Testosterone Does Not Appear to Increase The Risk For Cardiovascular Disease

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Testosterone replacement therapy does not appear to increase the risk for cardiovascular disease or thromboembolic events in middle-aged men.

In fact, the risk for a cardiovascular event was lower in men taking supplemental testosterone than in those who were not, said lead investigator Julian Hanske, MD, from Ruhr University Bochum in Herne, Germany, who collaborated on the study during a fellowship at Brigham & Women’s Hospital in Boston.

But physicians should know whether a patient suffers from obstructive sleep apnea before prescribing testosterone, Dr Hanske said here at the European Association of Urology 2017 Congress.

Cohort studies of the cardiovascular and thromboembolic consequences of supplemental testosterone have generally relied on sources such as the Surveillance, Epidemiology, and End Results Medicare database, which is limited to an older population, he told Medscape Medical News.

To get a better handle on the relative risks associated with testosterone replacement therapy in a younger population, Dr Hanske and his team searched the TRICARE American military insurance database, which covers all retired and active-duty military personnel and their dependents.

They looked for men 40 to 65 years of age treated for low levels of testosterone. Patients were excluded if they had a history of heart disease, thromboembolism, prostate cancer, or obstructive sleep apnea.

For the final cohort, 3422 men who took testosterone were matched with 3422 control subjects who did not by year of birth, then by date of first testosterone prescription, and then by race and baseline comorbidities.

The study outcomes were event-free survival and absolute risk for cardiovascular disease, thromboembolism or obstructive sleep apnea.

We have so many fears of testosterone replacement therapy.

Cardiovascular event-free survival was significantly better in the testosterone group than in the control group (P = .0085), and risk for coronary artery disease was lower in the testosterone group (P = .0082).

There was no difference in thromboembolic event-free survival between the testosterone and control groups (P = .0998).

These findings are reassuring, said session comoderator Raanan Tal, MD, head of the male infertility program at Rambam Medical Center in Haifa, Israel.

“We have so many fears of testosterone replacement therapy, and actually what they showed is that so many beliefs that we have cannot be supported,” he told Medscape Medical News.

“The fact that you don’t have an increase in cardiovascular events or thrombotic events is an important message — more important than the risk of increased obstructive sleep apnea,” he explained.

But the other comoderator said he thinks the findings would be more compelling if the investigators had used propensity-score matching or a similar statistical method to ensure a close case–control match.

“Age is a risk factor,” Andrea Salonia, MD, from the Vita-Salute San Raffaele University in Milan, pointed out. “The younger the patient, the lower the probability of having difficulties sleeping at night, and they did not adjust for that specific issue, or at least they did not find any kind of difference according to this specific variable.”

“At the same time, the number of patients they considered was amazing, and it is probably one of the most important studies in terms of the huge cohort they selected,” Dr Salonia told Medscape Medical News.

Dr Hanske, Dr Tal, and Dr Salonia have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2017 Congress: Abstract 256. Presented March 25, 2017.

Article Source: http://www.medscape.com/viewarticle/877786

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Testosterone therapy improves insulin sensitivity in diabetic men

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The January 2016 issue of the journal Diabetes Care reported the outcome of a randomized trial that revealed a beneficial role for testosterone treatment in men with diabetes.

“We hypothesized that testosterone may be an anti-inflammatory and insulin sensitizing agent since it has been known for some time that testosterone reduces adiposity and increases skeletal muscle,” remarked lead researcher Paresh Dandona, MD, PhD, who is a Distinguished Professor at the State University of New York and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo. “Our previous work has shown that obesity is associated with oxidative stress and inflammation, and inflammatory mediators are known to interfere with insulin signaling.”

The trial included 94 type 2 diabetic men, among whom 44 had low testosterone levels and reduced insulin signaling genes indicative of decreased insulin sensitivity. Participants with low testosterone received a weekly testosterone injection or a placebo for 24 weeks. Body weight, body fat, markers of inflammation, insulin sensitivity and other factors were assessed before and after treatment.

At the end of the trial, men who received testosterone experienced a more than six pound average loss of body fat and an equal increase in muscle mass. They also had lower levels of the inflammatory markers C-reactive protein, interleukin-1b and tumor necrosis factor-a. “Most importantly, we saw a dramatic increase in insulin sensitivity, demonstrated by a 32 percent increase in the uptake of glucose by tissues in response to insulin,” Dr Dandona reported.

“Testosterone treatment for men, where indicated, will improve sexual function and increase skeletal muscle strength and bone density,” Dr Dandona noted. “This is the first definitive evidence that testosterone is an insulin sensitizer and hence a metabolic hormone.”

Article Source: http://www.lifeextension.com/WhatsHot/2015/11/November-Whats-Hot-Articles/Page-01#test

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Effects of taking tadalafil 5 mg once daily on erectile function and total testosterone levels in patients with metabolic syndrome.

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We aimed to evaluate the efficacy of tadalafil 5 mg once-daily treatment on testosterone levels in patients with erectile dysfunction (ED) accompanied by the metabolic syndrome. A total of 40 men with metabolic syndrome were evaluated for ED in this study. All the patients received 5 mg tadalafil once a day for 3 months. Erectile function was assessed using the five-item version of the International Index of Erectile Function (IIEF) questionnaire. Serum testosterone, follicle-stimulating hormone and luteinising hormone levels were also evaluated, and blood samples were taken between 08.00 and 10.00 in the fasting state. All participants have three or more criteria of metabolic syndrome. At the end of 3 months, mean testosterone values and IIEF scores showed an improvement from baseline values (from 3.6 ± 0.5 to 5.2 ± 0.3, from 11.3 ± 1.9 to 19 ± 0.8 respectively). After the treatment, serum LH levels were decreased (from 5.6 ± 0.6 to 4.6 ± 0.5). There was significantly difference in terms of baseline testosterone and luteinising hormone values and IIEF scores (p < .05). Based on our findings, we recommend tadalafil 5 mg once daily in those men with erectile dysfunction especially low testosterone levels accompanied by metabolic syndrome.

Article Source: https://www.ncbi.nlm.nih.gov/pubmed/28295481

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Exploring the role of testosterone in the cerebellum link to neuroticism: From adolescence to early adulthood

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Highlights

  • Cerebellar volumes correlate inversely with neurotic personality traits in adolescents and young adults.
  • In males, higher endogenous testosterone levels is associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes.
  • Testosterone significantly mediates the relation between cerebellar gray matter and measures of neuroticism.

Abstract

Previous research has found an association between a smaller cerebellar volume and higher levels of neuroticism. The steroid hormone testosterone reduces stress responses and the susceptibility to negative mood. Together with in vitro studies showing a positive effect of testosterone on cerebellar gray matter volumes, we set out to explore the role of testosterone in the relation between cerebellar gray matter and neuroticism. Structural magnetic resonance imaging scans were acquired, and indices of neurotic personality traits were assessed by administering the depression and anxiety scale of the revised NEO personality inventory and Gray’s behavioural avoidance in one hundred and forty-nine healthy volunteers between 12 and 27 years of age. Results demonstrated an inverse relation between total brain corrected cerebellar volumes and neurotic personality traits in adolescents and young adults. In males, higher endogenous testosterone levels were associated with lower scores on neurotic personality traits and larger cerebellar gray matter volumes. No such relations were observed in the female participants. Analyses showed that testosterone significantly mediated the relation between male cerebellar gray matter and measures of neuroticism. Our findings on the interrelations between endogenous testosterone, neuroticism and cerebellar morphology provide a cerebellum-oriented framework for the susceptibility to experience negative emotions and mood in adolescence and early adulthood.

Article Source: http://www.psyneuen-journal.com/article/S0306-4530(16)30688-6/abstract?cc=y=

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Symptomatic response to testosterone treatment in dieting obese men with low testosterone levels in a randomized, placebo-controlled clinical trial

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Background:

Obese men commonly have reductions in circulating testosterone and report symptoms consistent with androgen deficiency. We hypothesized that testosterone treatment improves constitutional and sexual symptoms over and above the effects of weight loss alone.

Methods:

We conducted a pre-specified analysis of a randomized double-blind, placebo-controlled trial at a tertiary referral center. About 100 obese men (body mass index (BMI)greater than or equal to30kgm2) with a repeated total testosterone level less than or equal to12nmoll−1 and a median age of 53 years (interquartile range 47–60) receiving 10 weeks of a very-low-energy diet (VLED) followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (n=49, cases) or matching placebo (n=51, controls). Pre-specified outcomes were the between-group differences in Aging Male Symptoms scale (AMS) and international index of erectile function (IIEF-5) questionnaires.

Results:

Eighty-two men completed the study. At study end, cases showed significant symptomatic improvement in AMS score, compared with controls, and improvement was more marked in men with more severe baseline symptoms (mean adjusted difference (MAD) per unit of change in AMS score −0.34 (95% confidence interval (CI) −0.65, −0.02), P=0.04). This corresponds to improvements of 11%and 20% from baseline scores of 40 and 60, respectively, with higher scores denoting more severe symptoms. Men with erectile dysfunction (IIEF-5less than or equal to20) had improved erectile function with testosterone treatment. Cases and controls lost the same weight after VLED (testosterone −12.0kg; placebo −13.5kg, P=0.40) and maintained this at study end (testosterone −11.4kg; placebo −10.9kg, P=0.80). The improvement in AMS following VLED was not different between the groups (−0.05 (95% CI −0.28, 0.17), P=0.65).

Conclusions:

In otherwise healthy obese men with mild to moderate symptoms and modest reductions in testosterone levels, testosterone treatment improved androgen deficiency symptoms over and above the improvement associated with weight loss alone, and more severely symptomatic men achieved a greater benefit.

 Article Source: http://www.nature.com/ijo/journal/v41/n3/full/ijo2016242a.html?WT.ec_id=IJO-201703

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Low T & Low D: A Deadly Duo

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A new study sheds some light, albeit a disturbing illumination, on men who carry both low free testosterone and low Vitamin D levels.

The study was published in February of 2012 and consisted of 2,069 men*.  It’s findings concluded that when men were deficient in free testosterone and deficient in Vitamin D they had a 77% increase in cardiovascular-related mortality.

More disturbing, however, was the increase in non-cardiovascular deaths.  When deficient in both free testosterone and Vitamin D, the researchers concluded there was an astounding 133% increase in non-cardiovascular mortality.

The researchers conducting this study carefully adjusted for confounding factors like age, body-mass index, active smoking, physical activity, diabetes, C-reactive protein, prevalent coronary artery disease, serum calcium, and parathyroid hormone.

This new study closely resembles findings from a study of 858 US military veterans over the age of 40. The study took place over 8 years, with doctors monitoring the testosterone levels of the men in the group, and examining their accompanying health issues.  The results there showed an 88% increased risk of death among the men in the low testosterone range.  The study was published in the Archives of Internal Medicine.

In light of this new evidence, all men aged 30 years and older should begin testing immediately.  We recommend you seek out a qualified hormone physician who has been trained in testosterone restoration and hormone balancing.  Unfortunately, far too many primary care doctors do not test men’s testosterone levels, let alone their Vitamin D (25-Hydroxy) levels.  If they do, the resulting tests almost always omit estrogen levels.  And the therapy prescribed will, often times, be testosterone creams or gels, without any regard to estrogen increases or testicular atrophy.

Men concerned with low testosterone or who want to be tested should contact Boston Testosterone Partners.  Specialists in testosterone restoration, they now treat patients nationally through their numerous affiliate offices.

Boston Testosterone Partners has begun the widespread testing of men’s Vitamin D (25-Hydroxy) levels, in addition to their comprehensive hormone testing.  Where deficient, physician prescriptions for pharmaceutical grade Vitamin D are dispensed to patients.  Men are then retested 10 weeks post therapy to adjust and optimize their levels into the recommended 50-60 ng/mL range.

Boston Testosterone is uniquely positioned to quickly conduct testing for men nationwide.  If you are interested in having a National Hormone Physician order testing for you, please contact Boston Testosterone online.

Boston Testosterone is a Testosterone Replacement, Wellness and Preventative Medicine Medical Center that treats and prevents the signs and symptoms associated with Andropause and hormone imbalances.  With affiliates nationally, Boston Testosterone offers hormone replacement therapy, weight loss protocols, erectile dysfunction (ED), Sermorelin-GHRP2 therapy and neutraceutical injectable therapies for men and women.  Their medical facilities offer physician examinations and treatment programs that incorporate the latest in medical science.

*Lerchbaum E, Pilz S, Boehm BO, Grammer TB, Obermayer-Pietsch B, März W. Combination of low free testosterone and low vitamin D predicts mortality in older men referred for coronary angiography. Clin Endocrinol (Oxf). 2012 Feb 22. doi: 10.1111/j.1365-2265.2012.04371.x.

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Heart and bone damage from low vitamin D tied to declines in sex hormones

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Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.

In a national study in 1010 men, to be presented Nov. 15 at the American Heart Association’s (AHA) annual Scientific Sessions in Orlando, researchers say the new findings build on previous studies showing that deficiencies in vitamin D and low levels of estrogen, found naturally in differing amounts in men and women, were independent risk factors for hardened and narrowed arteries and weakened bones. Vitamin D is an essential part to keeping the body healthy, and can be obtained from fortified foods, such as milk and cereals, and by exposure to sunlight.

“Our results confirm a long-suspected link and suggest that vitamin D supplements, which are already prescribed to treat osteoporosis, may also be useful in preventing heart disease,” says lead study investigator and cardiologist Erin Michos, M.D., M.H.S.

“All three steroid hormones – vitamin D, estrogen and testosterone – are produced from cholesterol, whose blood levels are known to influence arterial and bone health,” says Michos, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. “Our study gives us a much better understanding of how the three work in concert to affect cardiovascular and bone health.”

Michos says the overall biological relationship continues to puzzle scientists because studies of the long-term effects of adding estrogen in the form of hormone replacement therapy in women failed to show fewer deaths from heart disease. Indeed, results showed that in some women, an actual increase in heart disease and stroke rates occurred, although, bone fractures declined.

The Hopkins team’s latest data were provided by analyzing blood samples from a subset of men participating in a study on cancer. That study was part of a larger, ongoing national health survey involving both men and women and was designed to compare the risk of diseases between those with the lowest blood levels of vitamin D to those with higher amounts. An unhealthy deficiency, experts say, is considered blood levels of 20 nanograms per milliliter or lower.

The men in the study had their hormone levels measured for both chemical forms of testosterone and estrogen found in blood, when each is either unattached or circulating freely, and when each is attached to a separate protein, known as sex hormone binding globulin, or SHBG for short.

Initial results showed no link between vitamin D deficiency and depressed blood levels of either hormone. And despite finding a harmful relationship between depressed testosterone levels and rates of heart disease, stroke, and high blood pressure, as well as osteopenia in men, researchers found that it was independent of deficiencies in vitamin D.

However, when researchers compared ratios of estrogen to SHBG levels, they found that rates of both diseases, especially osteopenia, the early stage of osteoporosis, were higher when both estrogen and vitamin D levels were depressed.

For every single unit decrease in ratios of estrogen to SHBG (both in nanomoles per liter), men low in vitamin D showed an 89 percent increase in osteopenia, but men with sufficient vitamin D levels had a less worrisome 64 percent jump.

Using the same measure of estrogen levels, men low in vitamin D were also at heightened risk of cardiovascular diseases, at 12 percent, compared to men with adequate levels of the vitamin, at 1 percent, numbers that researchers say are still statistically significant.

“These results reinforce the message of how important proper quantities of vitamin D are to good bone health, and that a man’s risk of developing osteoporosis and heart disease is heavily weighted on the complex and combined interaction of how any such vitamin deficits interact with both their sex hormones, in particular, estrogen,” Michos says.

Michos and her team next plan to analyze blood samples from women to see if the same results from men hold true.

Michos recommends that men and women boost their vitamin D levels by eating diets rich in fatty fish, such as cod, sardines and mackerel, consuming fortified dairy products, taking vitamin supplements, and in warmer weather briefly exposing skin to the sun’s vitamin-D producing ultraviolet light.

She points out that clinical trials are under way to determine whether or not vitamin D supplements can prevent incidents of or deaths from heart attack, stroke and other signs of cardiovascular disease.

The U.S. Institute of Medicine suggests that an adequate daily intake of vitamin D is between 200 and 400 international units, but Michos feels this is inadequate to achieve optimal nutrient blood levels (above 30 nanograms per milliliter). Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women are technically deficient in the nutrient, with vitamin D levels below 28 nanograms per milliliter.

###

Funding for this study was provided by the Hormone Demonstration Project, a part of the Maryland Cigarette Restitution Fund Research Grant Program at the Johns Hopkins University. Additional support was provided by the American College of Cardiology Foundation and a Clinician Scientist Award at the Johns Hopkins University.

Besides Michos, other researchers at Johns Hopkins involved in this study were Jared Reis, Ph.D.; and Meredith Shields and Elizabeth Platz, Ph.D., Sc.D., at the University’s School of Public Health; and Sabine Rohrmann, now at the German Cancer Research Center in Heidelberg. Another investigator in this research was Nader Rifai, Ph.D., at Children’s Hospital Boston and Harvard Medical School.

(Presentation title: The association of cardiovascular disease and osteopenia may be mediated through a vitamin D-sex steroid hormone interaction, results from the Third National Health and Nutrition Examination Survey, NHANES-III.)

Article Source: https://www.eurekalert.org/pub_releases/2009-11/jhmi-hab111109.php

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