Male birth control shot found effective, but side effects cut study short

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Both men and women are responsible for pregnancy, yet the burden of preventing it often falls on one gender. Women can choose from a variety of options to control fertility while for generations, men have been limited to withdrawal, condoms and sterilization. But someday soon, a new method may allow men to shoulder a greater share of responsibility.

A new hormonal birth control shot for men effectively prevented pregnancy in female partners, a new study found.
The study, co-sponsored by the United Nations and published Thursday in the Journal of Clinical Endocrinology and Metabolism, tested the safety and effectiveness of a contraceptive shot in 320 healthy men in monogamous relationships with female partners. Conducted at health centers around the world, enrollment began on a rolling basis in September 2008. The men, who ranged in age from 18 to 45, underwent testing to ensure that they had a normal sperm count at the start.
The injection, given every eight weeks, consisted of 1,000 milligrams of a synthetic form of testosterone and 200 milligrams of norethisterone enanthate, essentially a derivative of the female hormones progesterone and estrogen referred to as “progestin” in the synthetic form.
According to Dr. Seth Cohen, a urologist at NYU Langone Medical Center, when a man is given a shot of testosterone, “basically, the brain assumes the body is getting enough,” so the body shuts down its own production of testosterone — specifically “the testicle’s production of testosterone as well as the testicle’s production of sperm.”
The progestin “further drives the brain malfunction, so it stops the testicle’s production of both testosterone and sperm,” explained Cohen, who was not involved in the new study.
The researchers used a combination of hormones in order to reduce the testosterone dose to a level that they believed, based on previous studies, would effectively lower fertility yet still be safe.

Study terminated early

During the ramp-up pre-efficacy stage of the study, the couples were instructed to use non-hormonal birth control methods, while the men participants received shots and provided semen samples until their sperm counts dropped to less than 1 million per milliliter in two consecutive tests. At that point, couples relied on the injections as contraception.
Throughout the study, the men provided semen samples to ensure that their sperm counts stayed low. Once the participants stopped receiving the injections, they were monitored to see whether and how quickly their sperm counts recovered to levels described as “fertile” by the World Health Organization.
The researchers discovered that the shot effectively held the sperm count at 1 million per milliliter or less within 24 weeks for 274 of the participants. The contraceptive method was effective in nearly 96% of continuing users.
Four pregnancies (resulting in three live births) occurred among the men’s partners, all during the phase where other contraception was required. All the babies were normal, noted Doug Colvard, co-author of the study and deputy director for programs at the nonprofit research organization CONRAD, Eastern Virginia Medical School, a co-sponsor of the study.
Serious negative effects resulting from the shots included one case of depression and one experience of an abnormally fast and irregular heartbeat after the injections stopped. The researchers considered one intentional overdose of acetaminophen possibly related.
“It is possible that the fluctuations in the circulating progestin following bimonthly injections could haveresulted in the reported or observed mood swings, such as occurs in women, whether on a hormonal contraceptive or not,” Colvard speculated.
Overall, 20 men dropped out early due to side effects. A total of 1,491 adverse events were reported by participants, including injection site pain, muscle pain, increased libido and acne. The researchers say that nearly 39% of these symptoms — including one death by suicide — were unrelated to the shots.
However, due to side effects, particularly depression and other mood disorders, the researchers decided in March 2011 to stop the study earlier than planned, with the final participants completing in 2012.
“I immediately thought of the recent findings on female birth control,” Elisabeth Lloyd said of a study published last month in the journal JAMA Psychiatry. A faculty scholar at the Kinsey Institute, she is a professor of biology and an adjunct professor of philosophy at Indiana University Bloomington.
The study she refers to found an association between the use of hormonal birth control and depression. It looked at prescriptions filled during an 18-year period by more than 1 million women included in Denmark’s national registry.
According to the lead author, Dr. Øjvind Lidegaard of the University of Copenhagen, among women both with and without a psychiatric history who were using hormonal contraceptives, about 10% to 15% got a prescription for an antidepressant during a five-year period.
Annually, the risk of antidepressant use among the youngest group of women taking hormonal contraception amounts to between 2% and 3%. Two or three out of every 100 women between 15 and 19 years old who take hormonal contraceptives will become depressed over the course of a year. “Adolescents seemed more vulnerable to this risk than women 20 to 34 years old,” the researchers noted in their study.
Lidegaard said doctors need to tell women about the benefits and risks of hormonal contraceptive products when deciding which birth control to use.

Effects on fertility

After the men stopped receiving shots, most returned to fertility during a recovery period.
“The minimum recovery time was about 12 weeks after the last injection, and the average time was about 26 weeks,” said Colvard.
Still, there were problems. After 52 weeks in recovery, eight participants had not returned to fertility. The researchers continued to follow these men individually, and five eventually regained normal sperm counts over a longer period of time. One volunteer did not fully recover within four years, though he did “partially recover, so whether he is actually fertile is not known,” Colvard said.
“It shows that it’s a risk, a low-probability risk of it, and it’s not to be sneezed at as a risk of it, surely,” said Lloyd, who is unaffiliated with the new study.
Lloyd said, adding that this risk needs to be compared with those involved in hormonal birth control for women, such as potentially fatal strokes and blood clots.
“These risks of fertility damage are not fatal risks like the women endure with their birth control,” said Lloyd. “You have to compare what women are doing in terms of taking hormones with what men are doing in terms of taking hormones. Are they taking their life in their hands when they take the hormones? Women are. And that needs to be put right up in front when considering the risk.”
Colvard and his co-authors say more research is needed as they work to perfect their cocktail of hormonal contraceptives in an attempt to reduce the risk of side effects, including depression, increased sex drive and acne.
Despite the side effects of the male birth control shot, more than 75% of participants reported being willing to use this method of contraception at the conclusion of the study.
Cohen believes at least part of the reason for this is that they were getting testosterone.

Looking to the future

“Testosterone makes men feel pretty good,” Cohen said. “Testosterone is not a stimulant per se, but it is a steroid, and like a lot of steroids, it can give you a boost of energy. It can give you a boost of muscle mass. It can help with weight loss. It can help with mentation,” or mental activity.
Lloyd believes that if 75% of the men said they’d be interested in getting the shot if it were available, there’s real interest in the product. “That’s unbelievable. That’s fabulous. I’m very very impressed with that number,” she said.
Cohen, who says he he sees patients who face infertility or other hormonal problems, worries about the safety of this method. “Let’s just say, when I read it, I was highly alarmed,” he said, explaining that putting men on testosterone who have normal testosterone levels is not safe and amounts to a violation of the “ethical clinical practice guidelines.”
However, Lloyd thinks this product is a long time coming.
“It’s been a long time since people have been talking about male birth control. This goes back to the 1950s at least.” When scientists first began talking about hormonal birth control for women, they also discussed the same for men, explained Lloyd, but hormonal contraceptives for men were not acted on or investigated.
Cohen questions the general safety of hormonal birth control — for anyone.
“We’re talking about young people, and the scary thing is messing around with young people’s hormones, and that can be detrimental for the rest of their life, right?” Cohen said. “You take an 18-year-old girl or a 20-year-old boy and mess around with their hormones, you’ve really altered possibly how they go through their life.
“If anything, this may wake us up to finding out better hormonal contraceptives for women, right? Because certainly, I know that a lot of young women don’t get the type of counseling that maybe they deserve when it comes to contraception,” Cohen said. “Just a (prescription) and a visit to Duane Reade is all they get, and that may not be enough.”

Article Source: http://www.cnn.com/2016/10/30/health/male-birth-control/index.html?sr=fbCNN103116male-birth-control1030AMStoryGalLink&linkId=30515664

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The effects of running on testosterone levels

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 American marathoner Ryan Hall recently said that in the past year he has been dealing with bouts of low testosterone that affect his running – a malady he has concluded is a risk for men who train and run marathons. Hall noticed a sudden onset of fatigue that obviously affected his training and race preparation, and blood tests confirmed low testosterone levels.

Symptoms for men with low testosterone include fatigue, depression, irritability, and loss of sex drive. Commons causes include diabetes, liver disease, injury to the testicles, and obesity. Another risk associated with low testosterone is decreased bone density, which for runners could mean an increased risk of stress fractures.

So where does running fit into this?

Overtraining is the most likely the culprit. Mileage, intensity, and frequency of running also play a role – when you do too much, your body may react by not producing enough testosterone.

According to a study from the University of North Carolina, “Endurance training may have significant effects on the male reproductive system. The evidence suggests endurance training significantly affects the major male reproductive hormone, testosterone. At rest, testosterone appears to be lower in the endurance-trained male than in the untrained male.”

How do you treat low testosterone?

Vigorous resistance training, like weight lifting, eating enough fat, and getting enough sleep can help elevate testosterone levels – as will decreasing the amount of running.

While you could also take synthetic testosterone or steroids prescribed by a doctor, this could cause two problems: (1) It may be considered an illegal performance enhancing drug depending on your sport; and (2) Taking synthetic testosterone interferes with your body’s natural production of testosterone. In addition, steroids or synthetic testosterone could cause an unwanted increase in muscle mass, which could be detrimental for runners.

If you suspect you may have low testosterone, go see your doctor, get a blood test, and – if needed – see an endocrinologist who has worked with athletes.

Written by Rob Haneisen.

Article Source: http://blog.walkjogrun.net/2015/11/18/the-effects-of-running-on-testosterone-levels/

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Testosterone levels 5x lower reported by men taking long-acting chronic pain meds

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The study is the first to show a significant difference in risk between short-acting and long-acting opioids

Low testosterone levels occur five times more often among men who take long-acting instead of short-acting opioids for chronic pain, according to a new Kaiser Permanente study published in The Clinical Journal of Pain.

While it has been known that opioids cause low testosterone in men, this study is the first to show a significant difference in risk between short-acting (immediate release) and long-acting opioids.

The 81 men in the retrospective study were between 26 and 79 years old (median age 51) and were seen in the chronic-pain clinic at Kaiser Permanente’s Santa Rosa Medical Center (Calif.) between January 2009 and June 2010. All of the participants had been on a stable dose of an opioid for at least three months, and none had a previous diagnosis of low testosterone. A larger retrospective study of more than 1,500 male pain patients is currently under way.

“There’s a large gap in the evidence base with regard to opioids,” said Andrea Rubinstein, MD, of the Departments of Chronic Pain and Anesthesiology, Kaiser Permanente Santa Rosa Medical Center. “More safety and efficacy studies are needed. We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks.”

Once prescribed primarily to cancer patients, the use of opioid-based medications such as oxycodone (Oxycontin) and hydrocodone (Vicodin) for treating chronic, non-cancer pain has increased dramatically in recent decades. An estimated 4.3 million Americans use opioids on a daily basis for pain.

“For years, doctors have been encouraged to prescribe long-acting opioids rather than short-acting opioids because we believed they were safer, had less abuse potential, and offered more consistent pain control, but no study has ever been able to support this practice,” Dr. Rubinstein said.

The study compared the use of short-acting opioids, which immediately release the pain medication and are taken every four to six hours, and long-acting opioids, which slowly release the pain medication and are taken every eight to 12 hours.

A healthy young man should have testosterone levels between 300 and 800 nanograms per deciliter (ng/dL); in this study, low testosterone, also known as hypogonadism, was defined as less than 250 ng/dL. Low testosterone levels have been associated with decreases in muscle mass, bone density (osteoporosis or osteopenia), cognition, mood, libido (sex drive) and general quality of life.

Seventy-four percent of the men on long-acting opioids had low testosterone levels, compared with 34 percent of the men using short-acting opioids. After controlling for daily dosage and body mass index, the study found that the odds of having low testosterone were 4.78 times greater for men taking a long-acting opioid than a short-acting opioid. Dose was not associated with an increased risk of low testosterone.

“These medications work well for short-term, acute pain,” said Dr. Rubinstein. “It has long been extrapolated that they can also be used safely long-term to control chronic pain. We are now finding that the long-term use of opioids may have important unintended health consequences.”

###

Co-authors of the study were Diane M. Carpenter, MPH, Kaiser Permanente Division of Research; and Jerome R. Minkoff, MD, Kaiser Permanente Department of Endocrinology, Santa Rosa Medical Center.

The Clinical Journal of Pain is the official journal of the Eastern Pain Association.

Article Source: http://www.stonehearthnewsletters.com/testosterone-levels-5x-lower-reported-by-men-taking-long-acting-chronic-pain-meds/pain/

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More magnesium, more free testosterone

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Men with more magnesium in their blood are likely to have a higher amount of free testosterone in their body. Chemical analysts draw this conclusion in an article published in the Journal of Pharmaceutical and Biomedical Analysis.

About sixty percent of the body’s testosterone is attached to sex hormone binding globulin (SHBG) [spatial structure above]. Androgens bound to SHBG lose their anabolic effect but probably retain their androgenic effect. In the prostate, for example, there are SHBG receptors and they send error signs to the prostate cells if they attach themselves to SHBG with androgens bound to it. Androgen steroid hormones incorporated by SHBG therefore do have undesired effects, but no desirable effects.About two percent of the testosterone in the body is active: it is not attached to binding proteins which prevent testosterone from interacting with its receptor. About forty percent of the body’s testosterone is attached to albumin, a protein that can let go of the hormone. Free testosterone and testosterone attached to albumin are referred to as bio-available testosterone.

As men get older, SHBG sweeps up more and more testosterone. This is also because older men eat less protein. Low protein consumption raises the concentration of SHBG in the blood. A higher protein intake results in more albumin, and that increases the amount of bio-available testosterone. Within limits, of course.

The researchers, linked to the Université de Franche-Comté, extracted SHBG from the blood of young men, and exposed the protein to magnesium ions. Then they measured how fast the testosterone attached itself to SHBG at increasing magnesium concentrations. The higher the magnesium concentration, the lower the attraction.

Although the researchers did not examine whether more magnesium actually leads to more free testosterone in humans, they believe their findings are meaningful at the physiological level.

“The results presented here provide evidence for an Mg2+-mediated variation of the testosterone-SHBG association, suggesting that an increase of the Mg2+-concentration inside the biological concentration range (0.75mM-1.0mM) could lead an enhancement of the bioavailable testosterone”, they write.

Fifteen years ago researchers examined the effect of extremely high – and biologically improbable – magnesium concentrations. These led to a small decline in the testosterone level. [Horm Metab Res. 1993 Jan;25(1):29-33.]

The researchers have announced that they will soon be publishing their findings on the effect of plant substances on the binding of testosterone to SHBG.

Magnesium in food is found in plant products. Good sources are fibre-rich breakfast cereals, spinach, nuts and beans.

Sources:
Journal of Pharmaceutical and Biomedical Analysis, doi:10.1016/j.jpba.2008.10.041

Article Source: http://www.ergo-log.com/magnesiumtest.html

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Opioid Use Linked to Low Testosterone

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Exposure to opioids is associated with increased likelihood of low testosterone levels, with increased odds as age and number of comorbidities increase, according to a study published in Pain Medicine.

Maria Soledad Cepeda, MD, PhD, from Janssen Research & Development in Titusville, NJ, and colleagues used data from the 2011 to 2012 National Health and Nutrition Examination Survey to examine whether opioid use contributes to changes in testosterone levels. Testosterone levels were compared for participants who responded that they had been exposed to prescription opioids in the past 30 days (320 participants) versus those who were unexposed (4,909 participants).

The researchers found that the odds of having low testosterone levels were higher for participants on opioids versus unexposed participants (odds ratio, 1.40). The odds of having low testosterone levels increased significantly in all categories as the age and number of comorbidities increased, after adjustment for opioid exposure. The odds of having low testosterone levels were increased for participants aged older than 70 years versus those aged 17 to 45 years (odds ratio, 1.70) and for participants with more than two versus no comorbidities (odds ratio, 1.69).

“When assessing the impact of opioids on testosterone, the effects of age and medical conditions should be considered,” the authors write.

All authors disclosed employment by pharmaceutical companies, including Janssen Research & Development, which funded the study.

Source http://www.renalandurologynews.com/hypogonadism/opioid-use-linked-to-low-testosterone/article/462834/

  1. Soledad Cepeda M, Zhu V, Vorsanger G, and Eichenbaum G. Effect of Opioids on Testosterone Levels: Cross-Sectional Study using NHANES. Pain Medicine. doi:10.1111/pme.12843.

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Do Cholesterol Drugs Have Men By Their Gonads?

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Cholesterol-lowering agents in the statin drug class have long been linked with erectile dysfunction and low testosterone — effects that compromise more than just a man’s general sense of well-being and physical health, but his ego as well.

Now, a new study on statins and male fertility has found for the first time that this cholesterol-lowering class of drugs may be causing significant and lasting damage to men’s testicles and sperm, and by implication, possibly the health of future generations.

The new study published in Reproductive Biology and Endocrinology titled, “Evaluation of atorvastatin efficacy and toxicity on spermatozoa, accessory glands and gonadal hormones of healthy men: a pilot prospective clinical trial,” evaluated the effects of 10 mg daily of Lipitor (atorvastatin), daily, for 5 months, in 17 normal men with normal plasma lipid and standard semen parameters.

Sperm health parameters, accessory gland markers, semen lipid levels and blood levels of testicular hormones were evaluated before Lipitor intake, during the treatment, and 3 months after its withdrawal.

The alarming results were reported as follows:

  • Atorvastatin treatment significantly decreased circulating low-density lipoprotein cholesterol (LDL-C) and total cholesterol concentrations by 42% and 24% (p < 0.0001) respectively, and reached the efficacy objective of the protocol.”
  • “During atorvastatin therapy and/or 3 months after its withdrawal numerous semen parameters were significantly modified, such as total number of spermatozoa (-31%, p < 0.05), vitality (-9.5%, p < 0.05), total motility (+7.5%, p < 0.05), morphology (head, neck and midpiece abnormalities, p < 0.05), and the kinetics of acrosome reaction (p < 0.05). Seminal concentrations of acid phosphatases (p < 0.01), alpha-glucosidase (p < 0.05) and L-carnitine (p < 0.05) were also decreased during the therapy, indicating an alteration of prostatic and epididymal functions.”
  • “Moreover, we measured at least one altered semen parameter in 35% of the subjects during atorvastatin treatment, and in 65% of the subjects after withdrawal, which led us to consider that atorvastatin is unsafe in the context of our study.”

They concluded:

“Our results show for the first time that atorvastatin [trade name Lipitor] significantly affects the sperm parameters and the seminal fluid composition of healthy men.”

Why Are We Taking Statin Drugs If They Harm The Heart?

Statin drugs are purported to have cardioprotective properties because they reduce the production of low-density lipoprotein (LDL) – colloquially known as, and falsely equated with, ‘cholesterol‘ (there are actually hundreds of lipid species in the human liposome) – despite the fact the drug class itself has been found to be cardiotoxic to the heart muscle in several ways:

On the Greenmedinfo.com Statin Research database we have cataloged over 15 studies from the National Library of Medicine indicating the heart-damaging properties of this class of supposedly ‘heart friendly’ drugs.  View our professional data page here, or if you are not a member, view the open access reference page for public view and linking here.

Statins do not only reduce lipoprotein production but have so-called pleoitropic properties, which include immune system down-regulating and anti-inflammatory properties, which is why they are believed to have a small benefit in reducing the inflammatory burden caused by autoimmune processes in the artery that can precipitate myocardial infarction (heart attack) in some individuals — but not without having the unintended, adverse effect of increasing cancer risk (at all sites) and contributing to congestive heart failure, effectively cancelling out the small, mostly theoretical benefit of reduced heart attack risk. For instance, it has been estimated that “…at least 23,000 low-risk people would have to take statins for five years to prevent one death from heart disease.” [Source]

Statins are also clearly diabetogenic, increasing the risk of type 2 diabetes by about 50% in some populations, with the FDA now requiring drug manufacturers to include a warning of diabetes risk on statin drug labels. Considering morbidity and mortality from type 2 diabetes is caused not by the elevated blood sugar in and of itself, but the damage glycated sugar does to the vascular system and the subsequent cardiovascular harm it produces, the case against using statins for primary and secondary prevention of heart disease seems clear as day.

Moreover, cardiovascular harm is not the only concern. Statin drugs have been linked to over 300 adverse health effects. We issued a consumer alert on the topic several years ago. For the more technically minded, here is the database page on Statin drugs listing 300+ adverse health effects based on 465 published studies.

Heart Disease Is Not Caused By A Lack of A Drug

Should we be surprised to find so much research on this drug class’s adverse health effects? After all, cholesterol is fundamental for the health of each cell in the human body, and low cholesterol has been found to cause a wide range of health problems, including psychiatric states such as violence against self and other. The food and drug industries have used cholesterol phobia to manipulate health professionals and the lay public into believing that the cause of heart disease is genetic, and can only be addressed through the use of synthetic, patented, essentially toxic chemicals, i.e. pharmaceuticals, or eating semi-synthetic ‘low fat,’ ‘low cholesterol’ foods with very little nutritional value.

This latest study speaks to why we must exercise the precautionary principle when considering taking a patented chemical – technically a xenobiotic alien to human physiology – for suppressing a symptom of a much deeper and more complex problem. While oxidized cholesterol forms a significant part of the problem of atherosclerotic build-up in the arteries, it is not the primary cause of the damage to the inner lining of the arteries (endothelium), and the pre-existing endothelial dysfunction that can go on for many decades silently in the background. Ox-LDL deposits in atheromatous lesions have been viewed as an epiphenomenon, generated as part of a cascade of immune-mediated events the body activates in order to attempt to heal arterial damage. In certain respects, cholesterol deposits in the arteries at the site of damage can be likened to a Band-Aid. Do we blame the Band-Aid for causing the injury upon which it is placed?

It is important to point out that oxidized cholesterol (ox-LDL) can be toxic and harmful to the vascular system, but the problem with modern blood testing for ‘cholesterol’ is that it does not take into the quality of the lipoproteins, only their quantitative dimensions.  Depending on one’s diet, environmental factors, and overall bodily health, LDL particles will oxidize at different rates. If you are eating an antioxidant rich diet, full of healthy fats, phytocompounds, etc., your properly functioning LDL will be less susceptible to conversion to ox-LDL.  On the other hand, eating a diet full of non-essential, oxidized fats, deficient in phytonutrients, antioxidants, etc. – and adding in environmental toxins and toxicants, e.g. smoking – will produce more ox-LDL, rendering it artherogenic. Obviously, therefore, diet and lifestyle form the basis for a sound preventive approach if the ‘lipid hypothesis‘ of cardiovascular disease is even deemed truly relevant. [For more research on natural substances which inhibit cholesterol oxidation, view our database on the topic: Prevent Cholesterol Oxidation.]

Furthermore, there are many ways to address underlying vascular pathologies without suppressing the production of a vital building block and signaling molecule, which is what cholesterol is. Pomegranate, chocolate, and many other natural substances, have been confirmed in research to have profound heart disease preventive and reversing properties. You can explore our database sections relevant to the topic within our Heart Health guide, to find hundreds of studies proving this point. Basic nutritional incompatibilities, including the consumption of wheat which has cardiotoxic properties in genetically susceptible individuals, and excessive consumption of omega-6 versus omega-3 fats can profoundly increase the risk of heart disease. One groundbreaking study published last year, in fact, indicates that statins actually reduce the health benefits of omega-3 fats in the diet – adding another mechanism by which statin drugs exert heart disease promoting effects.

Beyond the Pharmaceutically-Driven Medical Paradigm

If statin drugs are toxic to human sperm, and if the men within whom this statin-induced damage is occurring are of reproductive age, the implications of this latest study on statins and fertility are potentially devastating to the health of future generations. Changes in our species germlines – sperm or egg – are carried on to future generations, possibly forever. With recent research indicating that even changes to somatic cells in this lifetime are capable of transferring information to the sperm, what we do here and now – our chemical exposures, our nutritional status, and even our psychospiritual and mental orientation (which gear into real physiological and genetic/epigenetic processes – can have critical and irreversible affects on our offspring.

Clearly, the time has come both to re-evaluate the role of pharmaceuticals in ‘preventive’ health care, as well as the effects these novel new chemical compounds will have on the next generation, and the next.

For alternatives to lipid lowering chemicals, take a look at the following, evidence-based natural interventions:

Source: http://www.greenmedinfo.com/blog/do-cholesterol-drugs-have-men-their-gonads

For more information and appointments, please contact Clinic Director Charlie Blaisdell at CBlaisdell@CoreNewEngland.com

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Is Male Menopause Real?

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If you have any of these symptoms or know anyone who does, please check out our website and give us a call to find out what you can do.

Is Male Menopause Real? 

By Daniel D. Federman, M.D., and Geoffrey A. Walford, M.D.

Newsweek Jan. 15, 2007 issue – You’re a guy in your late 50s. You’ve just awakened and are looking at yourself in the bathroom mirror—as you do every morning. Only today you notice for the first time what must have been there for a while: the love handles, the once bulging pecs that now sort of sag. It gets you thinking. You realize that for some time you haven’t had as much energy as you used to, you don’t have as much interest in sex, there are times when you feel down and discouraged, and your friends tell you that you’re more irritable than you used to be. Is this just aging? Is it simply the inevitable price of your nutritionally rich and exercise-poor lifestyle? Or is it a medical condition—one for which there might be a treatment?

Are you entering “male menopause”? You’ve heard the phrase, but is there really such a thing?

Like women, men experience a drop in the levels of sex hormones as they age. But in men, the pace of these changes is quite different. In women, levels of the main female sex hormone, estrogen, remain high for most of their adult lives, and then, around the age of 50, plunge over the course of five years. The lower levels of estrogen cause the physical and psychological changes of menopause, including the most obvious one: the cessation of menstrual periods. When a woman has entered menopause, it’s not hard for her to tell.

With men, it’s much more gradual. Levels of a man’s main sex hormone, testosterone, begin to drop as early as the age of 30. Instead of plunging over a few years, the testosterone levels drop very slightly (about 1 percent) each year—for the rest of his life. This change is so gradual that many men may not notice any effects until several decades have gone by. Yet, by 50, 10 percent of all U.S. men have low levels of testosterone. By 70, more than half are testosterone deficient.

Do the progressively lower levels of testosterone cause symptoms in a man, the way lower levels of estrogen do in a woman? There is no doubt that they can, but it can be very hard to tell. Men with certain rare conditions that cause extremely low levels of testosterone develop a loss of muscle mass and bone strength, increased body fat, decreased energy, less interest in sex, erectile dysfunction, irritability and depression. In men with these rare conditions, testosterone-replacement therapy can improve their symptoms.

In the average man, however, linking testosterone levels to symptoms and predicting which men with low levels will benefit from treatment is tricky, for several reasons. First, there are many conditions that can cause the symptoms associated with testosterone deficiency. Alcohol abuse, thyroid and other hormonal disorders, liver and kidney disease, heart failure and chronic lung disease can all cause similar symptoms. Depression can cause many of these symptoms in men with perfectly normal levels of testosterone.

Second, some testosterone in the blood is “active” and other testosterone is inactive. It is low levels of active testosterone that cause symptoms of testosterone deficiency, yet doctors typically test just for “total” testosterone. Third, testosterone levels vary widely among men of the same age, including the majority of men without symptoms of testosterone deficiency. Fourth, testosterone levels fluctuate over the course of the day and vary widely among healthy men. For all those reasons, it’s difficult to determine what a “normal” level of testosterone is.

Perhaps most perplexing, men experience symptoms of testosterone deficiency at very different levels: some men with what appear to be low levels of active testosterone have no symptoms, and some men with what appear to be “normal” levels of active testosterone have symptoms that improve with testosterone therapy.

Despite these complexities, symptoms due to testosterone deficiency in men older than 50 definitely occur and can be diagnosed and treated. As many as 10 million U.S. men may be affected. As the baby-boomer generation ages over the next 25 years, this number is expected to rise significantly.

So what should you do if you have symptoms that could reflect a testosterone deficiency? If you are older than 50 and have symptoms, see your doctor. The doctor should first determine whether the symptoms may be caused by other conditions. If not, the doctor should measure blood levels of total testosterone. The tests should be done in the morning, when testosterone levels are the highest, and repeated at least once to ensure accuracy.

If your levels are greater than 400 nanograms per deciliter, you are not testosterone deficient, and the symptoms must have some other cause. If your total testosterone level is less than 200ng/dl, you are clearly deficient. If your levels are borderline—between 200ng/dl and 400ng/dl—you may be deficient; to be sure, you should have your active testosterone measured.

When can you benefit from testosterone therapy? If you have symptoms and extremely low levels of total or active testosterone, you will likely benefit. If you have borderline levels, however, the evidence is less clear: some studies show a benefit, others do not.

Is there a risk to testosterone treatments? In some patients, testosterone-replacement therapy (TRT) can cause or worsen sleep apnea. High levels of testosterone can raise the number of blood cells, increasing the risk of blood clots, heart attacks and stroke. The most significant concerns regarding TRT are potential effects on the prostate. Prostate growth and cancer are both testosterone-dependent. Increasing testosterone levels could theoretically lead to a greater incidence of enlarged prostates, also known as BPH, and to progression of prostate cancer. Although no short-term studies have shown an increased frequency of prostate cancer in men taking TRT, the long-term effects on the prostate are still unknown.

So, for many men with borderline levels of testosterone, the benefits and the risks of testosterone therapy are uncertain. Despite this, for the past 20 years many men have begun using testosterone supplements. In 2005, more than 2.3 million testosterone prescriptions were written—most of them for men between the ages of 50 and 65. Yet men older than 65 have a much greater likelihood of having significant testosterone deficiency. So it may be that testosterone supplements are being overused by men below 65 and underused by those over 65.

Many formulations of testosterone supplements are available today. In the United States, the most commonly used preparations are patches, gels and intramuscular injections. Patches and gels are easy to use and provide a constant, steady release of testosterone through the skin and into the blood. However, patches can cause skin irritation, and gels are slow to be absorbed and can leave a musty smell. Intramuscular injections have to be given in a health-care setting every two to four weeks, inconvenient for many men. Additionally, intramuscular preparations produce unnaturally high blood levels right after the injection, which over several weeks fall to unnaturally low levels. Indeed, some men experience a return of their symptoms before the next injection.

Testosterone pills were popular 20 years ago, and prompted the widespread use of testosterone supplements. However, they were found to cause liver damage and liver tumors, and were removed from the market. Since then, newer and safer testosterone pills have been developed and are available in Europe. Once appropriate safety tests have been done, it is likely that they will also become available in the United States. In addition, new hormones called selective androgen receptor modulators (SARMs), which resemble testosterone but do not affect the prostate, are under development. Theoretically, these SARMs could offer the benefits of conventional testosterone therapy and significantly decrease the potential harmful side effects of the therapy.

If your doctor has prescribed testosterone treatment, the dose should be determined by symptom relief. In addition, your doctor should regularly measure your testosterone levels—to ensure that they do not become too high, increasing the risk of dangerous side effects. Finally, you should have regular physical examinations and blood tests to monitor for potential damage to the liver, blood and prostate. Additionally, you and your partner should watch for symptoms of sleep apnea: unusual snoring and daytime sleepiness, and periods of 10 seconds or longer during sleep when you do not take a breath. Sleep apnea is a potentially life-threatening side effect of TRT.

Whether you call it “male menopause” or not, some men do develop serious and bothersome symptoms from testosterone deficiency. Unfortunately, medical science knows much less about male menopause than about female menopause. With the growing interest in this problem, and the likelihood that testosterone pills will re-appear in the United States, that knowledge gap is likely to shrink. Now, if only our prostates would do the same.

Federman and Walford are members of the faculty of Harvard Medical School. For more information on male menopause and men’s health, go to health.harvard.edu/NEWSWEEK.

For more information on our unique Men’s Testosterone and Wellness therapies visit us at http://www.BostonTestosterone.com or http://www.Facebook.com/BostonTestosterone.

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