Ageless Forever Anti-Aging News Blog

Testosterone Replacement Therapy (TRT) in Testosterone Deficient men - effects on fat loss, waist reduction and metabolic syndrome components

Testosterone deficiency in men, aka hypogonadism, is associated with increased total and abdominal fat mass, and reduced muscle mass, which negatively impacts body composition.[1, 2] This contributes to development of risk factors like insulin resistance, chronic inflammation, and atherogenic dyslipidemia (a triad of increased blood levels of small, dense LDL particles and triglycerides, and decreased levels of HDL particles), which increase the risk for cardiovascular disease, metabolic syndrome and diabetes.[1, 3-16]

Previous studies have shown that testosterone replacement therapy ameliorates these risk factors in testosterone deficient (hypogonadal) men; it increases insulin sensitivity [17-20] and HDL (the "good" cholesterol) [9, 10, 20, 21], and reduces waist circumference [9, 20, 22], fasting blood glucose [9, 20] triglycerides (blood fats)[9], LDL (the "bad" cholesterol) [19, 22-24], and several inflammatory markers.[17, 25]

A 2011 meta-analysis concluded that testosterone replacement therapy improves metabolic control, as well as reduces abdominal obesity.[9] Many studies have shown that testosterone replacement therapy in hypogonadal men increases muscle mass and reduces fat mass.[19, 26-32] Further, adding testosterone (50 mg/day for 1 year, administered as a transdermal gel) to a diet and exercise program results in greater therapeutic improvements of glycemic control and reverses the metabolic syndrome.[20]

Testosterone also has direct (non-obesity mediated) beneficial effects on many metabolic and cardiovascular risk factors [12, 33-37], and reduces death risk independently of body fat status.[38] In line with all these effects, low testosterone levels are associated with increased risk of cardiovascular complications [39], and all-cause and cardiovascular disease death [40-42]. Low testosterone may thus be a predictive marker for men at high risk of cardiovascular disease.[41] In a group of men aged 50-91 who were followed for 20 years, it was found that men whose total testosterone levels were in the lowest quartile (241 ng/dl or lower) were 40% more likely to die than those with higher levels, independent of age, adiposity, lifestyle or presence of cardiovascular risk factors.[38]

Thus, treatment of testosterone deficient men with testosterone has demonstrated considerable health benefits. Despite this, critics state that most of the studies on testosterone replacement therapy were too small. They also argue that the studies were of too short duration (most of them lasting 6-12 months), and that the long-term effects of testosterone on body composition are not known.

Two 5 year long studies were just published that addressed the duration and small study size shortcomings in previous research...

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Does Testosterone Therapy Really Increase the Risk of Heart Attack?

A few days ago, Jan 29th 2014, a controversial study [1] was published showing that men aged 65 years and older, had a two-fold increase in the risk of heart attack in the 90 days after filling an initial TT

prescription, regardless of cardiovascular disease history. Among younger men below 65 years of age with a history of heart disease, the study reported two to three-fold increased risk of MI in the 90 days following an initial TT prescription. 

This study has stirred up heated discussions and media headlines. Let's dissect it and look under the hood... 

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Is testosterone a friend or a foe of the prostate?

This is an abstract from an interesting debate among leaders in the field of Testosterone and Men's Health. 

INTRODUCTION:

Is there any unequivocal evidence that testosterone (T) can stimulate growth and aggravate symptoms in men with locally advanced and metastatic prostate cancer (PCa)?

This is not a controversial point: the answer is yes.

However, this evidence does not imply that PCa is a result of T or therapy with T (TTh) of hypogonadal men.

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Testosterone Replacement Therapy - why is it so controversial?

"It is dangerous to be right when the government is wrong." - Voltaire

For reasons that are not readily apparent, there appears to be a conservative political movement that opposes the use of testosterone in older men. This was clearly demonstrated by the report of the Institute of Medicine, which felt that testosterone is not yet ready for prime time and that there is still a need for studies to prove its efficacy [1]. Along the same lines, the guidelines of the Endocrine Society on testosterone use in older men seem to be ultra-cautious [2]. But fortunately, there are also other, more liberal guidelines and recommendations [3-5].

Probably no other medical issue has been bombarded by the influx of “expert” views from all walks of life; from endocrinologists and psychiatrists to urological surgeons and gerontologists, from the lay press to the regulatory agencies and from the pharmaceutical to the entertainment industries. The dismal result of all this free-for all cacophony of opinions is a great deal of confusion, erroneous information and significant detriment to patients and physicians alike.

Let's take an in-depth look at the reasons for the negative attitudes to male testosterone replacement therapy (I will cover post-menopausal testosterone replacement in an upcoming article), and the hard scientific data that refutes it...

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Beneficial effects of testosterone therapy in women on menopause symptoms and quality of life

Testosterone levels in women decline steeply with age during the reproductive years; by the time women reach their late 40, their blood testosterone levels are approximately half what they were in their 20s.[1, 2]

Symptoms of androgen deficiency, including a reduced sense of well-being, dysphoric mood (sadness, depression, anxiety, and irritability), fatigue, decreased libido, hot flashes, bone loss, decreased muscle mass and strength, changes in cognition and memory, and insomnia may occur prior to cessation of menses.[3] Pre-menopausal patients frequently report ‘menopausal symptoms’, most of which are not related to estradiol levels.[4]

Adding testosterone to estrogen therapy in postmenopausal women has beneficial cardiovascular effects[5] and also results in meaningful improvements in sexual function in women not taking estrogen.[6]

Testosterone supplementation in both pre- and postmenopausal women has been shown safe, even in higher doses[7, 8], and shown not to affect the menstrual cycle.[9] It is increasingly used as part of postmenopausal HRT (hormone replacement therapy) regimens.[10] Contrary to old beliefs, testosterone can actually protect against breast cancer. It has been shown that addition of testosterone may counteract breast cell proliferation induced by estrogen/progestogen therapy in postmenopausal women.[11-15]

A notable study investigated the effectiveness of a 3 month continuous testosterone therapy, delivered by subcutaneous implant, on the relief of somatic, psychological and urogenital symptoms in both pre- and post-menopausal patients using the self administered Health-Related Quality of Life (HRQOL) questionnaire called the Menopause Rating Scale (MRS).

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Muscle function and lean body mass during testosterone therapy combined with strength training and in aging men

Study shows only a combination of testosterone therapy and strength training results in an increase in both mechanical muscle function and muscle mass (LBM).

OBJECTIVES:

To examine the effect of strength training and testosterone therapy on mechanical muscle function and lean body mass (LBM) in aging men with low-normal testosterone levels in a randomized, double-blind, placebo controlled 24-week study.

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Dr. Pierce's Medical Organization Affiliations

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