Aging Men, Obesity, Metabolic Syndrome, Decrease in Total Serum Testosterone Levels

Researchers writing in the Journal of Urology say that their study “…demonstrated that aging men with obesity and the metabolic syndrome have a significant decrease in total serum testosterone levels compared to aging, metabolically healthy men.”

Kaplan SA, Meehan AG, Shah A. The Age Related Decrease in Testosterone is Significantly Exacerbated in Obese Men With the Metabolic Syndrome. What are the Implications for the Relatively High Incidence of Erectile Dysfunction Observed in These Men? J Urol. 2006 Oct;176(4):1524-8
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Testosterone May Protect Against Hardening Of The Arteries

Testosterone supplementation has received a fair share of “bad press.” Mostly due to health problems (sterility, coronary artery disease, liver damage, and brain tumors), caused in young men and women who should not be taking testosterone supplementation, but do so at super-physiological doses, to enhance athletic performance.

Many physicians also think, based on some medical studies, that the supplementation of testosterone “encourages” atherosclerosis (Hardening of the arteries)

Now, new research says the opposite maybe true, Testosterone may protect you from atherosclerosis.

Publishing in the May 17, 2005 issue of the American College of Cardiology, researchers found that men with low testosterone levels had more arterial thickening in the carotid artery in the neck than men with “normal” testosterone levels.

In my opinion I have found little evidence to support that testosterone supplementation to restore levels lost to aging can cause health problems. Numerous research supports the opposite. Study participants and researchers noted gained muscle, a slowdown in bone loss, increased sexual desire, and better cognitive skills.

Certain Exemptions – When not to take Testosterone supplementation?
Men taking testosterone supplementation should have PSA tests performed twice a year and have an annual manual examination of their prostate gland. No evidence suggests that testosterone supplementation causes prostate cancer. In fact, studies show a higher incidence of prostate cancer in men with a lower baseline level of testosterone. Studies suggest that in the presence of existing prostate cancer, testosterone supplementation may accelerate tumor growth.

Heart Health

Testosterone May Protect Against Hardening Of The Arteries
Testosterone supplementation has received a fair share of “bad press.” Mostly due to health problems (sterility, coronary artery disease, liver damage, and brain tumors), caused in young men and women who should not be taking testosterone supplementation, but do so at super-physiological doses, to enhance athletic performance.

The Sooner You Cut Your Risk For Cardiovascular Disease The Longer You Will Live
Writing in the medical journal Circulation, researchers say that if you are at low risk for cardiovascular disease at age 50, it is unlikely that you will suffer from heart disease in your lifetime and that compared to others in the same age group with higher risk, men could expect to live 11 more years and women 9 more years.

Does Being Optimistic Really Lower Risk From Cardiovascular Disease in Elderly Men?
Researchers writing in the medical journal the Archives of Internal Medicine say that having an optimistic outlook, DOES lower mortality risk associated with cardiovascular disease.

Menopause and Heart Disease
researchers writing in the medical journal Climacteric say that “an ideal hormone replacement therapy that can overcome hypertension, prevent body weight gain and control serum triglycerides offers an important advance in cardiovascular risk management during the menopause.”

Testosterone, Diabetes, and Cardiovascular Disease
New research says Testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men.

Osteoporosis in Men

Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. J Clin Endocrinol Metab. 2006 Jul 18

From the article abstract:
Context: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain.

Objective: To examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

Participants: 2447 community-dwelling men aged >/=65.

Main Outcome Measures: Total testosterone deficiency defined as <200 ng/dl.

Total estradiol deficiency defined as <10 pg/ml.

Results: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3% and 6.0% (P = 0.003), and in those with deficient and normal total estradiol was 15.4% and 2.8% (P < 0.0001).

Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9% and 3.2% (P = 0.01) and prevalence of total estradiol deficiency was 9.2% and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5% and 8.6% (P = 0.007), and in those with deficient and normal total estradiol was 14.3% and 6.3% (P = 0.08).

Conclusions: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

Why am I so driven to work in the age management field?

Basically it was for my own personal, mental, and spiritual well being.

A few years back when I was in my early forties, I began to notice a significant decrease in my energy levels. In other words, I was dragging.

I also noticed that I was losing muscle mass, I was getting softer. I didn’t have the energy to “pump up,” anymore and I was not able to exercise at levels I was accustomed to. “Well, that’s it, I am getting old,” I thought.

I was at a medical convention and spoke to a colleague about “my condition,” and he suggested that I should get my hormone levels checked. When I got my test results back my testosterone levels were so low they didn’t make the charts; way below the normal of anyone I had ever seen before.

Suffice to say, my curiosity in hormone supplementation was sparked. Because my testosterone was so very low and testosterone is the well known builder of bone, I immediately got a Bone Densitometry Test to measure my bone density. I was stunned as the tech told me the news in disbelief. It was very low as well, putting me at a high risk for fracture. I was absolutely stunned, I had to stop a lot of sports I was doing, and loved. I realized that snow skiing, snow shoeing, water skiing, and surfing, some of my favorites, no longer existed for me. No more vacations in the snow or ice. No more high-speed water sports.

It was then that I started to study and research HGH (Human growth hormone), pregenenolone, DHEA, thyroid, Melatonin and the affects of diet on all of them and how the body works with this big maze of hormones to keep people feeling good, not only increasing quality of life but making them healthy on many levels. Initially, I used testosterone intermittently, because of the fear doctors projected based on the problems with body builders, and men with prostate cancer. As I researched more and more, I learned the healthy truth about hormones, and later began total Hormone Replacement Therapy.

As time passed, more and more patients arrived with similar issues that I had, and many with sexual dysfunction. Hormone supplementation was working miracles. I treated friends for free, and eventually learned the art of balancing female hormones. Many relationships were revitalized as the couples individually found their “mojo” again. Romance once again arose in couples that were ready to give it up, because they thought the chemistry was gone.

I have now been doing this work for years and continue to attend different seminars around the country to learn as much new research as possible. The field of age management medicine, as it is called by some is growing so quickly. Us baby boomers expect the best out of life, and demand the best quality of life, which is greatly enhanced by hormone supplementation. My goal in life is to remain young and loving, not only on the inside, but also physically, mentally, emotionally, and spiritually. My children are my finest teachers.

Pregnenolone

Pregnenolone is a steroid hormone synthesized from cholesterol mainly by the adrenal glands and in small part by our nervous system.

What does it do?
There is speculation as to the main role of pregnenolone in the body. Most researchers are now in agreement that the primary role of pregnenolone is as the precursor (the building block) of our other hormones including the estrogens, progesterone, testosterone and DHEA.

DHEA is considered the “daughter” hormone of pregnenolone. Indeed pregneolone is considered by some to be the “mother of all steroid hormones.”

It has been suggested by human and animal studies that pregnenolone may assist:
-Memory enhancement
-Feelings of well being
-Intelligence by increasing ability to acquire knowledge
-Reduction of physical and mental effects of stress
-Mood improvement
-Energy improvement
-Reduction of PMS and menopausal symptoms
-Better sleep and deeper sleep
-Reduction of wrinkles through skin hydration
-As an anti-inflammatory, and with benefits for rheumatoid arthritis

Pregnenolone supplementation
As do our other hormones, pregnenolone levels decline with age. In our seventies, many produce up to 60% less pregnenolone than we did in our thirties. Many physicians and scientists believe that replacement of pregnenolone to those levels of our thirties can help with the symptoms regularly attributed to aging.

Another aspect of pregnenolone that researchers find intriguing is that pregnenolone levels may regulate the levels of our other hormones. In other words, supplementation of pregnenolone may positively impact decreased levels of our other hormones and restore them to more optimal levels.

There is a negative. If increasing pregnenolone levels increases the body’s own ability to make hormones, such as DHEA, then concurrent supplementation can theoretically raise other hormone levels too high. This is yet another reason why self-administering any hormone is not advisable and should be done only after levels are drawn and analyzed by an age management specialist.

Pregnenolone Research

Male and Female Intimacy Dysfunctions

Researchers writing in the medical journal Lancet report on endocrine disease and male and female intimacy dysfunctions.

Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007 Feb 17;369(9561):597-611

Endocrine disease frequently interrupts sexual function, and sexual dysfunction may signal serious endocrine disease. Diabetic autonomic neuropathy and endothelial dysfunction impair erectile function, and phosphodiesterase inhibition produces only moderate benefit. The effect of diabetes on women’s sexual function is complex: the most consistent finding is a correlation between sexual dysfunction and depression. Reductions in testosterone level in men are associated with low sexual desire and reduced nocturnal erections and ejaculate volume, all of which improve with testosterone supplementation. The age-dependent decline in testosterone production in men is not associated with precise sexual symptoms, and supplementation has not been shown to produce sexual benefit. In women, sexual dysfunction has not been associated with serum testosterone, but this may be confounded by limitations of assays at low concentrations and by the greater importance of intracellular production of testosterone in women than in men. Testosterone supplementation after menopause does improve some aspects of sexual function in women, but long-term outcome data are needed. More research on the sexual effects of abnormal adrenal and thyroid function, hyperprolactinaemia, and metabolic syndrome should also be prioritised. We have good data on local management of the genital consequences of oestrogen lack, but need to better understand the potential role of systemic oestrogen supplementation from menopause onwards in sexually symptomatic women.

The Use of Testosterone with Estrogen and Progestogen and It’s Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Hofling M, Hirschberg A, Skoog L, Tani E, Hagerstrom T, von Schoultz, B. Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause. 13 November 2006

Conclusions: Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.

Testosterone For Women Studies and News

Testosterone and Libido in Post Menopausal Women
Researchers writing in the medical journal Gynecological Endocrinology say that there is emerging evidence that androgens are significant independent determinants affecting libido and satisfaction, as well as mood, energy and other components of women’s health.

Testosterone in postmenopausal women
An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Testosterone enhances libido and decreases depression
Researchers reporting in the Journal of Neuropsychiatry and Clinical Neurosciences say Testosterone enhances libido and decreases depression.

Schutter, et al. J Neuropsychiatry Clin Neurosci.2005; 17: 372-377. Depression Administration of Testosterone Increases Functional Connectivity in a Cortico-Cortical Depression Circuit.

From the abstract: “Increasing evidence suggests that the steroid hormone testosterone (T) enhances libido and decreases depression. Even a single administration of T (0.5 mg sublingually) in healthy young women is sufficient to enhance physiological sexual responsiveness….” Read the abstract

Testosterone For Libido Loss In Women
September 19, 2005’s Washington Post reported “a position statement from the North American Menopause Society (NAMS) and published in its journal, Menopause,” that testosterone therapy may aid many post-menopausal women dealing with loss of libido. You can read the Washington Post article here.

Study: An overview of testosterone deficiency and supplementation in women.
Davis SR, Androgen treatment in women. MJA 1999;170:545-549.

The researchers state: “Women reporting loss of libido may find physicians insufficiently empathetic, and a biological cause for sexual dysfunction in women is rarely sought. However, it is gradually becoming more accepted that androgen deficiency in women may underpin a variety of symptoms and pathophysiological conditions and that, in selected women, androgen replacement therapy is of clinical benefit.”

“Testosterone insufficiency in women: fact or fiction?”
Guay, A, Davis SR. Testosterone insufficiency in women: fact or fiction? World Journal of Urology 2002;20(2):106-10.

The researchers state: “Androgen deficiency is a true medical condition in both pre- and post-menopausal women. The most important recommendation is to listen to the patient and consider androgen deficiency when the symptoms are present, even if they seem non-specific…Treatment with androgens has to be monitored carefully because of the possible harmful effects of excessive levels of testosterone.”

Bone Loss and Testosterone in Women with Anorexia Nervosa
A study is being recruited, Anne Klibanski, M.D., Principal Investigator, by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Center for Research Resources (NCRR) to determine among other things if low dose testosterone will be a benefit in preventing bone loss in women with Anorexia Nervosa.

From the abstract: “Women with Anorexia Nervosa have been found to have low bone density. The study will determine whether administration of low doses of a natural hormone, testosterone and/or risedronate, a medication to help prevent bone breakdown will improve or prevent bone loss in this condition.”

Testosterone Beneficial for Libido and Cholesterol
Researchers reviewing the current medical literature on the role of Testosterone in enhancing libido in post-menopausal women say; “The available evidence is that adding testosterone to estrogen therapy, with or without progestin, appears to be effective in improving sexual function in postmenopausal women and is associated with a reduction in high-density lipoprotein (HDL) cholesterol.”

The findings appear in The Cochrane Library, read the abstract and summary of this article .

HRT, Testosterone and Post Menopausal Women – Problems of Sexual Dysfunction
Researchers writing in the medical journal Maturitas say that HRT along with testosterone supplementation helps postmenopausal women who complain of problems related to intimacy.

Women, Testosterone and Cardiovascular Disease
Researchers writing in the medical journal Coronary Artery Disease say that their study “could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline.”

The Use of Testosterone with Estrogen and Progestogen and Its Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Testosterone and Prostate

Research published in the Journal of Steroid Biochemistry and Molecular Biology says “Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.”

Raynaud JP. Prostate cancer risk in testosterone-treated men.
J Steroid Biochem Mol Biol. 2006 Dec;102(1-5):261-6.

Men with classical androgen deficiency have reduced prostate volume and blood prostate-specific antigen (PSA) levels compared with their age peers. As it is plausible that androgen deficiency partially protects against prostate disease, and that restoring androgen exposure increases risk to that of eugonadal men of the same age, men using ART should have age-appropriate surveillance for prostate disease. This should comprise rectal examination and blood PSA measurement at regular intervals (determined by age and family history) according to the recommendations, permanently revisited, published by ISSAM, EAU, Endocrine Society….

Testosterone replacement therapy is now being prescribed more often for aging men, the same population in which prostate cancer incidence increases; it has been suggested that administration in men with unrecognised prostate cancer might promote the development of clinically significant disease.

In hypogonadal men who were candidates for testosterone therapy, a 14% incidence of occult cancer was found. A percentage (15.2%) of prostate cancer has been found in the placebo group (with normal DRE and PSA) in the prostate cancer prevention study investigating the chemoprevention potential of finasteride.

The hypothesis that high levels of circulating androgens is a risk factor for prostate cancer is supported by the dramatic regression, after castration, of tumour symptoms in men with advanced prostate cancer. However these effects, seen at a very late stage of cancer development, may not be relevant to reflect the effects of variations within a physiological range at an earlier stage. Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.

A study on a large prospective cohort of 10,049 men, contributes to the gathering evidence that the long standing “androgen hypothesis” of increasing risk with increasing androgen levels can be rejected, suggesting instead that high levels within the reference range of androgens, estrogens and adrenal androgens decrease aggressive prostate cancer risk.

Indeed, high-grade prostate cancer has been associated with low plasma level of testosterone.

Furthermore, pre-treatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer; as testosterone decreases, patients have an increased likelihood of non-organ confined disease and low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations (patch or gel) that achieve physiological testosterone serum levels without supra physiological escape levels.

During the clinical development of a new testosterone patch in more than 200 primary or secondary hypogonadal patients, no prostate cancer was diagnosed.

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