Study finds that low free T and low Total T were associated with decline in desire, ED and activity versus none with Estradiol and SHBG in older men. The difficult issue is the threshold of "low T". The definition of "low T" is not uniform and varies with age. Thus baseline evaluations and correlation with symptoms, metabolic dysfunction must be done.
In obese men, low T is the result of increased estradiol formation from aromatase activity. Low SHBG is no enough to offset the decrease in free T levels.
New study shows that obese boys/young men pre and post puberty have up to 50% lower testosterone levels than comparative normal BMI counterparts. Also of note, estradiol levels were not associated with the low testosterone levels.
Estradiol levels significantly negatively correlated libido and orgasm frequency in men. Conversely, free levels of testosterone positively correlated with libido and orgasm frequency.
cross sectional study finds low vitamin D associated with a decrease in SHBG and an increase in free Testosterone; a decrease in estradiol and an increase in DHEA was seen in women. No association with total Testosterone was found. There are studies that show a direct decrease in testicular Testosterone production in men with low vitamin D and decrease in AR function.
Study shows that estradiol decreases ER beta in the prostate. ER beta is anti-inflammatory, inhibits growth, and promotes cell death: all of which would decrease risk of prostate growth and/or cancer.
We know that men increase estrogen production through increased aromatase activity, which according to this study, will decrease ER beta and the prostate associated benefits.
Chemical castration as seen in androgen deprivation therapy resulted in precipitous decline in Testosterone and Estradiol in men. Associated increased in beta-amylloid found.
Balance of Testosterone and Estradiol plays role in prostate disease. With age in men comes declining Testosterone, yet estrogen productions stay the same to increase. This significantly alters the estrogen receptors and prostate disease risk.
Estradiol found to be associated with increased IL-6 in older men. This after, the adjustments to exclude variables. Other inflammatory markers were not associated.
Declining Testosterone, calculated free Testosterone, Estradiol, and Estrone levels appear to be associated with muscle mass/strength decline in elderly men. This points to a global decrease in HPA function rather than an individual, specific hormone deficiency.
small cohort with low serum Total Testosterone improved T:E2 ratio with clomid. Clomid restores the HPA through inhibition of the negative feedback of Estradiol on the Hypothalamus and Pituitary in men. This allows for an increase in gonadotropin production and thus increase in testosterone production. Aromatase inhibition therapy would likely still prove beneficial in this situation.
Higher Testosterone and DHT levels in men was found to be positively associated with FEV1 and FVC; Estradiol was not. The question here is cause or effect.
Also interesting is the fact that smokers had higher Testosterone levels compared to non-smokers.
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.
Another study supports saliva hormone testing. This study involved 2,722 individuals and tested estradiol, progesterone, DHEA and testosterone in men and women. All of these are sex hormones. Someone needs to tell the insurance companies that the overwhelming evidence supports saliva hormone testing. But, that would mean they are even interested in the science.