Is testosterone replacement therapy the right thing for aging males?

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Testosterone (T) is a naturally occurring hormone in men, and most of it is produced in the testicles.

At puberty, T production escalates, bringing about masculinizing changes in muscle mass.  also promotes sex drive, sperm and red blood cell production, bone mass and determines how men store body fat.

It can impact quality of life issues as well, like mood, energy and motivation.

Beginning at about age 30, T production begins to decline on average by about 1 percent per year, plummeting late in life. This causes all sorts of problems, including lack of sex drive, inability to sleep, loss of muscle and bone mass, increased belly fat, the list goes on. Reversing these symptoms and improving the quality of life is the reason T replacement therapy (TRT) clinics supervised by physicians have sprung up around the country.

Although it is considered a male hormone, women also produce a modest amount of T in the ovaries. After menopause, estrogen production declines, which alters the ratio of estrogen to T, explaining why women begin taking on some male characteristics, like storing more fat around the midsection, rather than on the hips, thighs and buttocks as occurs earlier in life.

TESTOSTERONE REPLACEMENT THERAPY

Is TRT a good thing? It can be when managed responsibly. If you are older, and your T level is very low and falls below the normal range, it makes sense to address it with TRT because it can negatively impact health, increasing risks associated with diabetes, obesity and osteoporosis. Low T also may shorten life, but this is controversial because when TRT raises T levels it has not been shown to extend life.

More is not always better, and many TRT clinics are viewed with suspicion because they advertise that it’s possible to feel like you are 25 years old again, even though you are decades older. Perhaps this is possible, but at what price, and if you are taking huge doses of T, could you be damaging your health?

Research studies in 2013 and 2014 indicated that TRT increased the risk of heart disease in men 65 and older, and in younger men with a history of heart disease. However, subsequent studies refute these findings and some show a deceased risk of heart disease. Another area of concern is an increased risk of prostate cancer, but this, too, is controversial. There does appear to be solid evidence that TRT can increase the risk of blood clots and stroke, plus sleep apnea, acne and breast enlargement.

All in all, some experts believe the benefits outweigh the risks, while others are more cautious because TRT hasn’t been around long enough or impacted enough men to draw meaningful conclusions. Time will tell. In the meantime, like most things in life, moderation is the best approach.

ANABOLIC STEROIDS

Anabolic steroids (AS) are synthetic steroid hormones that resemble T. AS require a doctor’s prescription and were developed to promote muscle mass in postsurgical patients, particularly older patients. Unfortunately, AS use spilled over to strength athletes who wanted the advantages associated with increased muscle mass, and AS delivered as promised. This, in turn, inspired gross overdosing with AS as a means to producing freaky muscular proportions and super human strength.

AS can cause a long list of negative side effects, the most serious being growth of tumors in the liver and acceleration of atherosclerosis (clogging of the arteries). AS suppress HDL (good cholesterol) production, which leads to a ratio of bad to good cholesterol that is out of whack, promoting clogged arteries and ultimately leading to a heart attack. Worse, because a doctor’s prescription is required, AS often are obtained illegally from foreign countries through the mail, with no sense of the quality of the product or the dangers involved.

When I was young, I was an enthusiastic weight lifter, working out hours every day. Some of my friends went the AS route and developed amazing physiques. Recently, I have endeavored to track them down to see how they are doing, and I was saddened to learn that too many have died prematurely, in their fifties and sixties, some even earlier. The most likely cause was a heart attack.

THE BOTTOM LINE

TRT has a place and can be beneficial if managed prudently. Just be careful of extreme approaches and promises that seem too good to be true. As for AS, there is no justifiable reason for athletes to be taking them. Ever!

Article Source: https://www.courier-journal.com/story/life/wellness/health/2017/09/07/testosterone-replacement-therapy-aging-males/569708001/?cookies=&from=global

Written BY: Bryant Stamford

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Testosterone Therapy Beneficial to Men with Heart Disease

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New study finds that testosterone supplementation enables a reduction in the risks of major cardiovascular events, such as strokes, heart attacks, and death.

In a recent study, a research team from the Intermountain Medical Center Heart Institute studied 755 male patients, ranging from 58-78 years, who all had severe coronary artery disease, the most common type of heart disease. They were separated into three different groups, receiving varied doses of testosterone, administered intravenously or by gel. At the end of the first year, 64 patients who weren’t taking any testosterone supplements had serious adverse cardiovascular events, whereas only 12 who were taking medium doses of testosterone and 9 who were taking high doses did. At the end of 3 years, 125 patients who had not received testosterone therapy suffered severe cardiovascular events, whereas only 38 medium-dose and 22 high-patients did. Patients who were given testosterone as part of their follow-up treatment did much better than patients who had not been given testosterone supplementation. The non-testosterone-therapy patients were 80 percent more likely to suffer an adverse event. “Although this study indicates that hypo-androgenic men with coronary artery disease might actually be protected by testosterone replacement, this is an observational study that doesn’t provide enough evidence to justify changing treatment recommendations,” said Dr. Muhlestein, co-director of cardiovascular research at the Intermountain Medical Center Heart Institute. “It does, however, substantiate the need for a randomized clinical trial that can confirm or refute the results of this study.” This new study confirms the findings of a previous study from the Intermountain Medical Center Heart Institute, which found that testosterone therapy did not increase the risk of experiencing a heart attack or stroke for men with low testosterone levels and no prior history of heart disease.

The Intermountain Medical Center research team will presented their study at the American College of Cardiology’s 65th Annual Scientific Session on Sunday, April 3 at 12:15 p.m., CDT.

The Intermountain Medical Center Heart Institute is made up of clinical and research professionals who aim to advance cardiovascular treatment. Intermountain Medical Center is the flagship facility for the Intermountain Healthcare system, which is based in Salt Lake City.

Article Source: https://www.worldhealth.net/news/testosterone-supplementation-beneficial-men-heart-/

 

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Testosterone decline associated with increased mortality risk

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Men experiencing a pronounced, age-related decline in testosterone level are more likely to die of any cause during a 15-year period vs. men who have testosterone levels in the 10th to 90th percentile, according to findings reported in the European Journal of Endocrinology.

Stine A. Holmboe, MSc, a doctoral student in the department of growth and reproduction at the University of Copenhagen, Denmark, and colleagues analyzed data from 1,167 men aged 30 to 60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study, conducted between November 1982 and February 1984, as well as the follow-up examination 10 years later (MONICA10), conducted between 1993 and 1994. Researchers measured levels of testosterone, sex hormone-binding globulin and luteinizing hormone at baseline and follow-up, and then followed the cohort for up to 18 years (mean, 15.2 years) using data from national mortality registries. Researchers used Cox proportional hazard models, with age as the underlying time scale, to assess the association between intra-individual hormone changes and all-cause, CVD and cancer mortality.

During follow-up, 421 men (36.1%) died (106 cancer-related deaths; 119 CVD-related deaths). The estimated mean intra-individual percentage change in hormone levels per year for the cohort were –1.5% for total testosterone, 0.9% for SHBG, –1.9% for free testosterone and 1% for luteinizing hormone. When estimated cross-sectionally, however, mean percentage changes in hormone levels per year were –0.4% for total testosterone, 1.2% for SHBG, –1.1% for free testosterone and 1.1% for luteinizing hormone, according to researchers.

Researchers observed that men who experienced the most pronounced decline in total testosterone — men in the lowest 10th percentile — saw the greatest increased risk for all-cause mortality (HR = 1.6; 95% CI, 1.08-2.38) vs. the reference category. The risk corresponded with an annual total testosterone decline of at least –0.6 nmol/L.

Across tertiles of SHBG levels, researchers found no significant differences in all-cause mortality; however, there was a U-shaped trend observed, with increases in all-cause mortality for those with a change in SHBG levels below the 10th percentile (< –0.7 nmol/L per year) or above the 90th percentile (> 1.1 nmol/L per year) vs. the middle group.

Men with the most pronounced decline in free testosterone also saw an increased risk for all-cause mortality; however, this was significant only in the tertile model (HR = 1.45; 95% CI, 1.09-1.92), according to researchers. There were no disease-specific associations observed, and associations were independent of age, baseline hormone levels and lifestyle factors.

“A possible causal link between an increased tempo in age-related [testosterone] decline and subsequent health is unknown and remains to be investigated,” the researchers wrote. – by Regina Schaffer

Article Source: https://www.healio.com/endocrinology/reproduction-androgen-disorders/news/in-the-journals/%7Bb9ffabec-a385-4c19-b01b-4981f05e01d1%7D/testosterone-decline-associated-with-increased-mortality-risk

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5 Common Low Testosterone Health Myths Debunked

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As men age, they face a very serious problem than a decline in testosterone levels. In fact, five percent of older males live with low testosterone levels.

Although many of us understand that low testosterone levels can result in changes in health, we may be believing the wrong information when it comes to low testosterone. These misconceptions around low testosterone could prevent you from getting the help you need to feel energized, strong, and essentially like yourself once again. So, instead of still believing the myths around low testosterone, uncover the truth that can help you finally deal with your low testosterone.

5 myths about low testosterone

Low testosterone is normal to aging: This myth is partially true in the sense that yes, testosterone levels do generally decline as you get older but this drop can also be abnormal. Testosterone decline does occur at a normal rate, but for some men, this rate is much greater. So, if you think it’s normal, you could be preventing yourself from getting treatment for this alarming decline in testosterone. When testosterone drops at an abnormal rate, that’s when a man’s overall health can become impacted. If you experience any of these symptoms, your testosterone levels have dropped below normal and you should speak to your doctor.

Low testosterone only affects older men: Because low testosterone is associated with aging, it is believed that only older males live with it. Low testosterone can affect any man at any age. In order to determine whether you have low testosterone, you should discuss any symptoms you experience with your doctor so they can piece them together along with any medical testing.

Testosterone replacement increases sperm count: This is a complete and utter myth, as increasing sperm count is something that testosterone replacement cannot do. In fact, testosterone replacement can actually lower sperm count. On the other hand, testosterone replacement therapy can help you feel like yourself again by reducing fatigue, increasing muscle, and lift mood and libido.

Testosterone replacement increases the risk of heart disease and cancer: Early studies have outlined the potential risk to the heart with testosterone replacement therapy, but as of late, findings suggest that the risk of heart disease may actually decrease. In regards to cancer, it is still quite controversial among those men with pre-existing prostate cancer. So far, though, the data does show that testosterone replacement therapy does not cause prostate cancer.

It’s safe to order testosterone replacements online: Testosterone medications are a controlled substance that can only be prescribed by your doctor. Using such therapies without the guidance of your doctor can put your health at risk. Taking in excess testosterone may actually hinder your body’s ability to produce testosterone naturally on its own. Furthermore, excess testosterone can increase the risk of stroke or blood clots. Before going online and purchasing testosterone replacement medications, speak to your doctor first to determine whether or not you have low testosterone.

 

Article Source: https://www.belmarrahealth.com/5-common-health-myths-debunked/

 

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Is testosterone replacement therapy the right thing for aging males?

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A study suggests that exercise can reduce the risk of heart damage for middle-aged adults and seniors. According to the study, even those who are obese will benefit from physical activity. Wochit

Testosterone (T) is a naturally occurring hormone in men, and most of it is produced in the testicles.

At puberty, T production escalates, bringing about masculinizing changes in muscle mass.  also promotes sex drive, sperm and red blood cell production, bone mass and determines how men store body fat.

It can impact quality of life issues as well, like mood, energy and motivation.

Beginning at about age 30, T production begins to decline on average by about 1 percent per year, plummeting late in life. This causes all sorts of problems, including lack of sex drive, inability to sleep, loss of muscle and bone mass, increased belly fat, the list goes on. Reversing these symptoms and improving the quality of life is the reason T replacement therapy (TRT) clinics supervised by physicians have sprung up around the country.

Although it is considered a male hormone, women also produce a modest amount of T in the ovaries. After menopause, estrogen production declines, which alters the ratio of estrogen to T, explaining why women begin taking on some male characteristics, like storing more fat around the midsection, rather than on the hips, thighs and buttocks as occurs earlier in life.

TESTOSTERONE REPLACEMENT THERAPY

Is TRT a good thing? It can be when managed responsibly. If you are older, and your T level is very low and falls below the normal range, it makes sense to address it with TRT because it can negatively impact health, increasing risks associated with diabetes, obesity and osteoporosis. Low T also may shorten life, but this is controversial because when TRT raises T levels it has not been shown to extend life.

More is not always better, and many TRT clinics are viewed with suspicion because they advertise that it’s possible to feel like you are 25 years old again, even though you are decades older. Perhaps this is possible, but at what price, and if you are taking huge doses of T, could you be damaging your health?

Research studies in 2013 and 2014 indicated that TRT increased the risk of heart disease in men 65 and older, and in younger men with a history of heart disease. However, subsequent studies refute these findings and some show a deceased risk of heart disease. Another area of concern is an increased risk of prostate cancer, but this, too, is controversial. There does appear to be solid evidence that TRT can increase the risk of blood clots and stroke, plus sleep apnea, acne and breast enlargement.

All in all, some experts believe the benefits outweigh the risks, while others are more cautious because TRT hasn’t been around long enough or impacted enough men to draw meaningful conclusions. Time will tell. In the meantime, like most things in life, moderation is the best approach.

THE BOTTOM LINE

TRT has a place and can be beneficial if managed prudently. Just be careful of extreme approaches and promises that seem too good to be true. As for AS, there is no justifiable reason for athletes to be taking them. Ever!

Written by: Bryant Stamford

Article Source: http://www.courier-journal.com/story/life/wellness/health/2017/09/07/testosterone-replacement-therapy-aging-males/569708001

 

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Infertility in men could point to more serious health problems later in life

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Poor sperm quality affects about one in ten men and may lead to fertility problems. These men also have an increased risk of developing testicular cancer, which is the most common malignant disease of young males. And, even if they don’t develop testicular cancer, men with poor sperm quality tend to die younger than men who don’t have fertility problems.

Couples who can’t achieve pregnancy usually go to fertility clinics for treatment. At these clinics, emphasis is put on deciding whether the couple needs assisted reproduction or not, and, if so, to choose between different methods (such as IVF, IUI, or ICSI) for doing this. In most cases, these treatments lead to pregnancy and a live birth. So the problem seems to be solved. But if infertility is an early symptom of an underlying disease in the man, fertility clinics won’t pick it up.

Missed opportunity

Testicular cancer is easy to detect. In men seeking treatment for fertility problems, a simple ultrasound scan of the testes can reveal early cancer, so a life-threatening tumour can be prevented. If detected, 95% of all cases can be cured. But, unfortunately, testicular ultrasound scans are rarely performed at fertility clinics as the focus tends to be on sperm numbers and which method of assisted reproduction to use.

And testicular cancer is not the only threat to young infertile men’s health. Serious health problems, such as metabolic syndrome (high blood pressure, high blood sugar and obesity), type 2 diabetes and loss of bone mass are also much more common conditions among infertile men. These disorders are possible to prevent, but if left untreated often lead to premature death.

A possible culprit

At Lund University in Malmö, Sweden, we have – together with other research groups – made a number of studies focusing on the link between male fertility problems and subsequent risk of serious diseases. We cannot yet explain the causes, but testosterone deficiency is a strong candidate. My research team found that 30% of all men with impaired semen quality have low testosterone levels. And men totally lacking the hormone have early signs of diabetes and bone loss.

We recently conducted a study in which we investigated almost 4,000 men below the age of 50 and who had had their testosterone measured 25 years ago. We found that the risk of dying at a young age was doubled among those with low testosterone levels compared with men with normal levels of this hormone.

Although testosterone treatment may not necessarily be the best preventive measure, these findings makes it possible to identify men at high risk so that they can be advised about lifestyle changes, such as losing weight or quitting smoking – lifestyle changes that will help reduce the risk of developing type 2 diabetes, cardiovascular disease and osteoporosis.

A relatively high proportion of men get in touch with their doctor about infertility problems and, as they represent a high-risk group for some of the most common diseases occurring later in life, perhaps it is time to change the routines for managing them. With the knowledge we now have regarding these men’s health, the least we can demand from doctors is to identify those who are at risk of serious diseases after they have become fathers. This is cheap and only requires simple tests. It is no longer enough to just evaluate the number of sperm.

 

Written by:  Aleksander Giwercman And Yvonne Lundberg Giwercman, The Conversation

Article Source: https://medicalxpress.com/news/2017-05-infertility-men-health-problems-life.html

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Bone Density, Anemia Improve With Testosterone in Low-T Men

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Study Highlights

  • Snyder and colleagues:
    • Study participants were men at least 65 years old with 2 serum testosterone results of less than 275 ng/dL.
    • Men were randomly assigned to receive testosterone gel with titration to maintain serum testosterone levels commensurate with those of a young man, or placebo gel. The treatment period was 12 months.
    • The main study outcome was BMD. Participants underwent BMD testing with quantitative computed tomography and dual energy x-ray absorptiometry of the spine and hip at baseline and at 12 months.
    • 211 men participated in the trial. The mean age of participants was 72.3 years, and the baseline mean testosterone level was slightly more than 230 ng/dL.
    • vBMD increased in the testosterone group by a mean of 7.5%, compared with an increase of only 0.8% in the placebo group (P <.01).
    • Measurements of hip trabecular and peripheral vBMD were also superior in the testosterone group vs the placebo group.
    • Testosterone appeared more effective in increasing trabecular vs peripheral BMD, and in improving BMD in the spine vs the hip.
    • 19 fractures were reported during the treatment year and 1 year after the treatment period, with no evidence of a difference in fracture rates in comparing the testosterone group vs the placebo group.
  • Roy and colleagues:
    • The study was conducted as a double-blind, placebo-controlled trial among men 65 years or older. All participants had a serum testosterone level of less than 275 ng/dL.
    • Men were randomly assigned to receive testosterone gel with titration to maintain serum testosterone levels commensurate with those of a young man, or placebo gel. The treatment period was 12 months.
    • There were 788 men in the study, of whom 126 were anemic, as defined by a hemoglobin level of 12.7 g/dL or lower. Approximately half of men with anemia had no known cause for anemia.
    • The main study outcome was the effect of testosterone therapy on hemoglobin levels among men with anemia.
    • The mean age of participants was 74.8 years, and the mean serum testosterone level among men with anemia was 222 ng/dL at baseline.
    • 54% of men with unexplained anemia who were treated with testosterone experienced an increase in hemoglobin levels of 1.0 g/dL or more, compared with only 15% of men with similar anemia treated with placebo (adjusted OR, 31.5; 95% CI, 3.7-277.8).
    • 58.3% of men treated with testosterone experienced resolution of their anemia, compared with 22.2% of men treated with placebo.
    • Testosterone also raised hemoglobin levels vs placebo among men with a known cause of anemia.
    • Hemoglobin levels increased past 17.5 g/dL in 6 men without anemia at baseline.

Clinical Implications

  • A retrospective cohort study by Cheetham and colleagues finds that testosterone therapy among men with evidence of testosterone deficiency is associated with lower risks for cardiac disease and cerebrovascular disease, even among men older than 65 years and those with preexisting cardiovascular disease.
  • Two new studies demonstrate that testosterone treatment can correct anemia and improve BMD among men with low testosterone levels at baseline.
  • Implications for the Healthcare Team: The current studies further demonstrate potential benefits of testosterone therapy among men with testosterone deficiency. Testosterone therapy was also associated with a lower risk for cardiovascular events in one study. Nonetheless, clinicians should continue to perform shared decision making regarding testosterone therapy and apply this treatment only among men with established testosterone deficiency.

Article Source: http://www.medscape.org/viewarticle/876307

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