Testosterone Therapy: “Significant Reduction” in Heart Attack, Stroke Risks

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Large-scale Veterans Affairs database study reaffirms safety and benefits of testosterone replacement, in men.

A US Veterans Affairs database study of more than 83,000 male subjects found that men whose low testosterone was restored to normal through gels, patches, or injections had a lower risk of heart attack, stroke, or death from any cause, versus similar men who were not treated.  Rajat Barua and colleagues analyzed data collected on 83,010 male veterans with documented low total testosterone levels, dividing them into three clinical groups: those who were treated to the point where their total testosterone levels returned to normal (Group 1); those who were treated but without reaching normal (Group 2); and those who were untreated and remained at low levels (Group 3).  Importantly, all three groups were “propensity matched” so the comparisons would be between men with similar health profiles. The researchers took into account a wide array of factors that might affect cardiovascular and overall risk. The average follow-up across the groups ranged from 4.6 to 6.2 years. The sharpest contrast emerged between Group 1 (those who were treated and attained normal levels) and Group 3 (those whose low testosterone went untreated). The treated men were 56% less likely to die during the follow-up period, 24%less likely to suffer a heart attack, and 36%less likely to have a stroke.  The differences between Group 1 and Group 2 (those who were treated but did not attain normal levels) were similar but less pronounced.  The study authors conclude that: “normalization of [total testosterone] levels after [testosterone replacement therapy] was associated with a significant reduction in all-cause mortality, [myocardial infarction], and stroke.”

Sharma R, Oni OA, Gupta K, Chen G, Sharma M, Dawn B, Sharma R, Parashara D, Savin VJ, Ambrose JA, Barua RS. “Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men.”  Eur Heart J. 2015 Aug 6. pii: ehv346.

Article Source: https://www.worldhealth.net/news/testosterone-therapy-significant-reduction-heart-a/

 

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New ways to conquer sleep apnea compete for place in bedroom

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Every night without fail, Paul Blumstein straps on a mask that prevents him from repeatedly waking up, gasping for air.

It’s been his routine since he was diagnosed with a condition called sleep apnea. While it helps, he doesn’t like wearing the mask.

“It’s like an octopus has clung to my face,” said Blumstein, 70, of Annandale, Virginia. “I just want to sleep once in a while without that feeling.”

It’s been two decades since doctors fully recognized that breathing that stops and starts during sleep is tied to a host of health issues, even early death, but there still isn’t a treatment that most people find easy to use.

Airway pressure masks, the most common remedy, have improved in design, getting smaller and quieter, but patients still complain about sore nostrils, dry mouths and claustrophobia.

Now, new ways of conquering sleep apnea, and the explosive snoring that comes with it, are vying for a place in the bedrooms of millions of people craving a good night’s sleep. Products range from a $350 restraint meant to discourage back sleeping to a $24,000 surgical implant that pushes the tongue forward with each breath.

Mouthpieces, fitted by dentists, work for some people but have their own problems, including jaw pain. Some patients try surgery, but it often doesn’t work. Doctors recommend weight loss, but diet and exercise can be challenging for people who aren’t sleeping well.

So far, no pills for sleep apnea exist, but researchers are working on it. One drug containing THC, the active ingredient in marijuana, showed promise in a study this year.

What is sleep apnea? In people with the condition, throat and tongue muscles relax and block the airway during sleep, caused by obesity, aging or facial structure. They stop breathing, sometimes for up to a minute and hundreds of times each night, then awake with loud gasping and snoring. That prevents them from getting deep, restorative sleep.

They are more likely than others to have strokes, heart attacks and heart rhythm problems, and they’re more likely to die prematurely. But it’s hard to tease out whether those problems are caused by sleep apnea itself, or by excess weight, lack of exercise or something else entirely.

For specialists, the first-choice, most-studied remedy remains continuous positive airway pressure, or CPAP. It’s a motorized device that pumps air through a mask to open a sleeper’s airway. About 5 million Americans have tried CPAP, but up to a third gave up during the first several years because of discomfort and inconvenience.

Martin Braun, 76, of New York City stopped using his noisy machine and awkward mask, but now he’s trying again after a car crash when he fell asleep at the wheel. “That’s when I realized, OK this is serious stuff already,” said Braun, who has ordered a quieter CPAP model.

Sleep medicine is a relatively new field. The most rigorous studies are small or don’t follow patients for longer than six months, said Dr. Alex Krist of Virginia Commonwealth University, who served on a federal guidelines panel that reviewed sleep apnea treatments before recommending against screening adults who have no symptoms.

“We don’t know as much about the benefits of treating sleep apnea as we should,” said Krist, vice-chair of the U.S. Preventive Services Task Force.

While scientists haven’t proved CPAP helps people live longer, evidence shows it can reduce blood pressure, improve daytime sleepiness, lessen snoring and reduce the number of times a patient stops breathing. CPAP also improves quality of life, mood and productivity.

With noticeable results, many CPAP users, even those like Blumstein with a love-hate relationship with their devices, persist.

Blumstein was diagnosed about 15 years ago after he fell asleep behind the wheel at a traffic light. He shared his frustrations with using a mask at a recent patient-organized meeting with the Food and Drug Administration, as did Joelle Dobrow of Los Angeles, who said it took her seven years to find one she liked.

“I went through 26 different mask styles,” she said. “I kept a spreadsheet so I wouldn’t duplicate it.”

Researchers are now focused on how to get people to use a mask more faithfully and predicting who is likely to abandon it and could start instead with a dental device.

“It’s the bane of my existence as a sleep doctor,” said Dr. James Rowley of Wayne State University in Detroit. “A lot of what sleep doctors do in the first few months after diagnosis is help people be able to use their CPAP.”

Getting it right quickly is important because of insurers’ use-it-or-lose-it policies.

Medicare and other insurers stop paying for a rented CPAP machine if a new patient isn’t using it enough. But patients often have trouble with settings and masks, with little help from equipment suppliers, according to Dr. Susan Redline of Brigham and Women’s Hospital in Boston.

All told, it can drive people toward surgery.

Victoria McCullough, 69, of Escondido, California, was one of the first to receive a pacemaker-like device that stimulates a nerve to push the tongue forward during sleep. Now, more than 3,000 people worldwide have received the Inspire implant. Infections and punctured lungs have been reported; the company says serious complications are rare.

McCullough said she asked her doctor to remove the device soon after it was activated in 2015.

“It was Frankenstein-ish. I didn’t like it at all,” McCullough said. “My tongue was just thrashing over my teeth.”

Others like the implant. “My quality of life is 100 percent better,” said Kyleene Perry, 74, of Edmonds, Washington, who got one in February after struggling with CPAP for two years. “People are saying, ‘You look so much better.’ I have a lot more energy.”

The THC pill, known as dronabinol, already is used to ease chemotherapy side effects. A small experiment in 73 people suggests it helps some but wasn’t completely effective. It may work better in combination with CPAP or other devices, said researcher David Carley of the University of Illinois at Chicago. He owns stock in Respire Rx Pharmaceuticals, which has a licensing agreement with the university for a sleep apnea pill.

As the search for better treatments continues, listening to patients will be key, said Redline.

“We are actually just treating a very tiny percentage of people effectively,” she said.

Article Source: https://medicalxpress.com/news/2018-07-ways-conquer-apnea-bedroom.html

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Cancer: Can testosterone improve patients’ quality of life?

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Cachexia is a condition characterized by loss of body mass — including muscular atrophy — that is usually accompanied by severe weakness and fatigue. Many people who go through cancer experience this.

Studies have noted that “[a]pproximately half of all patients with cancer experience cachexia,” severely impairing their quality of life.

It appears to be “responsible for the death of 22 [percent] of cancer patients.”

What exactly causes this condition — which appears in some patients but not in others — remains unclear, and options to manage and address it are scarce.

But recently, researchers from the University of Texas Medical Branch in Galveston — led by Dr. Melinda Sheffield-Moore, from the Department of Health and Kinesiology — have been investigating the potential of administering testosterone in addition to chemotherapy in order to ameliorate the impact of cachexia.

We hoped to demonstrate these [cancer] patients [who received testosterone treatment] would go from not feeling well enough to even get out of bed to at least being able to have some basic quality of life that allows them to take care of themselves and receive therapy.”

Dr. Melinda Sheffield-Moore

The researchers’ findings — now published in the Journal of Cachexia, Sarcopenia and Muscle — confirm that administering testosterone to individuals experiencing cachexia can, in fact, improve their quality of life to some extent, by restoring some independence of movement.

Adjuvant testosterone shows promise

The most widely used approach to manage cachexia is special nutrition treatments, but these often fail to prevent or redress the loss of body mass.

So, Dr. Sheffield-Moore and team decided to investigate the potential of testosterone based on existing knowledge that this hormone can help build up muscle mass.

“We already know that testosterone builds skeletal muscle in healthy individuals,” she says, “so we tried using it in a population at a high risk of muscle loss, so these patients could maintain their strength and performance status to be able to receive standard cancer therapies.”

In order to test this theory, the scientists worked — for 5 years — with volunteers who had been diagnosed with squamous cell carcinoma, which is a type of skin cancer.

The patients received chemotherapy, radiotherapy, or both, in order to treat the cancer. For 7 weeks during their treatment, some also received a placebo (the control cohort), while others received testosterone.

Dr. Sheffield-Moore and colleagues noticed that the participants who had been given extra testosterone had maintained total body mass and actually increased lean body mass (body mass minus body fat) by 3.2 percent.

“Patients randomized to the group receiving testosterone as an adjuvant to their standard of care chemotherapy and/or radiation treatment also demonstrated enhanced physical activity,” she continues.

“They felt well enough to get up and take care of some of their basic activities of daily living, like cooking, cleaning, and bathing themselves,” says Dr. Sheffield-Moore.

This effect could make a world of difference to people with cancer, as it allows them to maintain more autonomy.

At present, she and her team are looking to describe cancer patients’ muscle proteomes — the totality of proteins found in skeletal muscles — so as to understand how cancer in general, and specifically cachexia, affects their composition.

According to Dr. Sheffield-Moore, “What the proteome tells us is which particular proteins in the skeletal muscles were either positively or negatively affected by testosterone or by cancer, respectively.”

“It allows us to begin to dig into the potential mechanisms behind cancer cachexia,” she claims.

The scientists’ ultimate goal is to be able to support individuals likely to experience cachexia in continuing to support standard cancer treatment, and maintaining, as much as possible, their quality of life.

Article Source: https://www.medicalnewstoday.com/articles/322487.php?utm_source=dlvr.it&utm_medium=gplus

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Low sperm count not just a problem for fertility

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A man’s semen count is a marker of his general health, according to the largest study to date evaluating semen quality, reproductive function and metabolic risk in men referred for fertility evaluation. The study results, in 5,177 male partners of infertile couples from Italy, will be presented Sunday at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago, Ill.

“Our study clearly shows that low sperm count by itself is associated with metabolic alterations, cardiovascular risk and low bone mass,” said the study’s lead investigator, Alberto Ferlin, M.D., Ph.D. He recently moved as associate professor of endocrinology to Italy’s University of Brescia from the University of Padova, where the study took place in collaboration with professor Carlo Foresta, M.D.

“Infertile men are likely to have important co-existing health problems or risk factors that can impair quality of life and shorten their lives,” said Ferlin, who is also president of the Italian Society of Andrology and Sexual Medicine. “Fertility evaluation gives men the unique opportunity for health assessment and disease prevention.”

Specifically, Ferlin and his colleagues found that about half the men had low sperm counts and were 1.2 times more likely than those with normal sperm counts to have greater body fat (bigger waistline and higher body mass index, or BMI); higher blood pressure (systolic, or top reading), “bad” (LDL) cholesterol and triglycerides; and lower “good” (HDL) cholesterol. They also had a higher frequency of metabolic syndrome, a cluster of these and other metabolic risk factors that increase the chance of developing diabetes, heart disease and stroke, the investigators reported. A measure of insulin resistance, another problem that can lead to diabetes, also was higher in men with low sperm counts.

Low sperm count was defined as less than 39 million per ejaculate, a value also used in the U.S. All the men in the study had a sperm analysis as part of a comprehensive health evaluation in the university’s fertility clinic, which included measurement of their reproductive hormones and metabolic parameters.

The researchers found a 12-fold increased risk of hypogonadism, or low testosterone levels, in men with low sperm counts. Half the men with low testosterone had osteoporosis or low bone mass, a possible precursor to osteoporosis, as found on a bone density scan.

These study findings, according to Ferlin, suggest that low sperm count of itself is associated with poorer measures of cardiometabolic health but that hypogonadism is mainly involved in this association. He cautioned that their study does not prove that low sperm counts cause metabolic derangements, but rather that sperm quality is a mirror of the general male health.

The bottom line, Ferlin stressed, is that treatment of male infertility should not focus only on having a child when diagnostic testing finds other health risks, such as overweight, high cholesterol or high blood pressure.

“Men of couples having difficulties achieving pregnancy should be correctly diagnosed and followed up by their fertility specialists and primary care doctor because they could have an increased chance of morbidity and mortality,” he said.

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The researchers will discuss the study during a press conference Sunday, March 18 at 9 a.m. Central. Register to view the live webcast at endowebcasting.com.

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

Article Source: https://www.eurekalert.org/pub_releases/2018-03/tes-lsc031418.php

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Got ED?

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Are struggling with erectile dysfunction? Impotence is a common problem among men and is characterized by the consistent inability to sustain or maintain an erection. Did you know stress, smoking, poor diet, depression, being overweight, and a sedentary lifestyle can increase your chances of developing ED? Here are some additional facts about ED:

1️⃣It is estimated that half of all men between the ages of 40 and 70 suffer from erectile dysfunction to some degree.
2️⃣Although not exactly defined, failure to achieve an erection more than 50 percent of the time is generally considered by medical professionals as erectile dysfunction.
3️⃣Erectile dysfunction can be caused by a number of issues, including hormonal imbalance, a restriction in the flow of blood to your penis, conditions affecting your nervous system, and psychological causes such as depression and anxiety.
4️⃣Taking certain medications can cause erectile dysfunction.

These may include but not limited to: diuretics, antidepressants, corticosteroids, and antihistamines. Testosterone replacement therapy can be an effective treatment for erectile dysfunction.

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Artificial Sweeteners Linked To Obesity And Diabetes

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People are becoming more health conscious and are bending towards use of artificial sweeteners, especially zero calorie ones. These replacements sugars have been demonstrated to be likely to cause health changes which are associated with obesity and diabetes.

 Worldwide these artificial sweeteners have become one of the most common food additives which are used. They can be found in a wide variety of beverages and food items including diet soda. One of the largest populations was looked at to investigate the effects of these artificial sweeteners and what they are capable of doing within the body, and metabolism of sweeteners and sugar after consumption; and the effects on blood vessel health. Results of this study were presented at the 2018 Experimental Biology Meeting.

 Model rats were fed diets which were high in fructose or glucose or acesulfame potassium, or aspartame; which are natural and zero calorie artificial sweeteners. Differences in concentrations of amino acids, fats, and other blood parameters observed within the animals after 3 weeks of being on the diets, specifically acesulfame potassium was found to be accumulating with in the blood and in higher concentrations damaging the blood vessel wall linings.

There has been a significant rise in diabetes and obesity despite the use of non-caloric artificial sweeteners. Researchers explain that this study shows that both artificial sweeteners and sugar have negative effects on the body which leads to diabetes and obesity, with the mechanisms for the cause of obesity differing for both.

When there was an overload of sugar machinery which handles them breaks down. Non-caloric artificial sweeteners lead to negative changes in metabolism, energy, and fat. More research is required on the subject, but results are enough to show high dietary sugars and artificial sweeteners do have negative health outcomes.

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https://www.eurekalert.org/pub_releases/2018-04/eb2-wzs041218.php

 

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Do athletes really need protein supplements?

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Protein supplements for athletes are literally sold by the bucketful. The marketing that accompanies them persistently promotes the attainment of buff biceps and six-pack abs.

In 2014, the protein supplement market in Australia was valued at A$545 million dollars, and is predicted to keep growing by about 10% per year. But do athletes really need them?

First, let’s consider what protein is and why we need it. Protein is an essential macronutrient in the diet. This means it provides energy to fuel the body but also has structural properties.

Protein is formed by smaller units called amino acids. Amino acids are used by the body to make muscle and other essential body proteins that are used in the immune system, and also to regulate many of the processes in the body.

Protein and amino acids indirectly affect performance by building muscle to improve performance. There is little evidence to suggest consuming extra protein directly aids physical performance in either endurance or resistance exercise.

Protein is fairly ubiquitous in the diet – it can come from animal sources (fish, meat, offal, eggs and dairy), and in smaller amounts from vegetable sources (cereals and legumes).

How much protein do we need?

Protein requirements for Australians are based on our life stage and gender. The estimated average requirement for an adult aged 19-70 is 0.68g per kilo of body weight for women and 0.75g per kilo of body weight for men. This means a 65kg woman will need about 45g of protein per day. An 80kg man will need about 60g a day.

Athletes need more protein as they are building and/or repairing muscle as well as connective tissue. Their requirements are two to three times the amount of protein as normal people, or between 1.4-2g per kilo of body weight per day.

This is a large range, allowing variation for the sort of sport they play. An elite endurance male may be in the lower range, as they have a smaller body frame and less musculature. A power sportsman, such as an AFL player, would require more.

Are we getting enough?

A 2011-12 survey found most Australians were consuming about double the recommended intake of protein per day. Almost all (99%) Australians met or surpassed the required intake.

Evidence also indicates most athletes consume enough, and often more, protein than they require.

But actually it’s the timing of consuming the protein that is most important to building muscle. After any sort of exercise or performance activity that results in muscle resistance, the muscle has to be rebuilt. For maximal synthesis to occur there needs to be adequate levels of amino acids circulating in the blood. It’s been determined that, to achieve this, around 20-30g of protein must be consumed within 1-4 hours after exercise.

This doesn’t mean you need to down a protein shake as soon as you leave the gym. If you’re having a meal within this time frame, you can consume the 20-30g in that meal (which most people would anyway). This amount of protein from animal sources includes enough of the critical amino acid, leucine, that is needed for muscle resynthesis.

This is the equivalent of 120g of beef or chicken, three whole eggs, 70g of reduced fat cheddar cheese or 600ml of skim milk. However if we look at plant-based foods, you would need the equivalent of seven slices of bread, 350g of kidney beans or lentils, or 900ml of soya milk.

So does anyone need protein supplements?

There may be situations where an athlete is travelling or can’t access a meal within a few hours of their training session. So they could either snack on one of the foods listed above, or take a protein supplement. Protein supplements will usually be lower in kilojoules, so if an athlete is on a kilojoule-restricted diet they’ll get more bang for their buck from a protein supplement.

But of course protein supplements don’t have the other nutrients that natural foods contain, such as iron and zinc from red meat, calcium from dairy, or omega-3 fatty acids from fish.

Additionally, one needs to weigh up the risk of potential contamination with banned substances like anabolic agents, stimulants, and diuretics. This may be intentional by the producer (as their product will appear to be more effective in building muscle) or accidental due to an error in the manufacturing process or using ingredients that may have been contaminated.

Analytical studies have also shown there may be contamination with the heavy metals lead, mercury and arsenic. The other consideration for the athlete is the impact on the hip pocket and environment.

Is there any harm in taking extra protein?

The question of “protein overdose” partially depends on exactly how much extra protein is being consumed. We can be reasonably confident levels up to 2-3g per kilo of body weight per day (so around 200g for a 75kg person) have no health risk. But there has always been concern higher levels of protein may accelerate underlying kidney disease (particularly if there is a family history) leading to a progressive loss of kidney capacity.

Athletes and weekend warriors should exercise caution if they’re considering intakes of protein beyond 2-3g per kilo of body weight per day. In these situations, athletes should seek advice from an accredited sports dietitian.

Article Source: https://medicalxpress.com/news/2018-04-athletes-protein-supplements.html

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