Nov
01
2008

Low Testosterone And Heart Disease

More men than women seem to be affected by cardiovascular illness, and the reasons have been manifold. At one time work stress was cited for the prevalence of heart disease in men. Other lifestyle factors, lack of exercise, being overweight, poor dietary choices and smoking have been found to play significant roles. The risk for cardiovascular disease increases with age, as does the likelihood for hypertension, elevated cholesterol levels and glucose intolerance.

Some attention has been paid to the fact that hormones can also play a role, and research has now shown that testosterone has some direct cardiovascular effects. Testosterone has been found to dilate blood vessels. The effect can be likened to the calcium channel blocker Nifedipine. It has also been substantiated that males with coronary artery disease and heart failure tend to have low levels of testosterone. If testosterone deficient men receive replacement therapy, vasodilatation (dilation of blood vessels) has been demonstrated in males who have received testosterone replacement for a few months. Male hormone replacement therapy has also been found to relieve the symptoms of angina in patients with heart failure. The question, how testosterone fits into the concept of disease prevention, comes up in this context. Researchers have found enough evidence that a low testosterone blood level has an independent association with accelerated atherosclerosis (hardening of arteries).

Low Testosterone And Heart Disease

Testosterone in men prevents heart disease

Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding is the fact that this condition is reversible by replacement of testosterone. Male hormone therapy has received a lot of bad press in the case of overtreatment with androgens to achieve muscle growth in body building. However, in this case there was no testosterone deficiency and athletes and their coaches were using doses that were too high. This type of administration entails grave health risks and has nothing to do with good medicine. In case of hormone deficiency replacement the normal body function of a younger male is restored with bioidentical testosterone, which can be a tool to better health for the aging male. Anti-aging physicians are very familiar with this treatment modality.

More on the heart vessel protecting effect of bio-identical hormones:

http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

Journal of Men’s Health – Volume 5, Issue Suppl (September 2008)

Last updated Nov. 6, 2014

Apr
01
2005

Hormone Replacement Worsens Incontinence

Once hailed as the miracle pill for the aging woman, hormone replacement therapy (HRT) is now being approached with caution. The infamous Women’s Health Initiative study, which first disproved benefits of hormone therapy, first pointed out an increase of breast cancer risk and risk of cardiovascular disease. On re-analysis of the data the Journal of the American Medical Association has published a study in its issue of February 23, 2005, which shows some more reason for caution with HRT. The previous notion that hormone replacement would improve the symptoms of urinary incontinence has turned out to be a fallacy. Dr. Susan Hendrix and her colleagues from Wayne State Untiversity School of Michigan in Detroit analyzed the data from 23,296 women with urinary incontinence. In randomized trials they received either estrogen alone, estrogen with progestin (Prempro) or the placebo effect (“fake pills”). Among those who were continent at the baseline, both, estrogens alone as well as the combination therapy were associated with an increased risk of incontinence at one year. Estrogen (Premarine) alone produced the most marked effect: stress incontinence increased by a factor of 2.15, the combination therapy increase stress incontinence by a factor of 1.87. In addition, women who were already suffering of incontinence, tended to report a worsening of their symptoms after beginning hormone therapy. The Women’s Health Initiative trials were stopped because the treatment risks appeared to outweigh its benefits. These new findings tilt the scales even further against hormone therapy, the authors say in their study.

Hormone Replacement Worsens Incontinence

Hormone Replacement Worsens Incontinence

Reference: National Review of Medicine, Canada, March 15, 2005, page 28

Comments on Nov. 8, 2012: We have to keep these observations in perspective. The authors of that study were using the “regular” Big Pharma manufactured hormone substitutes that the body cannot read. There are no Premarin or Provera receptors in the tissue, only testosterone receptors, estrogen receptors and progesterone receptors. These artificial hormones cannot be metabolized in the woman’s body into testosterone as bio-identical estrogen and progesterone would, because they are structurally different from the bio-identical hormones. The sad truth is that an anti-aging physician could have treated these poor women with incontinence safely by prescribing small amounts of testosterone cream that would have had to be applied to the urethral opening. From there the body would have sent it to the bladder, the bladder sphincter and the testosterone receptors that control these tissues and would have taken care of the incontinence problem.  You do not need a clinical trial. This type of treatment has been used in Europe for decades and has been used in the US for maybe 10 to 15 years as well by some open minded urologists and anti-aging physicians. The heading for this post is only applicable for HRT in the conventional sense (using Big Pharma drugs), but none of this applies to bio-identical hormone replacement for menopause.

More info on bio-identical hormone replacement in menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

Last edited October 28, 2014

Mar
01
2004

Vitamins C And E – A Weapon Against Alzheimers

A study in a recent edition of the Archives of Neurology reports about 4740 patients from Cache County, Utah, who were 65 years or older and were followed over 5 years. At the start it was found that those who had taken vitamin C and E on a regular basis as separate supplements had a 78% lesser risk of developing Alzheimers (correct medical term: “Alzheimer’s disease”).

5 years later out of 3227 survivors who were at risk 104 more people had developed Alzheimers, but 64% of those who combined vitamin C and E as a supplement did not develop Alzheimers. Dr. Peter Zandi from the Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University/ Baltimore, Md was the lead author of this study. He stated that this was only an observational study, but that the data was convincing enough to warrant a full-scale controlled trial to examine the value of anti-oxidant agents (such as vitamin C and E) as a preventative against Alzheimers. There were a number of built-in controls such as vitamin C alone, vitamin E alone and multiple vitamins (including vitamin C and E in smaller dosages) that were all ineffective in preventing Alzheimers. The daily dosages that were necessary for the protective effect were vitamin C 500mg to 1000 mg or more per day as well as 400 IU to 1000 IU of vitamin E per day. The U.S. recommended daily allowance was insufficient for the protective effect. These dosages typically are in the order of 22 IU of vit. E and 75 to 90 mg of vit. C. Vitamin B complex alone was also ineffective in protecting against Alzheimers.

Vitamins C And E - A Weapon Against Alzheimers

Vitamins C And E – A Weapon Against Alzheimers

Comments: There are many unanswered questions about Alzheimers, but this paper gives valuable hints in terms of the protective effect of two vitamins (vitamin C and E taken as separate supplements daily). There are other factors such as genetic ones and perhaps a dysregulation of the cholesterol brain metabolism that lead to the production of a glue-like substance, called “beta-amyloid” ,that causes memory loss in Alzheimers patients. Testosterone has recently also been noticed to be important in the prevention of Alzheimers disease. In addition to these vitamin supplements a low glycemic, low fat diet would likely be very beneficial together with a regular exercise program and calorie restriction to prevent Alzheimers disease in many patients (prevention of the metabolic disease).

More info on Alzheimer’s disease: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/

Arch Neurol – 01-JAN-2004; 61(1): 82-8

Last edited October 26, 2014

Feb
01
2004

Low Testosterone Linked To Alzheimers

A recent publication in the medical journal Neurology by Dr. Susan Resnick revealed a surprise link between a lack of testosterone and Alzheimer’s disease.

574 men from the Baltimore Longitudinal Study of Aging who had been followed for about 19 years were analyzed with respect to hormonal factors and their neurological status was also observed. Of these men who ranged in age from 32 to 87 years initially 54 were diagnosed with Alzheimers disease.

When the researchers looked at the hormone status of the men whose mental functioning stayed stable versus those who developed Alzheimers, it was clear that the height of the free testosterone level in the blood (expressed by dividing testosterone by the sex hormone-binding globulin) was a significant predictor for not getting Alzheimers. In other words, if men could maintain a stable level of free testosterone with aging they were significantly protected from Alzheimers disease. The effect was so marked that the blood test could predict 10-years in advance whether a man would develop Alzheimers in future or not. There was a 26% reduction in the risk of Alzheimers with each 10-unit increase in free testosterone.

The same edition of Neurology contains a second report by Dr. Gian Benedetto Melis and coworkers (University of Cagliari, Italy) where around 100 patients (males and females) with Alzheimers were compared with a similar number of patients without Alzheimers. All of their body mass index was in the normal range (20 to 22). These researchers found that the Alzheimers group (both male and female) had an extremely high sex hormone-binding globulin.

Low Testosterone Linked To Alzheimers

Low Testosterone Linked To Alzheimers

The testicles in males and the adrenal glands in males and females can produce testosterone. Dr. Resnick remarked that free testosterone can enter the brain tissue (via the blood brain barrier) easily and act directly on the brain or can be converted to estrogen. Estrogen has been shown in other studies to have a protective effect against Alzheimers. Dr. Resnick cautioned that another study where males with low testosterone levels are getting testosterone supplementation has to be done first before a male should be advised to get treated with testosterone for prevention of Alzheimers disease.

This article is based on a publication by Dr. Resnick et al. in Neurology 2004;62:188-193,301-303.

Comments: It is interesting to note that the “old fashioned” remedies such as weight loss, exercise (particularly anaerobic exercises such as weight training) and a low glycemic diet will naturally increase testosterone levels and vitality in both sexes. A comprehensive program such as the zone diet (by Dr. Barry Sears) or a similar such low glycemic program when combined with exercise will automatically make you lose weight down to a normal body mass index and allow you to maintain it without hunger pangs. It will also normalize hormones in most people on its own as previously elevated insulin levels normalize and the sex hormone-binding globulin will normalize as well. This will make the necessary hormones available to you whether female or male, will prevent osteoporosis (from exercise) and provide enough hormones before and after menopause or andropause to most people. Only a minority of patients will need to get blood tests from their doctors depending on symptoms and those need to seek medical advice to see whether they might benefit from bioidentical hormone replacement therapy.

Further information can be found here: bioidentical hormone replacement.

Last edited October 26, 2014

Mar
01
2003

Men Need Testosterone For the Male Menopause

Introduction

Men need testosterone for the male menopause as their testicles no longer produce enough of the male hormone. 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).

Here is a link to the ADAM questionnaire regarding andropause by Dr. Morley, a geriatrician at the St. Louis University 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.

The 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.

Replacement of missing testosterone

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 should have testosterone replacement therapy, if there are also clinical signs and symptoms of hormone deficiency.

Testosterone For Male Menopause (Andropause)

Testosterone For Male Menopause (Andropause)

Gonadotropins

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 gonadotropins. 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 themselves. The good news though is that with a simple testosterone patch this can be fixed. Your doctor can discuss this further with you.

Injections of testosterone

Other possibilities are injections every 3 to 4 weeks with a Depo-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 think that testosterone tablets are not safe for this reason. Prostate cancer is the other worry and regular PSA tests and prostate exams should be done by your doctor. No clinical trials are available regarding the safety of long term 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 in the normal range and the clinical signs and symptoms disappear. Avoid overtreatment with testosterone.

Andropause symptoms (male menopause)
Symptoms: Comments:
loss of sex drive (libido) testosterone from the testicles, is responsible 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

Additional information about effects of testosterone

Addendum Nov. 2, 2012: At the 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011) Dr. Abraham Morgentaler, a Harvard trained urologist explained that with bio-identical testosterone replacement there is no longer any concern about prostate or liver cancer with long-term use. It has been one of the “medical myths” that has been around. Dr. Morgentaler also noted that testosterone replacement is safe and actually prevents prostate cancer. He suggested replacement of testosterone with blood values being in the higher range of normal.

See also link to andropause/male menopause from the Net Health Book.