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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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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Jane Fonda reveals testosterone is the secret behind her sex success at 73

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She has attributed her youthful looks to a healthy love life and given hope to millions by saying she had the best sex of her life at 71.

So it is something of a let down to find out that even sex symbol Jane Fonda needs artificial help.

The Barbarella star has revealed she took the male sex hormone testosterone from the age of 70 to boost her libido.

Miss Fonda said it made ‘a huge difference’.

Advising other women of a certain age how to pep up their love lives, three-times married actress, political activist and fitness guru said: ‘Here’s something I haven’t said publicly yet: I discovered testosterone about three years ago, which makes a huge difference if you want to remain sexual and your libido has dropped.

‘Use testosterone, it comes in a gel, pill or patch.’

Earlier this year, Robbie Williams shocked his legions of female fans by admitting he was injecting himself with testosterone to boost his sex drive.

Although testosterone is usually thought of as a male hormone, it is also made by women, but in much smaller amounts.

Levels drop off after the menopause, leading to some doctors prescribing testosterone alongside more traditional hormone replacement therapy.

It is relatively cheap, costing around £50 for six months’ supply and comes in patches, implants and gels.

But a reinvigorated love life can come at a cost.

Miss Fonda, now 73, and in a relationship with music producer Richard Perry, who is four years her junior, told the Sunday Telegraph: ‘I had to stop because it was giving me acne.

‘It’s one thing to have plastic surgery, but it is quite another to have adolescence acne. That is going too far.’

Two years ago, she created envy in millions of bedrooms by telling how she was having the best sex of her life, despite having had spinal surgery and boasting an artificial knee and a titanium hip.

She said: ‘How do I still look good?  I owe 30 per cent to genes, 30 per cent to good sex, 30 per cent because of sports and healthy lifestyle with proper nutrition and for the remaining ten per cent, I have to thank my plastic surgeon.

But I’m happier, the sex is better and I understand life better. I don’t want to be young again.’

More recently, she has devoted 50 pages of her new autobiography to explaining how couples can keep the passion alive long after the vigour of their youth has failed.

However, her use of testosterone has remained secret until now.

British experts welcomed the revelation.

Professor John Studd, of the London PMS and Menopause Clinic has been prescribing testosterone for women for 30 years.

He said: ‘It is not just about libido.  The benefits include more energy, more self-confidence, better mood and all of those things.’

He added that carefully balancing the dose should remove the risk of side-effects such as acne and excessive bodily or facial hair.

Dr John Stevenson chairman of the charity Women’s Health Concern, said: ‘Jane Fonda clearly thinks there should be no time limit to being sexually active, which is fine. Good for her.’

However, the Royal College of Obstetricians and Gynaecologists warns that the long-term consequences of the treatment are unknown.

THE TRUTH BEHIND TESTOSTERONE

Testosterone can be part of the hormone replacement therapy given to menopausal women.

Gels that are rubbed into the skin are the most popular.  But patches, creams and implants are also available.

Topping up levels of the hormone can give a woman in her 50s or 60s the libido of someone half her age, as well as boost energy and mood.

But too high a dose carries the risk of acne and greasy skin and hair.

‘Masculine’ side-effects such as excessive bodily and facial hair and a deepened voice are also possible.

Testosterone pills aren’t given to women but can raise cholesterol, increasing the odds of heart attacks and strokes.

The Royal College of Obstetricians and Gynaecologists urges caution when prescribing the libido-boosting treatment to women other than those who have had their ovaries removed.

It advises: ‘Testosterone replacement may be associated with adverse clinical and metabolic side effects and long-term consequences are unknown.

Written By: Fiona Macrae

Read more: http://www.dailymail.co.uk/femail/article-2028544/Jane-Fonda-reveals-testosterone-secret-sex-success-73.html#ixzz4cj0r8L4x

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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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Study suggests another look at testosterone-prostate cancer link

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The long-standing prohibition against testosterone therapy in men with untreated or low-risk prostate cancer merits reevaluation, according to a new study published in The Journal of Urology.

“For many decades it had been believed that a history of prostate cancer, even if treated and cured, was an absolute contraindication to testosterone therapy, due to the belief that testosterone activated prostate cancer growth, and could potentially cause dormant cancer cells to grow rapidly,” says Abraham Morgentaler, MD of Men’s Health Boston. “Generations of medical students and residents were taught that providing testosterone to a man with prostate cancer was like pouring gasoline on a fire.”

This study, involving 13 symptomatic testosterone deficient men who also had untreated prostate cancer, suggests this traditional view is incorrect, and that testosterone treatment in men does not cause rapid growth of prostate cancer. It is the first to directly and rigorously assess changes in the prostate among men with prostate cancer who received testosterone therapy.

The men received testosterone therapy while undergoing active surveillance for prostate cancer for a median of 2.5 years. Median age was 58.8 years. The initial biopsy Gleason score was 6/10 for 12 of the men, 7/10 for the other (Gleason score grades the aggressiveness of prostate cancer by its microscopic appearance on a scale of 2-10. Gleason 6 is generally considered low to moderately aggressive, and Gleason 7 moderately aggressive).

Mean testosterone concentration increased from 238 to 664 ng/dl with treatment, yet neither prostate specific antigen (PSA) concentrations nor prostate volume showed any change. Follow-up biopsies of the prostate were performed in all men at approximately yearly intervals, and none developed cancer progression. In fact, 54 percent of the follow-up biopsies revealed no cancer at all.

Although the number of men in the study was small, and none had aggressive or advanced prostate cancer, Morgentaler observed, “These men were rigorously followed. The cancers in these men were typical of the prostate cancers for which men have undergone invasive treatment with surgery or radiation for 25 years. Clearly, the traditional belief that higher testosterone necessarily leads to rapid prostate cancer growth is incorrect.”

In a Journal of Urology editorial comment, Martin M. Miner, MD, of the Miriam Hospital and Warren Alpert School of Medicine of Brown University notes the conclusions represent “a remarkable shift in thinking from only five years ago. … If testosterone therapy was not associated with disease progression in men with untreated prostate cancer, how concerned must we be about testosterone therapy in men with treated prostate cancer?”

“An increasing number of newly diagnosed men with prostate cancer opting for active surveillance, and with many of them also desiring treatment for their signs and symptoms of testosterone deficiency, the results suggest a reevaluation of the long standing prohibition against offering testosterone therapy to men with prostate cancer,” says Morgentaler.

Refraining from testosterone therapy due to unmerited prostate cancer fears may have adverse lifestyle and health consequences, since testosterone therapy in testosterone deficient men has been shown to improve symptoms of fatigue, decreased libido, and erectile dysfunction. Testosterone therapy may also improve mood, blood sugar control, increase muscle, decrease fat, and improve bone density. Four recent studies have shown that men with high testosterone levels appear to live longer than men with low levels, although it has not yet been shown that treating men with testosterone increases longevity.

Morgentaler commented on an Italian study that showed that low levels of testosterone were associated with aggressive prostate cancer. The risk of aggressive cancer was reduced for men with normal testosterone compared with men with low testosterone.

In an editorial in the journal Cancer, “Turning Conventional Wisdom Upside Down: Low Serum Testosterone and High-Risk Prostate Cancer Morgentaler wrote, “After seven decades of circumstantial evidence pointing us in the wrong direction, perhaps it is time to consider the once unthinkable – conducting a testosterone therapy trial of sufficient size and duration to determine whether normalization of serum testosterone in older men many reduce the risk of prostate cancer, particularly high-risk prostate cancer.”

Article Source: https://www.eurekalert.org/pub_releases/2011-04/bidm-ssa041911.php

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