Ageless Forever Anti-Aging News Blog

Video Summary: Testosterone Deficiency and Treatment - International Expert Consensus Resolutions

In a previous article "Testosterone Deficiency and Treatment - the FACTS" I presented the conclusions from an International Expert Consensus Conference on Testosterone Deficiency and Its Treatment.[1]
 
Here I summarize the key points, and link to a video summary by Dr. Abraham Morgentaler, an internationally renowned testosterone scientist and clinician.
 
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Watch Your Belly – not just to look good!

Over the past two decades it has been established beyond any doubt that the amount of fat around the waist (aka abdominal fat and visceral fat) is at least as important, if not more important, than the total amount of body fat in predicting and /or causing complications that have been traditionally associated with overweight/obesity.[1]
 
Abdominal obesity is a strong risk factor for cardiovascular disease independent of BMI (a proxy for obesity) [2, 3] and is thought to affect disease risk through increased insulin resistance.[4, 5]  Actually, the common development of insulin resistance with aging is caused by growing bellies, rather than aging per se.[6] Notably, normal-weight abdominal obesity is associated with higher mortality than generalized obesity (as defined by BMI).[7]
 
An enlarged belly is an especially strong indicator of metabolic risk in men.[8, 9] People with large a waist circumference – i.e. those having a belly - have an increased risk of cardiovascular disease, diabetes and cancer, compared to those with smaller waist circumferences, regardless of BMI. [10-14] Your waist also impacts your longevity, which I covered in a previous article "Watch Your Waist - it may shorten your life!"
 
And your belly can interfere with your sex life...
 
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Testosterone Deficiency and Treatment - the FACTS

 
Testosterone deficiency and treatment is a very misunderstood and controversial topic among scientists, regulatory agencies (such as the FDA and EMA) and doctors, as well as the popular media.
 
On October 1, 2015, an international expert consensus conference about testosterone deficiency and its treatment was held in Prague, sponsored by King’s College London and the International Society for the Study of the Aging Male (ISSAM). The impetus for this meeting was to address the widespread misinformation and confusion about testosterone deficiency and testosterone therapy.[1]
 
The ultimate goal of this consensus conference was to document what is true or untrue about testosterone deficiency and testosterone therapy, to the best degree possible based on existing scientific and clinical evidence.
 
There were 18 experts from 11 countries on 4 continents. Specialties included urology, endocrinology, internal medicine, diabetology, and basic science research. Experts were invited on the basis of extensive clinical experience with testosterone deficiency and its treatment and/or research experience.
 
The final consensus on several key issues related to testosterone therapy was published in the form of 9 resolutions (i.e. firm decisions), coupled with expert comments.[2] These are summarized in table 1.
 
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Blood Testing - why?

Blood Testing

 
Most people don’t do any blood tests until they get ill and are forced to go through a health checkup, or are already diagnosed with metabolic syndrome, cardiovascular disease or diabetes etc. This is unfortunate, because regular blood testing is the single best strategy to stay healthy thought life. In this article I will explain why you want to get your blood tests and which ones to get.
 
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Real-life experience of continuous long-term testosterone therapy on anthropometric, endocrine and metabolic parameters for up to 10 years

While it is well documented that testosterone levels decline in aging men, recent studies show that in some cases obesity and impaired general health can be more influential causes of testosterone deficiency than chronological age and aging per se.[1, 2]
 
Here I present real-life results from a registry study which investigated the effects of continuous long-term testosterone therapy for up to 10 years on anthropometric (body measurements), endocrine and metabolic parameters in obese hypogonadal men.[3]
 
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Remnant Cholesterol and non-HDL – What’s that? Why bother?

 
In a previous article "Blood Cholesterol Testing - don't let the routine standard lipid panel fool you!" I talked about the standard lipid panel that doctors use to check your “bad” cholesterol, aka LDL level. In "Why you need to look beyond your “bad" cholesterol” - level" I’ve also gone into some depth on why a myopic focus on LDL-C can do more harm than good.
 
In this article I will talk about 2 relatively unknown cholesterol parameters and explain why you want to keep an eye on these…
 
The routine standard lipid panel checks your levels of:
 
- Total cholesterol 
 
- LDL-C (or just LDL, low-density lipoprotein cholesterol, the “bad" cholesterol)
 
- HDL-C (or just HDL, high-density lipoprotein cholesterol, the “good" cholesterol) 
 
- VLDL-C (or just VLDL, very-low-density lipoprotein cholesterol) 
 
- Triglycerides (a.k.a. blood fats)
 
If you have read my previous articles you know the limitations of LDL-C and the standard lipid panel. However, while the advanced lipid panel gives you much more accurate information on your health status, the standard lipid panel is not totally worthless if you know what to look for…The caveat is, what to look for - non-HDL-C and remnant cholesterol – are not printed in your standar lipid test results. And your doctor may not even know about non-HDL-C and remnant cholesterol! That’s why I had to write this article…
 
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Survival and cardiovascular events in men on testosterone treatment

On the surface, testosterone therapy is a controversial treatment because previous studies investigating the effects of testosterone therapy have been conflicting, with some studies showing supposed harm and others showing significant benefit.
 
Here I summarize the results of a new study published in The Lancet Diabetes & Endocrinology on May 7 2016, which addressed some shortcomings in previous studies by analyzing effects based on duration of testosterone treatment.[1]
 
 
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Everything We Learned About TESTOSTERONE Is WRONG - video presentation by Dr. Morgentaler

Historically testosterone therapy was only indicated in men with pituitary tumors and testicular dysfunction. Dr. Morgentaler pioneered the field when he started to treat men – who did not have any underlying pituitary tumors and testicular dysfunction - with Low-T with testosterone therapy. His patients reported improved erections, libido, orgasm, as well as increased energy, mood, cognition and wellbeing.
 
This use of testosterone therapy in otherwise healthy men defied standard medical practice in the 1990s...
 
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Testosterone levels, testosterone therapy and all-cause mortality in men with type 2 diabetes - impact of PDE5 inhibitors and statins

The prevalence of testosterone deficiency is higher in men with type 2 diabetes than among non-diabetic men [1-6], and testosterone deficiency is associated with increased mortality.[7, 8]
 
Type 2 diabetic men often have dyslipidemia [9] and erectile dysfunction [10, 11], and hence statins and phosphodiesterase 5 inhibitors (PDE5I) are widely used in these men.
 
Here I summarize the results of a study published in International Journal of Clinical Practice, which investigated the impact of testosterone levels and testosterone therapy on mortality, and assessed if this was affected by concomitant statin and PDE5I use.[12] 
 
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Effects of Testosterone Treatment in Older Men

The so called double-blind randomized controlled trial (RCT) is accepted by medicine as the gold standard objective scientific methodology, and provides the highest strength of evidence for the effectiveness of a treatment.[1-4]
 
An accumulating body of evidence shows that treating hypogonadal men with testosterone therapy provides a number of wide-ranging benefits beyond mere relief of symptoms, including improvements in muscle mass, insulin sensitivity, fat mass (both total body fat and visceral fat), endothelial function, blood pressure, lipid profile and bone mineral density.[5, 6]
 
Recent clinical practice guidelines state that testosterone therapy is safe if treatment and monitoring are appropriately executed [7-9], and the totality of available evidence to date does not support alleged concerns regarding risk of cardiovascular disease [10] and prostate cancer.[11] Despite this, opponents state that the clinical benefits and potential long-term risks of testosterone therapy have not been adequately assessed in large RCTs, and that therefore a general policy of testosterone replacement in all older men with age-related decline in testosterone levels is not justified.[12]
 
To address the lack of large RCTs on testosterone therapy, the US National Institute of Health has funded The Testosterone Trials, which is a coordinated set of 7 large double-blind RCTs. Here I report the first results from The Testosterone Trials,  which were released February 18, 2016.[13]
 
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Dr. Pierce's Medical Organization Affiliations

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