric diet
In human male ex vivo adipose tissue, testosterone decreased adipocyte differentiation by 50%.
Testosterone enhances catecholamine-induced lipolysis in vitro and reduces lipoprotein lipase activity and triglyceride uptake in human abdominal adipose tissue in vivo
in men with prostate cancer receiving 12 months of androgen deprivation therapy, fat mass increased by 3.4 kg and abdominal VAT by 22%, with the majority of these changes established within 6 months
severe sex steroid deficiency can increase fat mass rapidly
bidirectional relationship between testosterone and obesity
increasing body fat suppresses the HPT axis by multiple mechanisms [30] via increased secretion of pro-inflammatory cytokines, insulin resistance and diabetes; [19],[44] while on the other hand low testosterone promotes further accumulation of total and visceral fat mass, thereby exacerbating the gonadotropin inhibition
androgens may play a more significant role in VAT than SAT
men undergoing androgen depletion for prostate cancer show more marked increases in visceral compared to subcutaneous fat following treatment
Interesting: low T increases VAT, yet T therapy does not reduce VAT, yet T therapy reduces SAT.
irisin, derived from muscle, induces brown fat-like properties in rodent white fat
androgens can act via the PPARg-pathway [37] which is implicated in the differentiation of precursor fat cells to the energy-consuming phenotype
low testosterone may compound the effect of increasing fat mass by making it more difficult for obese men to lose weight via exercise
pro-inflammatory cytokines released by adipose tissue may contribute to loss of muscle mass and function, leading to inactivity and further weight gain in a vicious cycle
Sarcopenic obesity, a phenotype recapitulated in men receiving ADT for prostate cancer, [55] may not only be associated with functional limitations, but also aggravate the metabolic risks of obesity;
observational evidence associating higher endogenous testosterone with reduced loss of muscle mass and crude measures of muscle function in men losing weight
genuine reactivation of the HPT axis in obese men requires more substantial weight-loss
A number of intervention studies have confirmed that both diet- and surgically-induced weight losses are associated with increased testosterone, with the rise in testosterone generally proportional to the amount of weight lost
men, regardless of obesity level, can benefit from the effect of weight loss.
Even back in 1980, DHT metabolism was known. Elderly men, 3alpha oxidoreductase is decreased resulting in decreased DHT to 3-alpha-diol. This study discussed the DHT metabolite as inactive. We now know that is not the case.
Article discusses the the conversion of 3-alpha-diol back to DHT and this role in prostate cancer in androgen deprivation therapy. What we now know is that this metabolite interacts with ER alpha receptor to promote proliferation. Carcinogenesis appears to be primarily an estrogen driven process and her in prostate cancer, the androgen metabolites are promoting proliferation through estrogen receptors.
the dihydrotestosterone
metabolite 5α-androstane-3β,17β-diol (3β-Adiol), a steroid which does not bind androgen receptors, but efficiently binds the
estrogen receptor β (ERβ), exerts a potent inhibition of prostate cancer cell migration through the activation of the ERβ
signaling
estradiol is not active
3β-Adiol, through ERβ, induces the expression of E-cadherin, a protein known to be capable
of blocking metastasis formation in breast and prostate cancer cells
DHT metabolite 3-beta androstanediol inhibits prostate cancer via its interaction with ER beta not AR. This study finds increased E-cadherin transcription to reduce metastasis. Estrogen was not active, according to this study. This implies that estrogen in early disease may have a different signal than late.
Study finds that "midrange" Testosterone and DHT associated with a reduced ischemic heart disease and death rate. No association was found with Estradiol. One flaw of this study is in their use of serum.
Mouse study finds that DHT metabolite provides negative feedback to HPA via 3beta androstaendiol. What is interesting is that this signaling occurred through ER beta. Androgen signaling processed through estrogen receptors.