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Nathan Goodyear

Testosterone and metabolic syndrome Cunningham GR - Asian J Androl - 0 views

www.ajandrology.com/article.asp

Testosterone metabolic syndrome MetS TT total Testosterone SHBG men male hormone hormones Estradiol insulin resistance

shared by Nathan Goodyear on 02 Mar 15 - No Cached
  • The relationship of low testosterone to MetS often is considered to be bidirectional; however, the relationships probably are not direct
  • Many of the components of the MetS are recognized risk factors for the development of cardiovascular disease (CVD)
  • Multiple cross-sectional studies have found low TT and low sex hormone binding globulin (SHBG) levels in Caucasian and African-American men with the MetS, irrespective of age
  • ...20 more annotations...
  • Low TT and SHBG levels also are prevalent in Chinese [7],[8] and Korean [9] men with the MetS
  • Normally 40%-50% of TT is bound to SHBG, so reducing SHBG levels will decrease TT.
  • Hyperinsulinism suppresses SHBG synthesis and secretion by the liver
  • significant increase in SHBG levels occurred after acutely lowering insulin levels in obese men
  • Estradiol levels are increased in men with the MetS, and they are positively correlated with the number of abnormal components of the MetS.
  • Although it is known that estrogen will increase SHBG levels, apparently the hyperinsulinism associated with obesity has a greater effect on SHBG levels
  • Estradiol also can inhibit luteinizing hormone (LH) secretion
  • Inflammatory cytokines are thought to have a direct effect on the pituitary to reduce LH secretion [15] and also a direct effect on Leydig cell secretion of testosterone
  • Low TT Levels have been shown to predict development of the MetS in men with normal BMI
  • Men in the lowest quartiles of serum TT, calculated free testosterone (cFT) and SHBG at baseline had the highest odds ratios for developing the MetS or DM during the 11 years follow-up
  • More recently, investigators conducting population-based studies have reported that only SHBG is associated with future development of the MetS
  • Additional evidence that low TT increases the risk of MetS comes from androgen deprivation treatment of prostate cancer
  • Low TT and low bioavailable testosterone (bT) were each significantly associated with elevated 20 years risk of CVD mortality in an older population in which cause-specific mortality was age, adiposity, and lifestyle-adjusted.
  • combination of low bT and ATP III-defined MetS is associated with increased cardiovascular mortality in men aged 40 years and above
  • in elderly men, testosterone may weakly protect against CVD. Alternatively, low TT may indicate poor general health
  • Muraleedharan and Jones [27] concluded that there is convincing evidence that low T is a biomarker for disease severity and mortality.
  • The evidence that TRT improves insulin sensitivity and glucose control is conflicted
  • It is widely recognized that testosterone treatment can reduce fat mass and increase lean body mass; however, until recently most reports have not been associated with much weight loss
  • Changes in body composition and weight loss are considered potential mechanisms by which testosterone treatment improves insulin sensitivity and glucose control in patients with diabetes. Effects on inflammatory cytokines [38] and changes in oxidative metabolism [39] also have been reported to improve glucose metabolism.
  • Testosterone replacement therapy has been reported to improve some or all of the components of the MetS.
  • Nathan Goodyear on 02 Mar 15
     
    To be read article on Testosterone and Metabolic Syndrome.
Nathan Goodyear

Hypothalamic-Pituitary-Testicular Axis Disruptions in Older Men Are Differentially Link... - 0 views

press.endocrine.org/...jc.2007-1972

low T low Testosterone low T Testosterone aging LH hormone hormones men male SHBG

shared by Nathan Goodyear on 03 Sep 14 - No Cached
  • 0.4–2% annual decline
  • the age trend in free T was more substantial (−1.3% per annum)
  • The core hormonal pattern with increasing age is suggestive of incipient primary testicular dysfunction with maintained total T and progressively blunted free T associated with higher LH.
  • ...16 more annotations...
  • Obesity was associated with progressively lower total and free T independent of the simultaneous decrease in SHBG.
  • our data highlight the fact that LH was unchanged or even lower in older men in the face of lower T in obesity, suggesting that there may be a failure at the hypothalamic-pituitary level.
  • a change in BMI from nonobese to obese may be equivalent to a 15 yr fall in T.
  • This pattern supports the hypothesis that different underlying mechanisms influence the functions of the HPT axis: age predominantly affects testicular function, whereas obesity impairs hypothalamic/pituitary function.
  • the effects of aging on testicular function can be moderated by increased LH compensation for many decades
  • obesity impairs hypothalamic/pituitary function independent of age, arguably an adaptive response for which there should be no compensatory mechanism.
  • the concurrent but opposite (and separate) effects of obesity and age on SHBG
  • SHBG was negatively associated with increasing strata of obesity
  • Obesity is associated with insulin resistance (28), and the increased circulating insulin inhibits hepatic SHBG synthesis
  • the SHBG increase with age may be related to relative IGF-I deficiency (27), although this has not been directly proven.
  • Obesity is associated with peripheral and central insulin resistance (30) and proinflammatory cytokine production (TNFα and IL-6) from adipocytes (31) and central nervous system endocannibinoid release (32), all of which are potential candidates for abrogating hypothalamic endocrine and downstream reproductive axis functions.
    • Nathan Goodyear
      Nathan Goodyear on 03 Sep 14
       
      The HPA axis effect may be the result of inflammation.
  • The relationship between obesity and T can be bidirectional: low T may be the cause rather than consequence of obesity
  • chronic alcohol abuse is known to suppress LH (40), our data showed no significant association among the three hormones or SHBG and alcohol intake.
  • increase in total T in smokers occurs through a primary increase in SHBG with a compensatory rise in LH
  • the effects of obesity (BMI or waist circumference) was by far the most important determinant of variance in total T, whereas age per se was important for SHBG, LH, and free T with comorbidity and smoking being comparatively minor contributors
  • It is noteworthy that these predisposing lifestyle and health factors are modifiable. This implies that the apparent age-related decline in T may constitute a barometer of health and thus be potentially preventable and/or reversible.
  • Nathan Goodyear on 03 Sep 14
     
    Age induced decline in Testosterone is more associated with a decline in leydig cell function and thus elevated LH will be associated.  In contrast, obesity is more of a HPA axis disruption and thus LH may be normal to low.  The pulse amplitude is decrease.  No change in pulse frequency is noted.   With obesity, a decline in TT and fT was independent of SHBG. Aging is associated with a greater decrease in fT versus TT.
Nathan Goodyear

http://www.nature.com/ijo/journal/v24/n2s/pdf/0801281a.pdf?origin=publication_detail - 0 views

www.nature.com/...0801281a.pdf

SHBG IR insulin resistance insulin Estrogen Estradiol obesity hormone hormones

shared by Nathan Goodyear on 02 Mar 15 - No Cached
  • Nathan Goodyear on 02 Mar 15
     
    Elevated insulin levels in men is associated with decreased liver production of SHBG and thus reduced SHBG levels.  Obesity is associated with decreased urinary cortisol in this study.  The authors found the low cortisol also contributed to the low SHBG as well. Low SHBG is associated with puberty, obesity, IR, hypothyroidism, and during androgen therapy.  SHBG is increased as a result of aging, short-term fasting, Estrogen, hyperthyroid, and liver disease.
Nathan Goodyear

Secular Decline in Male Testosterone and Sex Hormone Binding Globulin Serum Levels in D... - 0 views

jcem.endojournals.org/...4696.long

decline male testosterone hormone danish low t low Testosterone men SHBG serum levels

shared by Nathan Goodyear on 10 Dec 12 - No Cached
  • Serum SHBG levels are negatively associated with obesity and various measures of insulin resistance
  • SHBG levels increase during pharmacological oral estrogen treatment
  • insulin decreases SHBG productio
  • ...5 more annotations...
  • The secular decline in SHBG and testosterone serum levels did not lead to a change in the level of free testosterone
  • existence of specific binding sites for SHBG at the cell membrane of steroid-responsive tissues has been shown
  • it is alarming that changes of this magnitude can be detected over such a relatively short time
  • Sex steroids stimulate SHBG production and secretion in vitro
  • Serum testosterone levels decreased and SHBG levels increased with increasing age
  • Nathan Goodyear on 10 Dec 12
     
    lower levels of SHBG and serum testosterone were found in more recently born men.  Preceding generations of men produced higher testosterone levels than men born in more recent generations.
Nathan Goodyear

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

jama.jamanetwork.com/article.aspx

SHBG Diabetes type II DM testosterone hormone hormones

shared by Nathan Goodyear on 11 Jun 13 - No Cached
  • 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
  • ...1 more annotation...
  • the inverse association of SHBG was stronger in women than in men
  • Nathan Goodyear on 11 Jun 13
     
    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

ENDOGENOUS SEX HORMONES, BLOOD PRESSURE CHANGE, AND RISK OF HYPERTENSION IN POSTMENOPAU... - 0 views

www.ncbi.nlm.nih.gov/...PMC3428144

hormone hormones Testosterone Estradiol Estrogen women CVD cardiovascular disease female SHBG hypertension post-menopause blood pressure

shared by Nathan Goodyear on 02 Feb 15 - No Cached
  • Among postmenopausal women, serum T was elevated in hypertensive participants [9, 11, 12], and total T, free T, and DHEA were positively correlated with SBP
  • T and DHEA were attenuated by adjustment for BMI, reflecting either a confounding or a mediating effect of obesity
  • SHBG concentration was inversely associated with risk of hypertension and longitudinal rise of BP over time
  • ...8 more annotations...
  • SHBG has been postulated as a marker for insulin resistance
  • In vitro studies showed that insulin inhibits SHBG production from hepatoma cells
  • In intervention studies, successful weight loss and weight maintenance increased SHBG in men with obesity
  • E2 may also induce insulin resistance and thereafter tend to raise BP.
  • strong association between E2 and measures of insulin resistance in postmenopausal women, independent of adiposity
  • In postmenopausal women that received hormone replacement therapy, estrogen therapy increased mononuclear cell secretion of tumor necrosis factor alpha (TNF-α)
  • estrone levels were positively associated with inflammatory markers in postmenopausal women
  • higher baseline concentrations of endogenous E2, total and bioavailable T, and DHEA and lower concentration of SHBG were associated with a higher incidence of hypertension and a greater increase in BP during follow-up
  • Nathan Goodyear on 02 Feb 15
     
    Data from MESA study finds that increasing endogenous Estradiol, Total and free Testosterone, DHEA, and lower SHBG were associated with hypertension in postmenopausal women.
Nathan Goodyear

Regulation of production and secretion of sex hormone-binding globulin in HepG2 cell cu... - 0 views

jcem.endojournals.org/...160.abstract

SHBG hormones insulin IGF-1 EGF estradiol testosterone T3 cortisol

shared by Nathan Goodyear on 11 Dec 12 - No Cached
  • Nathan Goodyear on 11 Dec 12
     
    SHBG and hormones.  Insulin, IGF-1, and EGF decrease SHBG levels.  Contrast that with estradiol, testosterone, T3, and cortisol that increase SHBG
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

Nature Clinical Practice Endocrinology & Metabolism | Testosterone and ill-health in ag... - 0 views

www.nature.com/...ncpendmet1050.html

low T Testosterone health men male hormone hormones metabolic syndrome metabolic syndrome MetS insulin resistance diabetes aging

shared by Nathan Goodyear on 03 Mar 14 - No Cached
  • Levels of total and bioavailable testosterone and SHBG were reported to be inversely correlated with the prevalence of the metabolic syndrome in men aged 40–80 years
  • as were total testosterone and SHBG in men aged 65–96 years
  • and in a cross-sectional analysis of a large cohort of non-diabetic men aged 70–89 years
  • ...18 more annotations...
  • In longitudinal studies, decreased levels of total testosterone and SHBG predicted an increased incidence of metabolic syndrome in nonobese men
  • Free testosterone level is not associated with the prevalence of metabolic syndrome in middle-aged and older men
  • Levels of free, bioavailable and total testosterone are lower in men with T2DM than in age-matched controls,34, 35 and decreased total testosterone level predicts incident T2DM in middle-aged men.
  • men with T2DM commonly have low total or free testosterone levels
  • Total, bioavailable and free testosterone levels are inversely correlated with fasting insulin level and insulin resistance in middle-aged men without T2DM
  • total testosterone is positively correlated with insulin sensitivity in men with normal or impaired glucose tolerance or T2DM
  • low SHBG level is more strongly associated with metabolic syndrome than low total testosterone in aging men
  • the recognized association between low SHBG level and insulin resistance
  • Low levels of SHBG are also associated with smaller, denser LDL-cholesterol molecules in nondiabetic men,58 and were found to predict increased cardiovascular disease mortality in one study of older men
  • Low levels of SHBG might reflect obesity, insulin resistance and overall poor health
  • Compared with those who have normal testosterone levels, men aged 40 years or more with total testosterone levels <9.8 nmol/l or elevated LH level have greater CIMT
  • In men aged 73–94 years, total testosterone was inversely correlated with CIMT
  • a prospective analysis of men aged 73–91 years, progression of CIMT was not related to total testosterone level, but it was inversely related to free testosterone level
  • A study of men aged 55 years or more found that those with total and bioavailable testosterone levels in the highest tertile had a lower risk of severe aortic atherosclerosis (detected by radiography as abdominal aortic calcification) than those with the lowest testosterone levels.
  • a large study of men aged 69–80 years, those with total or free testosterone in the lowest quartile had increased odds of lower-extremity peripheral arterial disease
  • the possibility of reverse causation has to be considered, as systemic illness can result in decreased testosterone levels
  • previous case–control studies and longitudinal studies have failed to identify low testosterone levels as strong predictors of clinically significant coronary disease
  • Reviews of trials on testosterone therapy in men with either low or low-to-normal testosterone levels have not shown consistent beneficial effects either on lipid profiles or on actual cardiovascular events.24, 54, 55 These trials, however, have not been designed or powered to detect treatment-related differences in cardiovascular outcome
  • Nathan Goodyear on 03 Mar 14
     
    Declining Testosterone or low Testosterone is clearly associated with poor health in men.   Very nice review of the association between low Testosterone and metabolic dysfunction.  Low T is associated with increased metabolic syndrome, Diabetes, weight gain, insulin resistance...
Nathan Goodyear

Serum levels of sex hormone-binding globulin (SHBG) are not associated with lower level... - 0 views

www.ncbi.nlm.nih.gov/...15807883

SHBG Testosterone men male hormone hormones

shared by Nathan Goodyear on 01 May 15 - No Cached
  • Nathan Goodyear on 01 May 15
     
    Age increases SHBG.  This study doesn't find a correlation with non-SHBG Testosterone in "health" men.  The term health is probably key.
Nathan Goodyear

Inverse association between serum insulin and sex hormone-binding globulin in a populat... - 0 views

www.endocrineconnections.com/...18.full

SHBG insulin hormone hormones diabetes

shared by Nathan Goodyear on 07 Aug 14 - No Cached
  • Nathan Goodyear on 07 Aug 14
     
    Low SHBG associated with elevated insulin levels. This was found in both sexes.  Low SHBG associated with type II Diabetes, but Increased SHBG found to be associated with Type I Diabetes.
Nathan Goodyear

http://www.hairlosshelp.com/pdf/insulin.pdf - 0 views

www.hairlosshelp.com/...insulin.pdf

insulin SHBG Testosterone male men hormone hormones obese obesity

shared by Nathan Goodyear on 03 Mar 15 - No Cached
  • Nathan Goodyear on 03 Mar 15
     
    Men with Obesity are found to have lower SHBG and Testosterone levels.  This study found that suppression of insulin resulted in an increase in SHBG production from the liver in both obese and normal weight men.  Of note, the decrease in insulin resulted in a decrease in male Testosterone in both normal weight and obese men.
Nathan Goodyear

Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Me... - 0 views

press.endocrine.org/...jcem.86.2.7219

low t low Testosterone Testosterone SHBG FAI free androgen index male hormone hormones aging obesity

shared by Nathan Goodyear on 30 Mar 15 - No Cached
  • NUMEROUS CROSS-SECTIONAL INVESTIGATIONS have demonstrated lower concentrations of circulating testosterone (T) and/or free T in older men
  • Two small-scale longitudinal investigations have observed decreases, with aging, in total T
  • T levels decline at a more or less constant rate, with age, in men, with no period of accelerated decline
  • ...15 more annotations...
  • aging in men is associated with decreases in bone mineral density (BMD) (18, 19), lean body and muscle mass
  • strength (22, 23) and aerobic capacity (24), as well as with increases in total and abdominal body fat, low-density lipoprotein cholesterol, and/or low-density lipoprotein/high-density lipoprotein cholesterol ratios (25, 26, 27, 28), all of which also occur in nonelderly hypogonadal men
  • Most (1, 5, 6, 7, 8, 9), but not all (10, 11, 12), cross-sectional studies have demonstrated a decrease, with age, in total T in men
    • Nathan Goodyear
      Nathan Goodyear on 30 Mar 15
       
      FAI: 100 x total Testosterone nmol/L/SHBG nmol/L
    • Nathan Goodyear
      Nathan Goodyear on 30 Mar 15
       
      These numbers do point to an increase in ng/dl decline in Total Testosterone with increasing age (decade group)
  • total T, but not free T index, tended to decrease with greater BMI is consistent with prior studies showing that obesity is associated with decreases in both SHBG and total T, with an unchanged T-to-SHBG ratio
  • The conventional definition for T levels is statistical (values more than 2 sd below the mean), rather than functional. Such a definition does not reflect clinical realities, such as the existence of characteristic individual set points for circulating hormone levels, below which one, but not another, individual may develop metabolic changes of hormone deficiency; nor does it address the concept of reserve capacity, the possibility that persons with hormone levels 2 sd below the population mean still may have adequate hormone concentrations to meet their metabolic needs.
    • Nathan Goodyear
      Nathan Goodyear on 30 Mar 15
       
      good explanation of problems with just using a number to define low T
  • both T and free T index (a calculated value related to free or bioavailable T) decreased progressively at a rate that did not vary significantly with age, from the third to the ninth decades.
  • contrasts with other studies showing diminished free, as well as total, T in with increasing total (48) or abdominal (49) obesity in men.
  • Our analysis of date-adjusted T and free T index levels, by decade, showed that relatively high numbers of older men in this generally healthy population had at least one hypogonadal value (defined as below the 2.5th percentile for young men)
  • The issue of how properly to define hypogonadism, or indeed any hormone deficiency, remains problematic
  • The decrease in free T index was somewhat steeper than that of total T, owing to a trend for an increase in SHBG with age
  • LH for gonadal function
  • It would clearly be better to define the lower limit of normal for a hormone as: the blood level at which metabolic and/or clinical sequelae of hormone deficiency begin to appear, or the level below which definite benefits can be demonstrated for hormone supplementation for a significant proportion of the population
  • an effect of aging to lower both total and bioavailable circulating T levels at a relatively constant rate, independent of obesity, illness, medications, cigarette smoking, or alcohol intake
  • Nathan Goodyear on 30 Mar 15
     
    Article highlights the problems with the definition of low T.  This article finds consistent decline in Total Testosterone and FAI with increasing age groups, with a significant portion of men > 60 meeting the required levels for "low T".  This study found a decrease in total T and FAI at a consistent rate independent of variables, such as BMI.    This study did find a decrease in SHBG and total T with obesity; in contrast to other studies.
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

SHBG and testosterone are associated with inflammation in obese men - 0 views

www.endocrine-abstracts.org/...ea0032p761.htm

inflammation CRP cytokines obesity low T low Testosterone SHBG men male hormone hormones

shared by Nathan Goodyear on 07 Apr 15 - No Cached
  • Nathan Goodyear on 07 Apr 15
     
    Though, obesity is associated with increasing SHBG, inflammation (which is typically elevated in obesity) is negatively associated with SHBG.  CRP was used to evaluate inflammation in this study of obese men.  Testosterone was also negatively associated with inflammation in these men.
Nathan Goodyear

Sex Hormone-Binding Globulin and Insulin-Like Growth Factor-Binding Protein-1 as Indica... - 0 views

jcem.endojournals.org/...1550.abstract

SHBG insulin metabolic syndrome metabolic syndrome

shared by Nathan Goodyear on 11 Dec 12 - No Cached
  • Nathan Goodyear on 11 Dec 12
     
    SHBG decreased in hyperinsulinemic states, such as in metabolic syndrome.  Low Testosterone has proven to be the same, though not looked at in this study.   Also, in this study, low SHBG is associated with increased cardiovascular mortality.
Nathan Goodyear

Diet and Sex Hormone-Binding Globulin - 0 views

jcem.endojournals.org/...293.full

diet SHBG flax seed protein men

shared by Nathan Goodyear on 12 Jun 13 - No Cached
  • Nathan Goodyear on 12 Jun 13
     
    In men, flax intake is positively associated with SHBG; whereas protein intake is inversely associated with SHBG.
Nathan Goodyear

Androgen insufficiency in women: diagnostic and therapeutic implications - 0 views

humupd.oxfordjournals.org/...421.full

SHBG androgen testosterone androgens DHT women insufficiency deficiency

shared by Nathan Goodyear on 12 Jun 13 - No Cached
  • SHBG has a differing binding affinity for sex steroids in the following order; DHT > testosterone > androstenedione > estradiol > estrone
  • SHBG also weakly binds DHEA, but not DHEAS
  • Nathan Goodyear on 12 Jun 13
     
    Good discuss of androgen deficiency in women.  Also, good discussion of SHBG.  
Nathan Goodyear

Sex Hormone Binding Globulin Modifies Testosterone Action and Metabolism in Prostate Ca... - 0 views

www.hindawi.com/...6437585

low T low Testosterone Testosterone SHBG hormones male hormones

shared by Nathan Goodyear on 30 Nov 16 - No Cached
  • Nathan Goodyear on 30 Nov 16
     
    SHBG plays an important role in Testosterone's cellular effect. Every man should have SHBG checked with Testosterone
Nathan Goodyear

Redefining Metabolic Syndrome in Men (July 2012) Townsend Letter for Doctors & Patients - 0 views

www.townsendletter.com/...metsyndrome0712.html

testosterone male men hormone hormones saliva salivary low T low metabolic syndrome MetS

shared by Nathan Goodyear on 28 Aug 12 - No Cached
  • Approximately 95% to 98% of testosterone is bound to a carrier protein at any given time, leaving just the remaining 2% to 5% as completely unbound and available for tissues to use
  • most serum laboratories offer a free testosterone level, which is a calculated value based on SHBG levels or determined with equilibrium dialysis
  • the hormone enters the salivary gland by passive diffusion
  • ...11 more annotations...
  • Testosterone has a known age-related decline, and total levels typically drop by approximately 1.6% per year beginning for most men in their 30s
  • As estrogen levels rise, they prompt the body to produce more SHBG, which in turn has a higher binding affinity for testosterone, and drives the unbound fraction of the testosterone pool down even further
  • When the increase in SHBG is taken into account, the age-related decline in the level of hormone that can be used by the body is closer to 2% to 3% per year.
  • Stinging nettle (Urtica dioica), an herb commonly used for allergies, can also be employed to bind to SHBG, which leaves more testosterone available to tissues
  • Leptin, an adipose-derived peptide hormone that regulates appetite and metabolism, has been shown to directly inhibit testosterone production in animal models
  • tumor necrosis factor alpha (TNF-alpha) and interleukin-1 (IL-1) further inhibit Leydig cell testosterone production
  • Natural aromatase inhibitors include the bioflavonoids chrysin and luteolin
  • Zinc deficiency causes an upregulation of the aromatase enzyme
  • Testosterone reduces lipoprotein lipase (LPL) activity
  • there are several herbs that can work to boost testosterone levels, including longjack (Eurycoma longifolia), horny goat weed (Epimedium grandiflorum), and tribulus (Tribulus terrestris).
  • the majority of the hormone is bound to carrier proteins including sex hormone binding globulin (SHBG) and albumin
  • Nathan Goodyear on 28 Aug 12
     
    nice and short review on testosterone and men's  health.
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