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Ageless Forever Anti-Aging News Blog

TRT and Fertility – how to get the best of both worlds - part 1

The prevalence of testosterone deficiency (aka hypogonadism or Late Onset Hypogonadism), defined as total testosterone (TT) at or below 300 ng/dl is close to 40% in men aged 45 years and older presenting to primary care offices in the US.[1] Year 2006 is was estimated that more than 13.8 million men over 45 years of age visiting a primary care doctor in the United States have symptomatic androgen deficiency.[1] 
 
A large international web survey using the Aging Males' Symptoms (AMS) questionnaire showed the prevalence of symptomatic testosterone deficiency to be 80% in men aged 16–89 (mean 52 years).[2] It is notable that in the survey 40% of respondent were at younger ages when ‘Late Onset Hypogonadism’ is generally not believed to be occurring.[2] The surprisingly high prevalence of raised scores indicating testosterone deficiency in the younger age groups may be due to the increasing prevalence of conditions in these age groups known to reduce testosterone levels, such as obesity [3-7] and chronic work stress. [8-10] Stress induced cortisol elevation, by increasing SHBG, lowers the free active fraction of testosterone and thereby reduces its action.[11] 
 
This large and rising prevalence of testosterone deficiency is gaining recognition among doctors and patients alike. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in infertility...however, in most cases, TRT induced infertility is reversible. If paternity is of interest to you, read on...
 
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Fish oil supplementation - benefits for young healthy adults

Fish oil is well known for protecting against development and progression of cardiovascular disease in high risk individuals, mostly middle-age and older.[1-4] A notable recent study shows that fish oil supplementation also confers health benefits in young healthy adults.[5]

Young healthy males, aged 21-24 years, were given a fish oil supplement providing 2 g EPA and 1 g DHA per day for 3 months. It was found that the fish oil supplementation significantly reduced fasting blood triglycerides (i.e. blood fats) by a whopping 38% (from 86 mg/dL to 54 mg/dL) and also improved the total cholesterol/HDL ratio, by reducing it from 3.25 to 3.05.

Relevance of blood triglycerides and the total cholesterol/HDL ratio for cardiovascular disease

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Do long-chain omega-3 fatty acids (like those in fish oil) increase prostate cancer risk?

A hotly debated recent study, the SELECT trial, has casted doubt on the well documented health benefits of omega-3 fatty acids. This study found that a higher content of long-chain omega-3 fatty acids (EPA+DPA+DHA) in blood plasma was associated with a greater risk of low-grade (44%) and high-grade (71%) prostate cancers over a 5-year follow-up [1]. Associations were similar for individual long-chain omega-3 fatty acids. Higher linoleic acid (omega-6) was associated with a 25% reduced risk of low-grade and 23% reduced risk of total prostate cancer [1].This has understandably generated confusion among the general public and intense discussions among health professionals and researchers. However, a deeper look at the data and study methodology reveals a different picture... 

This has understandably generated confusion among the general public and intense discussions among health professionals and researchers. However, a deeper look at the data and study methodology reveals a different picture...

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The Androgen Study Group - Cutting Through Misleading Headlines and Exposing the Truth about Testosterone Therapy and Health

Recently several flawed studies, implicating that testosterone replacement therapy increases risk for heart attack and death, created large media headlines. This despite a large body of research evidence showing the contrary, ie. that testosterone replacement therapy decreases risk for heart disease and that higher testosterone levels are associated with reduced death rates. No wonder there is confusion and unnecessary concern and among healthcare providers and their patients.
 
In response to this, The Androgen Study Group was formed. The Androgen Study Group is a multidisciplinary group of androgen researchers and clinicians who are dedicated to education and accurate reporting on the science of testosterone deficiency in men and its treatment. With the media attention that testosterone therapy is attracting it is critical that clinical trials are properly conducted and analyzed, and that results are presented in a way that is not misleading. The mission of the Androgen Study Group is to ensure that the results of research on testosterone deficiency and its treatment is presented accurately and fairly in the medical literature as well as in public media.
 
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Niacin - vitamin B3 - elevates HDL levels (the "good" cholesterol) more than popular medications

Low HDL-C levels are an independent risk factor for development of coronary heart disease (CHD).[1] At all levels of total cholesterol, HDL-C shows a strong inverse association with incidence of CHD. Every 1 mg/dl increase in HDL is associated with a 2-3% decrease cardiovascular risk.[1]

Among men and women aged 49-82 years, who were free of CHD at baseline, after a follow up of 12 yr, the participants with high HDL-C levels (over 60 mg/dL) had half the risk of cardiovascular events compared with participants with low HDL-C levels (below 40 mg/dL).[2] Another large study of 4,500 subjects aged 16-65 years, found after a follow-up of 6 years that individuals with HDL-C levels below <35 mg/dl were at 4 times higher heart disease risk than those with HDL-C levels over 35 mg/dl.[3]

The prevalence of low HDL levels in apparently healthy US adults is 35% in men (defined as below 40 mg/dL or 1.03 mmol/) and 39% of women (below 50 mg/dL or 1.29 mmol/L).[4] Among patients with established cardiovascular disease, 20% to 60% have low HDL levels.[5-7] Furthermore, low HDL levels are part of the criteria for the metabolic syndrome [8] and are highly prevalent among patients with diabetes, affecting more than 50% of men and 66% of women who are diabetic.[9, 10]

Statins are the most commonly used medications for heart disease. However, while statin is the most effective medication to reduce LDL (the "bad" cholesterol) levels, there remains an unacceptably high residual risk in patients who have been on statin treatment. Even after intensive statin treatment that has achieved very low LDL levels, morbidity and mortality rates among statin-treated patients still remain approximately two thirds to three quarters of those found in patients who were getting placebo.[11, 12] This large residual risk clearly indicates that LDL only modestly impacts atherosclerosis at best. Therefore, medical research is investigating HDL elevating treatments with the aim to reduce residual risk, and prevent development of cardiovascular diesase in the first place.

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Cheating on a diet - good or bad?

In discussions about dieting, a topic that often comes up is that of "cheating"; is it good or bad to cheat once in a while during a diet?

In order to answer this question appropriately, it is necessary to look at both the quantitative and qualitative aspects of dieting, and the physiological and psychological responses they each elicit...


Dieting - what are we really talking about?

The dictionary definition of "diet" and "dieting" is "to eat and drink sparingly or according to prescribed rules" or "a controlled intake of foods, as for medical reasons or cosmetic weight loss". 

However, these definitions do not tell us anything about the two different aspects of dieting; the quantitative and qualitative parts, and their respective consequences.  In everyday parlance, dieting usually implies both eating less calories (quantitative aspect) than usual, and eating "specific" foods (qualitative aspect). 

Nevertheless, when considering the consequences of "cheating" and trying to answer the question whether it is a good or bad practice, it is important to distinguish these aspects of dieting. Let's take a quick look at each: 

 

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Watch Your Waist - it may shorten your life!

Your waistline not only makes or breaks your esthetic appearance; if you belly gets too large, it may greatly jeopardize your health and even longevity.

Waist circumference strongly correlates with abdominal obesity and is the most commonly used measure of body fat distribution.[1, 2] Many studies have found enlarged waist circumferences to be associated with all-cause mortality, in most cases independently of general obesity.[3-11]

Abdominal obesity (aka visceral obesity) appears to be more strongly associated with multiple chronic diseases than is gluteo-femoral obesity (fat deposition around the butt and thighs).[1] Increased waist circumference confers a health risk even in normal weight people.[12]

A notable large study investigated the association of waist circumference with mortality using intuitive 2 in (5 cm) increments for men and women, and also evaluated risk within narrow categories of body fatness (BMI). In addition, the study estimated years of life lost due to a large waist circumference.[13]


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Multiple Hormonal Deficiencies in Anabolic Hormones in Frail Older Women

Reduced levels of anabolic hormones can contribute to aging and frailty. Most studies that have investigated this focused on the relationship between individual hormones and specific age-associated diseases. An interesting study in older women aged 70-79 years sought to examine the associations of individual anabolic hormonal deficiencies of free testosterone, IGF-1 and DHEA, and to assess their combined effects as well.[1]

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Relationship between Low Levels of Anabolic Hormones and Mortality in Older Men

The anabolic hormones testosterone, IGF-1 and DHEA (a pre-hormone) are receiving more and more attention by health professionals because the anabolic-catabolic imbalance that favors catabolism is a key factor in accelerated physical deterioration aging.[1, 2] Anabolic impairment can speed up the age-related decline in muscle mass and physical performance, increase in fat mass, development of insulin resistance, cardiovascular risk factors, metabolic syndrome and diabetes, conditions that in turn affect mortality.[3-18]

Interestingly, low levels of multiple anabolic hormones, rather than a single one, has a stronger association with age related muscle loss and the frailty syndrome. [19, 20] In men with chronic heart failure, deficiency of more than one anabolic hormone identifies patients with higher mortality rates.[21]

An interesting study sought to investigate the relationship between parallel deficiency of several anabolic hormones and mortality in a general population of older men, regardless of coexisting disease:[22]

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Combined Testosterone and GH therapy for best results on body composition and safety profiles

Prevention of age-related muscle loss (sarcopenia)

Many studies have highlighted the importance of investigating all major hormones, and correcting deficiencies and imbalances if present.[1-8] Given the known mechanisms of testosterone and GH/IGF-1 in building muscle (and possibly also DHEA in elderly) it is reasonable that age-related low levels of anabolic hormones contribute over time to sarcopenia and frailty.[1, 2, 4, 7, 9, 10]

Thus, multiple small effects in aggregate can lead to adverse loss of muscle and disability. In this scenario, if replacement was to occur, it would require lower doses of multiple anabolic hormones. An added benefit to this approach would be fewer side effects from the use of lower hormone doses [11]. In addition, multiple anabolic hormone replacement might also have beneficial additive or even synergistic effects.[11-13]

A notable study investigated whether supplementation with testosterone and GH together, in physiological doses, results in greater improvements in body composition and muscle performance in older men, compared to testosterone supplementation alone...

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