| §§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§ |
|
Testosterone
For Male Menopause (Andropause)
At a recent
continuing education meeting at the University of Calgary
in Alberta/Canada, which was reported in the Jan. 14, 2003
edition of the Medical Post, Dr. Norman Wong (professor of
medicine, biochemistry and molecular biology) reviewed the
symptoms, investigations and treatment modalities available
for men who experience andropause (the male equivalent of
menopause). They are as follows (my summary in table form).
| Androgen
symptoms (male menopause) |
| Symptoms: |
Comments:
|
| loss
of sex drive (libido) |
testosterone, which is the male hormone produced by the
testicles, is needed for a normal sex drive |
| erectile
dysfunction (impotence) |
inability
to have sustained erections |
| loss
of male characteristics |
loss
of male type hair distribution, deep voice, muscle mass
etc. |
| fatigue
and depression |
brain
hormones dysbalanced from low testosterone levels |
| decrease
in muscle mass, increase in fat mass |
lack
of testosterone responsible for muscle loss and change
in bone metabolism |
| oligospermia
or azoospermia |
too
little sperm count or no sperm present |
Here is
a link to the ADAM
questionnaire regarding andropause by Dr. Morley,
a geriatrician at the St. Louis Unversity in Missouri. If
you answer "yes" to question #1 and #7 (sexual dysfunction
or lack of sex drive) or if you answer "yes" to
any three of the other total of 10 questions, you should see
your physician and ask for a testosterone blood test.
What should
you know about testosterone blood tests? What counts is the
free testosterone or bioavailable testosterone. Dr. Ronald
Swerdloff, professor of internal medicine and endocrinology
at the UCLA School of Medicine in Torrance, California, stated
at this conference that testosterone production decreases
with aging, but is actually also one of the causes of aging.
Testosterone levels decrease 1% to 2% every year from the
age of 30 onwards. However, the sex hormone binding protein
(SHBP) can buffer these changes for a certain period of time,
if the SHBP is binding less testosterone thus keeping the
free or biologically available testosterone relatively stable
for a number of decades or years. Often, however, the andropausal
men who need testosterone replacement have high SHBP levels.
Nobody knows why some men have problems earlier than others.
So, if the free testosterone serum level is low (and the LH
and FSH hormones are low or normal) this means that this man
likely should have testosterone replacement therapy, if there
are also clinical signs and symptoms of hormone deficiency.
As can
be seen from this link to menopause
in women , the pituitary hormones LH and FSH,
which are also known as gonadotropins, should be high to indicate
that the feedback mechanism between the estrogen (or in the
male the testosterone) no longer suppresses the production
of these gondotropins. The fact that this mechanism is lost
in most older men shows that the hormone deficiency is likely
much more profound than a simple deficiency, it may actually
be indicative of the aging process of the hormone glands themsevles.
The good news though is that with a simple testosterone patch
this can be fixed. Your doctor can discuss this further with
you.
Other
possibilities are injections every 3 to 4 weeks with a Depot-testosterone
hormone preparation or tablets. However, with the tablets
the problem is that this will get metabolized in the liver
and higher amounts of hormone are required to overcome the
liver barrier. Liver cancer has been reported in a small percentage
of men taking tablets for a long period of time (I do not
like testosterone tablets for this reason). Prostate cancer
is the other worry and regular PSA tests and prostate exams
should be done by your doctor. As no controlled trials have
been done yet regarding the safety of longterm testosterone
replacement in andropausal men, Dr. Swerdloff recommended
to replace only in the lower dose range to the point where
the free testosterone serum values are just barely normalized
and the clinical signs and symptoms disappear. Overtreatment
should be avoided.
| §§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§ |
|
The New
Hot Asthma Treatment: Bronchial Thermoplasty
There
is a new concept in the treatment of asthma, a mechanical solution
rather than the familiar pharmacological solution. As is outlined
in the lung disease chapter of my nethealthbook.com, the treatment
of asthma is usually a combination of inhaled and
oral medications that have as a target the smooth
muscular envelope of the bronchial tubes, which is
depicted in this link. In addition to the spasm of the bronchial
tubes some anti-inflammatory steroid inhalers are also needed to
control the swelling of the lining of the bronchial tubes, which
can obstruct the air flow from inside.
Dr. John
Miller has done research with the Alair catheter system at Broncus
Technologies Inc. in Mountain View, CA (San Francisco Bay Area).
Dr. Miller helped to develop this bronchoscopic instrument with
a concealed expandible wire basket
that can be heated. In co-operation with Dr. Gerard Cox from the
Respiratory Division of McMaster University in Hamilton/Ontario/Canada
they tested this procedure on a small group of 14 mild to moderately
severe asthma patients. The procedure consisted of a 30 minute bronchoscopy
during which several heat cuts were made through the muscle layer
of the bronchial tubes using this instrument (the heat used is only
as hot as a cup of coffee). The smooth muscle layer of the bronchial
tubes remains relaxed after this. A total of four such treatments
were given, 3 weeks apart. The result was surprising in that the
breathing performance doubled, which would have been considered
to be a good drug effect, if this result had been achieved with
the help of medication. However, this effect is permanent and medication
can still be used on top of this, if necessary.
The researchers
will now start a larger multinational trial including a total of
110 moderate to severe asthma patients from Canada, England and
Scotland, Germany and Denmark. Results of this study are expected
to be published in 2004. (Based on The Medical Post, Feb.11, 2003,
page 37).
| §§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§ |
Do Diet
Drinks Make You More Hungry?
There were some
articles recently that stated that diet drinks would make you hungry.
However, they lacked proper controls. For this reason the gastroenterologist,
Dr. Khursheed Jeejeebhoy, from the University of Toronto/Ontario
designed a well controlled 10 week trial where several parameters
were measured while patients were either snacking on diet drinks
or on sugar containing soft drinks on top of their regular food
intake, which was also closely monitored. The only requirement in
the beginning of the study was that the subjects had to be overweight
(body
mass index of 27 to 28). Participants of the study
were then divided randomly into subjects drinking soft drinks with
either sugar or sugar substitutes. The drinks were blindly given,
but meticulous records were kept of what was consumed. In addition
the subjects were allowed to eat as many snacks as they liked with
either sugar in it or sugar substitutes. Here is a tabular summary
of the findings:
| Artificial
sweeteners and weight loss (10-week study) |
| Findings: |
Comments:
|
| additional
Calories from drinks per day: |
AS:250
Cal. |
SG:870
Cal. |
| total
caloric intake over the 10 weeks: |
AS:decreasing
steadily |
SG:increasing steadily |
| appetite
sensation: |
AS:no
appetite complaints |
SG:sugar
stimulated appetite |
| weight
gain or loss: |
AS:significant
weight loss |
SG:significant
weight gain |
| activity
level (exercise) |
no change in either groups (AS or SG) |
| blood
pressure |
AS:no
change |
SG:sugar
increased blood pressure significantly |
| Explanation:
AS=Artificial sweetener group |
SG=Sugar
group |
The surprising
findings were that the sugar group had an increased appetite and
wanted to eat more and more. Sugar also raised the blood pressure
significantly.
The result was
a significant weight gain during the 10 weeks of the trial while
the other group (AG) had lost a significant amount of weight without
any hunger pangs. The researchers also measured body fat versus
muscle mass and found that the sugar group (SG) had gained fat mass
without changing the muscle mass. On the other hand the atrtificail
sweetener group (AG) had lost only fat mass, not muscle mass.
Dr. Jeejeebhoy
concluded according to the article in The Medical Post (Jan.14,
2003 edition, page 27) that sugar in snacks and drinks should be
kept to a minimum to prevent obesity from developing or getting
worse. Patients with high blood pressure should avoid sugar as much
as possible and stick to a low glycemic-index diet. Drinks should
be diet drinks or fluids without sugar content. Do
diet drinks make you more hungry? The answer is: "NO!"
| §§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§ |
|
