Ageless Forever Anti-Aging News Blog

Effects of testosterone treatment on body fat, lean mass, symptoms and leptin resistance in obese men on a calorie-restricted diet

Effect of testosterone therapy on body composition and leptin resistance

 

It is well-documented that the relation between testosterone deficiency and body fat is bi-directional; low testosterone levels contribute to the development of excessive body fat accumulation, and an excessive amount of body fat contributes to a reduction in testosterone levels.[1-3]

Here I present a series of three reports from a study that specifically investigated if testosterone therapy has beneficial effects on body composition, symptomatic response, adipokines (hormones secreted by fat cells, such as leptin and adiponectin) and gut hormones, over and above caloric restriction alone.[4-6]

 

Key Points

-    Compared to diet alone, combining diet + testosterone therapy results in a greater reduction in fat mass (-2.9 kg) and visceral fat, and a reduced loss of lean mass after 1 year.

-    Dieting men who receive testosterone therapy display higher physical activity levels than dieting men not receiving testosterone therapy.

-    The elevation in testosterone levels by diet alone is not enough to optimize body composition results. Diet alone results in less body fat reduction and more lean mass loss than diet + testosterone therapy. 

-    Diet + testosterone therapy ameliorates symptoms long-term after a diet. Diet alone does not confer long-term symptomatic improvements.

-    Diet + testosterone therapy, but not diet alone, reduces leptin resistance.

 
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Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease: Real-Life Results

 
Most men with testosterone deficiency need testosterone therapy for the rest of their life in order to achieve and maintain best possible health outcomes. Therefore, studies that investigate the effects of testosterone therapy in real-life are needed, to shed light on adherence and health outcomes in routine clinical practice.[1] While randomized controlled trials (RCTs) are gold standard in medical research [2, 3], RCTs are conducted in highly controlled environments and therefore their results may not carry over to the uncontrolled setting of real-life.[1] It is increasingly recognized that conclusions drawn from RCTs are not always a useful aid for decision-making because evaluating the value of a drug or technology requires an understanding of its impact on current clinical practice and management of patients in a real-life setting.[4]
 
A series of “real-life studies” have been conducted, all showing numerous health benefits of testosterone therapy in testosterone deficient (hypogonadal) men and confirming its safety, with an observation period of up to 17 years.[5-23] Here I summarize the results from the most recent real-life study, published February 9th 2017 in the Journal of Cardiovascular Pharmacology and Therapeutics which investigated the long-term effects and safety of testosterone therapy for up to 8 years in testosterone deficient men attending a urological office.[5] Differences in cardiovascular risk factors and deaths with testosterone therapy were compared to those seen in testosterone deficient men not receiving testosterone therapy but attending the same urological office.[5] 
 
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Exercise – much more than just a calorie burning tool

Exercise is commonly seen as a tool to burn off calories and stored body fat. While exercise has potential to greatly increase calorie burn off and fat burning, as seen in elite athletes [1], studies show that for most people who are struggling with fat loss, dieting – i.e. reducing caloric intake - results in a greater weight loss (or fat loss in some cases) than exercising.[2-5] Why?
 
The problem is not that exercise is ineffective, but that the prescribed exercise dose or adherence to the prescribed exercise dose, is poor.[4, 6] In most studies, the energy deficit produced by the prescribed exercise is far smaller than that usually produced by dietary restriction.[4] In contrast, in studies that carefully compared the effects of an equal energy deficit caused by either aerobic exercise versus caloric restriction, the effect on weight loss is similar.[7-10] In these studies, subjects achieved an identical daily energy deficit of 500-700 calories, created either by diet or by supervised daily exercise, for a 12-week period. Similar weight losses (approximately 6 kg in women and 8 kg in men) occurred in both the diet-only and exercise-only groups.[7, 8]
 
Unfortunately, adherence to exercise programs that daily burn 500-700 calories per session is low and over half end up dropping out after 16 months, despite getting paid for their time.[11, 12] But this does not mean that lower amounts of exercise are "worthless". Here I will tell you how regular exercising – even if your workouts don’t result in large calorie expenditures - helps you stay on the fitness track…
 
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Testosterone treatment is NOT associated with risk of adverse cardiovascular events – the RHYME study

It is well-documented that testosterone therapy effectively restores testosterone levels in hypogonadal men and improves many health outcomes, such as quality of life [1-4], libido [4, 5], metabolic parameters [5-9] and body composition.[4, 5, 9, 10]
 
However, a few conflicting studies raised concerns about the cardiovascular safety of testosterone therapy [11, 12], which in 2015 prompted the FDA to issue warnings to physicians and patients about potential cardiovascular risks of testosterone therapy.
 
In contrast, the European Medicines Agency (EMA) acknowledged the flaws of the conflicting studies and concluded that there is no consistent evidence of harm associated with testosterone therapy, regardless of mode of delivery.[13]
 
Here I summarize the cardiovascular results of the notable RHYME (The Registry of Hypogonadism in Men) study, which contrary to prior clinical trials, enrolled men with a wide range of comorbid illnesses and cardiovascular risk factors.[14] The aim was to evaluate the safety of testosterone therapy in a sufficiently diverse population to reflect real-world, clinical experience.[14]
 
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Testosterone Therapy in Men with Prostate Cancer – Yes or No?

Historically, prostate cancer – both active and treated - has been an absolute contraindication to testosterone therapy and – from a regulatory perspective – still is. The incidence of prostate cancer is higher in older men, in whom prostate cancer accounts for one in five new cancer diagnoses.[1]
 
Thanks to improvement in early detection and treatment of prostate cancer, prostate cancer mortality has decreased 50% during the past two decades, and more men are living with a history of prostate cancer. 
 
The aging of the male population and the increasing number of prostate cancer survivors have resulted in a significant increase in the number of men presenting with hypogonadism and treated prostate cancer. Therefore, it is important to consider the growing number of recent studies which have challenged the long-standing belief that prostate cancer is an absolute contraindication to testosterone therapy.[2-4]
 
Here I summarize the results of a notable study which investigated the effects of testosterone therapy in men with treated and untreated prostate cancer [5], and conclude with the latest recommendations on managing testosterone deficiency in men with history of prostate cancer.
 
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How is anabolic steroid use different from testosterone replacement therapy?

One main reason testosterone replacement therapy (aka testosterone treatment) is surrounded by controversy is that testosterone can be abused, both in athletic populations and the general public.[1] Scientific evidence is undisputed that testosterone y potently enhances physical performance and increases muscle growth.[1-3]
 
The ethical issue of fair play in sports, coupled with the well-known adverse health effects of supra-physiological doses of anabolic steroids [4-14], has given medically legit testosterone replacement therapy (aka TRT, testosterone therapy or testosterone treatment) a bad reputation and is depriving many suffering men with testosterone deficiency from receiving medically needed testosterone treatment.[15] 
 
In this article I will point out the salient differences between use testosterone replacement therapy – a.k.a. testosterone therapy or testosterone treatment - and abuse of anabolic steroids, and explain why testosterone treatment - which per definition is medically provided and supervised - has no parallel with abuse of anabolic steroids.
 
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Dispelling the myth of testosterone treatment and prostate cancer

 
Fear of prostate cancer remains one of the major concerns with testosterone therapy among doctors, and reason to deny suffering hypogonadal men testosterone treatment.[1, 2]
 
This fear persists despite mounting research over the past decade that has clearly refuted the belief that testosterone therapy increased risk of prostate cancer among men in the general population.[3-5]
 
Aside prostate cancer, benign prostatic hyperplasia (BPH) with its associated lower urinary tract symptoms (LUTS) are also common concerns with testosterone therapy.[6]
 
In this article I summarize and comment on the results of the Registry of Hypogonadism in Men (RHYME) study; a large, multi-national prospective registry of men with testosterone deficiency, which was designed and powered specifically to assess prostate cancer outcomes in hypogonadal men receiving testosterone therapy compared with untreated hypogonadal men or general population estimates.[7]- 
 
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Metformin: is it an anti-aging pill?

 

The science of aging is moving forward as scientists are elucidating the biology of aging. The ultimate goal is to develop treatments that delay aging, and in so doing, delay the development of aging-related diseases.[1] 
 
Aging is the greatest risk factor for the majority of chronic diseases that are driving morbidity and health costs [2], but the aging process can be delayed with lifestyle (exercise and nutrition), genetics, and pharmacologic approaches.[3-8] 
 
The so called “geroscience hypothesis” (“gero” is short for gerontology, which is the scientific study of the process of aging and its consequences)  holds that treatments that are targeting fundamental processes of aging may delay, prevent, alleviate, or reverse a wide range of diseases and conditions for which age is the primary non-modifiable risk factor.[1] Interventions that target fundamental aging processes have the potential to transform human health and health care.[9]
 
Excitement is now high because time has come for the first study to test the effect of metformin on aging-related outcomes in humans and see if it qualifies as an "anti-aging pill"... 
 
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Caloric Restriction for anti-aging and longevity - does it work in non-obese humans?

If you are following the anti-aging news, you’ve heard about the supposed benefits of chronic calorie restriction for increasing longevity. These claims are based on research done in various species such as flies, worms and mice.
 
Here I will explain that chronic calorie restriction makes it impossible to implement and reap the health benefits of an active lifestyle with regular exercise, and causes severe health consequences for humans.  
 
While animal studies can and do shed light on what’s going on at mechanistic level, we have to be very careful and resist the temptation to extrapolate results from animal experiments to humans.
 
Here I will make the case that chronic calorie restriction actually counteracts the prospects of a healthy vital long life.
 
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Waist-to-Height Ratio as a Screening Tool for Testosterone Deficiency

A bidirectional relationship exists between excess body fat, and/or belly fat, and testosterone levels in men. That is, excess body (belly) fat decreases testosterone levels and may cause testosterone deficiency, and low testosterone levels increases body (belly) fat.[1-4]  I covered this in-depth in a previous article “Testosterone and Fat Loss - the Evidence”.
 
In “Keep your waist to less than half your height” I introduced the waist-to-height ratio and explained that it is a better tool for predicting health outcomes and mortality than is waist circumference alone. I have also covered the association between a large waist (i.e. belly) and reduced testosterone levels in "Young Men, Waist, Testosterone and Erectile Function: Low-T is not only an old man's issue".
 
Here I will summarize research showing that the waist-to-height ratio can also be used as a screening tool for testosterone deficiency. 
 
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Dr. Pierce's Medical Organization Affiliations

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