• Low Serum Testosterone and Mortality in Male Veterans

    Background Low serum testosterone is a common condition in aging associated with decreased muscle mass and insulin resistance. This study evaluated whether low testosterone levels are a risk factor for mortality in male veterans.

    Methods We used a clinical database to identify men older than 40 years with repeated testosterone levels obtained from October 1, 1994, to December 31, 1999, and without diagnosed prostate cancer. A low testosterone level was a total testosterone level of less than 250 ng/dL (<8.7 nmol/L) or a free testosterone level of less than 0.75 ng/dL (<0.03 nmol/L). Men were classified as having a low testosterone level (166 [19.3%]), an equivocal testosterone level (equal number of low and normal levels) (240 [28.0%]), or a normal testosterone level (452 [52.7%]). The risk for all-cause mortality was estimated using Cox proportional hazards regression models, adjusting for demographic and clinical covariates over a follow-up of up to 8 years.

    Results Mortality in men with normal testosterone levels was 20.1% (95% confidence interval [CI], 16.2%-24.1%) vs 24.6% (95% CI, 19.2%-30.0%) in men with equivocal testosterone levels and 34.9% (95% CI, 28.5%-41.4%) in men with low testosterone levels. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P <.001) while equivocal testosterone levels were not significantly different from normal testosterone levels (hazard ratio, 1.38; 95% CI, 0.99%-1.92%; P =.06). In a sensitivity analysis, men who died within the first year (50 [5.8%]) were excluded to minimize the effect of acute illness, and low testosterone levels continued to be associated with elevated mortality.

    Conclusions Low testosterone levels were associated with increased mortality in male veterans. Further prospective studies are needed to examine the association between low testosterone levels and mortality.

    Testosterone levels decline with aging, with an average decrease in total serum testosterone levels of approximately 1.5% per year. 1 The prevalence of low serum total testosterone levels is approximately 20% by the age of 50 years and 50% by the age of 80 years. Manifestations of low testosterone include decreased muscle mass and bone mineral density, increased fat mass, central obesity, insulin resistance, decreased libido and energy, irritability, and dysphoria. 2 In contrast to menopause, in which all women undergo a nearly complete cessation of gonadal estrogen secretion, in men, gonadal androgen secretion decreases gradually and progressively after the age of 30 years, but does not generally cease, and androgen levels remain highly variable in older men. The prevalence of clinical androgen deficiency (symptoms plus low testosterone levels) was recently reported to be about 6% to 12% in middle-aged and elderly men. 3 Testosterone levels also decrease with acute and chronic illnesses and with medications such as glucocorticoids and opiates. 2 Because of the aging of our society, many older men are affected by age-associated low testosterone levels. 2 In addition, the use of testosterone has increased significantly, with a tripling in prescriptions for testosterone over a 3-year period. 4 However, despite the marked increase in testosterone use, the overall risks and benefits remain unclear. 4 , 5

    In a recent small study 6 in a geriatric rehabilitation unit, we found that men with a low testosterone level had an increased 6-month mortality compared with men with a normal testosterone level who were of a comparable age and had comparable medical morbidity. Given these unforeseen preliminary findings, we conducted the present retrospective cohort study to examine if repeatedly low serum testosterone levels were associated with increased mortality in a larger sample of middle-aged and elderly men with a longer follow-up, of up to 8 years.

    Article Source: http://archinte.jamanetwork.com/article/?articleid=410768

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  • Testosterone therapy does not raise risk of aggressive prostate cancer

    Men with low levels of the male sex hormone testosterone need not fear that testosterone replacement therapy will increase their risk of prostate cancer.

    This is the finding of an analysis of more than a quarter-million medical records of mostly white men in Sweden, research led by investigators at NYU Langone Medical Center and its Laura and Isaac Perlmutter Cancer Center. The international team of study authors will present these results on May 9 at the annual meeting of the American Urological Association in San Diego, Calif.

    In the study, researchers found that, as a group, men prescribed testosterone for longer than a year had no overall increase in risk of prostate cancer and, in fact, had their risk of aggressive disease reduced by 50 percent.

    “Based on our findings, physicians should still be watching for prostate cancer risk factors — such as being over the age of 40, having African-American ancestry, or having a family history of the disease — in men taking testosterone therapy, but should not hesitate to prescribe it to appropriate patients for fear of increasing prostate cancer risk,” says lead study investigator and NYU Langone urologist Stacy Loeb, MD, MSc.

    Loeb points out that much of the concern over cancer risk is that, as part of standard therapy for advanced prostate cancer, tumor growth is decreased by drugs that drastically reduce rather than increase male hormones. “But when used appropriately by men with age-related low testosterone who are otherwise healthy, testosterone replacement has been shown to improve sexual function and mood.”

    The researchers say use of testosterone therapy — taken by mouth, gel patch, or injection to treat “low T” — has skyrocketed in the past decade. Its popularity is a consequence, experts say, of an aging “boomer” population and heavy drug industry marketing, and has come about despite its unknown, long-term health risks. According to some surveys, use of testosterone therapy has more than tripled since 2001, with more than 2 percent of American men in their 40s and nearly 4 percent of men in their 60s taking it. Testosterone levels drop naturally by about 1 percent per year in men past their 30s.

    Specifically, the current study found that 38,570 of the men whose records were examined developed prostate cancer between 2009 and 2012. Of these men, 284 had prescriptions for testosterone replacement therapy before they were diagnosed with prostate cancer. Their records were compared with 192,838 men who did not develop prostate cancer, of whom 1,378 had used testosterone therapy.

    Researchers noted that while their initial analysis showed an uptick (of 35 percent) in prostate cancer in men shortly after starting therapy, the increase was only in prostate cancers that were at low risk of spreading and was likely a result from more doctor visits and biopsies performed early on. The authors stressed that the long-term reduction in aggressive disease was observed only in men after more than a year of testosterone use, and the risk of prostate cancer did not differ between gels and other types of preparations.

    “Overall, our study suggests that what is best for men’s health is to keep testosterone levels balanced and within a normal range,” says Loeb, who suggests that men with testosterone levels below 350 nanograms per deciliter and symptoms should seek medical advice about whether they should consider testosterone therapy.

    For the study, researchers matched and analyzed data from the National Prostate Cancer Register and the Prescribed Drug Register in Sweden. The country is one of the few in the world that collects detailed information on cancer and medication prescriptions for its entire population, and for which no comparable North American data source exists.

    Loeb says the team next plans further studies to determine why low testosterone levels might trigger aggressive prostate cancer and why maintaining normal levels may protect against aggressive disease.

    Story Source: https://www.sciencedaily.com/releases/2016/05/160507143326.htm

    The above post is reprinted from materials provided by NYU Langone Medical Center / New York University School of Medicine . Note: Materials may be edited for content and length.

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  • Many men with low testosterone levels do not receive treatment

    The majority of men with androgen deficiency may not be receiving treatment despite having sufficient access to care, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

    Androgen deficiency in men means the body has lower than normal amounts of male hormones, including testosterone , according to background information in the article. Although prescriptions for testosterone therapy for aging men have increased in recent years, treatment patterns for androgen deficiency are not clearly understood in community-dwelling U.S. males.

    Susan A. Hall, Ph.D., of New England Research Institutes, Watertown, Mass., and colleagues examined data collected from 1,486 Boston-area men (average age 46.4) from April 2002 to June 2005 to estimate the number of men receiving treatment for androgen deficiency, to explain how treated and untreated men varied in seeking care and to understand potential barriers to health care. Specific symptoms of androgen deficiency include low libido, erectile dysfunction and osteoporosis and less-specific symptoms include sleep disturbance, depressed mood and tiredness.

    A total of 97 men met the criteria for having androgen deficiency. Eighty-six men were symptomatic and untreated, and 11 were prescribed testosterone treatment. “Men were using the following: testosterone gel (n=1), testosterone patch (n=3), testosterone cream (n=1), testosterone cypionate [an injectable form of testosterone] (n=1) or unspecified formulations of testosterone (n=5),” the authors write. “All of the unspecified forms of testosterone used were self-reported as administered in intervals defined in weeks, which suggests that these were injectable formulations.”

    “Men with untreated androgen deficiency were the most likely of the three groups to have low socioeconomic status, to have no health insurance and to receive primary care in an emergency department or hospital outpatient clinic,” the authors write. However, all men with treated and untreated androgen deficiency were more likely to report receiving regular care than those without the condition and reported visiting their doctor more often throughout the year (with averages of 15.1 visits for those with untreated androgen deficiency, 6.7 visits for those without the condition and 12 visits for those with treated androgen deficiency).

    “Under our assumptions, a large majority (87.8 percent) of 97 men in our groups with androgen deficiency were not receiving treatment despite adequate access to care,” the authors conclude. “The reasons for this are unknown but could be due to unrecognized androgen deficiency or unwillingness to prescribe testosterone therapy.”

    Article Source: http://www.eurekalert.org/pub_releases/2008-05/jaaj-mmw052208.php

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  • FACTS ABOUT DIM AND MEN’S HEALTH

    Several classes of chemical compounds which naturally occur in fruits and vegetables possess anticarcenogenic properties. The cruciferous vegetables, such as cabbage and broccoli are particularly rich sources of such compounds, including Indole derivatives [indole-3-carbinol (I3C) and indole-3-acetonitrile], dithilthiones and isothiocyanates. Increased consumption of cruciferous vegetables is associated with reduced tumor incidents in humans and experimental animals.

    Diindolylmethane (DIM, in short) is the principal breakdown product of indole 3-carbinol (I3C), the phytochemical found in cruciferous vegetables like cabbage, cauliflower, broccoli, brussel sprouts, kale, collards, mustard greens, radishes, watercress, and turnips. DIM, has been shown in scientifi­c studies to reduce the risk of prostate and other hormone-driven cancers by helping the body to make a better balance of the hormones.*

    Can taking 250 – 300 mg. of DIM (or its equivalent in raw cruciferous vegetables) reduce your risk for prostate cancer?
    Yes, according to Dr. Michael Zeligs, M.D. author of All About DIM. “A recent study of Seattle men showed that three or more servings of cruciferous vegetables a week can reduce prostate cancer risk almost by half.” His statement is based on an article by J. H. Cohen, et. al. Fruit and vegetable intakes and prostate cancer risk. Natl. Cancer Inst. Jan 2000; 5;92 (1): 61-8.

    The following quotations are taken from All about DIM by Michael A. Zeligs, M.D. and A. Scott Connelly, M.D., based on research related to men’s use of diindolylmethane (DIM) and the phytochemical compounds (indole-3-carbinol) found in cruciferous vegetables from which DIM is derived. Following the quotations is a partial bibliography substantiating the claims made in the article.

    DIM & Testosterone

    What is Testosterone?

    Testosterone is an important contributor to healthy hormonal balance in both men and women. Testosterone is known as an androgen because when its effect dominate male characteristics are seen. These include male distribution of body hair, a deeper voice, and male genital development. Testosterone is also identified as anabolic hormone due to its ability to promote protein synthesis. Active protein synthesis produce bigger muscles and stronger bones, especially in response to exercise. This process also increase metabolic rate and consumes fat, resulting in a leaner physique. The more subtle effects of testosterone have to do with its action as a support for mood and libido. Testosterone has a clear anti-depressant action and promotes interest in sex and men and women.

    How does DIM benefit testosterone activity?

    Testosterone acts differently depending on whether it is free or bound to carrier proteins in the blood. DIM, through its effects on estrogen metabolism supports testosterone by helping to maintain the level of free or active testosterone. Free testosterone refers to defraction of testosterone that circulates in the blood and is not associated with or bound by SHBG (Sex Hormone Binding Globulin), its carrier protein. Since only free testosterone easily crosses into the brain, muscles, and fat cells much of the desirable action of testosterone has to do with the free portion. However, this represents only a tiny amount of the total testosterone equal to only to 2% of the total in men and even less in women.

    High levels of SHBG lock up free testosterone making it unavailable to support mood or metabolism. Interestingly, unmetabolized estrogen is the body’s primary signal to increase the production and levels of the testosterone-binding protein. Low levels of free testosterone have been identified during perimenopause and are most dramatic in women with severe premenstrual syndrome (PMS) symptoms. (24)

    How can DIM help with age-related reduced levels of free testosterone?

    Since DIM promotes a more active metabolism of estrogen, unmetabolized estrogen levels fall and the 2-hydroxy-estrogens increase. The 2-hydroxy-estrogens possess the unique ability to displace testosterone from SHGB and set it free. Therefore, the combined effect of DIM to reduce unmetabolized estrogen and increase 2-hydroxy-estrogens can reduce elevations in SHGB and allow for more free testosterone. Both of these changes help maintain and restore a youthful balance between estrogen and free testosterone. This balance is a key to a healthy and active metabolism. (25)

    Does DIM help maintain a healthy testosterone level in older men?

    Zelligs: “The same dynamics for maintaining higher total and free testosterone levels apply to healthy aging in men. Estrogen metabolism is slowed during aging in men, especially in association with obesity and regular alcohol use.” [translation: As we age, our bodies take longer to “clear” the estrogen in our cells and higher than healthy levels of estrogen are common, especially in men who are obese or who are regular social drinkers.]

    “Avoiding overactive testosterone metabolism, [clearing the testosterone too quickly] and reducing the conversion of testosterone into estrogen are goals of nutritional support in middle aged and older men.”

    “It is well documented that estrogen accumulates in the prostate gland starting at age 50 (42) and that estrogen is associated with the degree of prostate enlargement. (43)

    “Based on animal and human testing, DIM is again preferable to I3C in the area of men’s health. Using DIM in men avoids accelerating testosterone metabolism, especially regarding unwanted conversion of testosterone into estrogen.”

    Does DIM help improve prostate health and reduce night time urination in older men?

    “Regarding men’s health, supplementation with absorbable DIM has resulted in reports of improved prostate function based on reduced nighttime urination in symptomatic older men.”

    “Once absorbed, DIM is uniquely active in promoting healthy estrogen metabolism and improving symptoms of estrogen-related imbalance in both men and women.”

    “Apart from therapeutic potential, dietary supplement use of DIM and I3C relates to hormonal balance and symptoms of “estrogen dominance.”

    Even more impressive is research showing that unmetabolized estrogen accumulates in prostate tissue in men as they age. Exposure of human prostate tissue to unmetabolized estrogen in the laboratory did indeed result in activation and increased production of prostate specific antigen protein (PSA). The PSA protein level in men’s blood is now used as a screening test to determine the severity of prostate enlargement or to determine the chance of prostate cancer. Recent studies also have shown that estradiol, the active form of estrogen, causes the prostate gland to increase its production of prostate specific antigen (PSA). Increased PSA production, however, can be inhibited by the “good” estrogen metabolites promoted by DIM. This indicates that “good” estrogen metabolites are more beneficial for prostate health than unmetabolized estrogen-like estradiol. (53)

    Various supplements, including DIM, can now be used to reduce the risk of prostate enlargement and promote a healthy prostate. Optimum testosterone-2-estrogen hormonal balance achieved with the use of DIM can help to preserve a youthful urinary tract, prevent age-related prostate growth, and perhaps reduce the risk of prostate cancer.

    Long term safety has been demonstrated in DIM.

    Article source: https://wholeworldbotanicals.com/facts-about-dim-and-mens-health/

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