Ageless Forever Anti-Aging News Blog

Critical Update of the 2010 Endocrine Society Clinical Practice Guidelines for Hypogonadism

In 2010, the Endocrine Society published a Clinical Practice Guideline “Testosterone Therapy in Adult Men With Androgen Deficiency Syndromes”, which addressed important issues regarding the diagnosis and treatment of male hypogonadism.[1] 
 
Since publication of this Guideline, several high-quality trials have been conducted, warranting an update of the 2010 recommendations in several areas, especially that of testosterone therapy in men with the metabolic syndrome, type 2 diabetes, sexual dysfunction, and frailty.
 
In addition, many of the previously stated contraindications to testosterone therapy – including severe lower urinary tract symptoms (LUTS) and untreated obstructive sleep apnea (OSA) - have been reexamined in recent trials.
 
Here I summarize the results of a recent systematic analysis of the latest high-quality studies, which call for some important updates of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism.[2] 
 
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Krill Oil - what you need to know

Krill oil is becoming increasingly popular, and many people use it as an alternative to fish oil, since both provide the long-chain “marine” omega-3 fatty acids EPA and DHA. 
 
In addition, krill oil has some unique properties, and marketing claims about krill oil’s purported superiority over fish oil abound, centering on the following:
 
- Krill oil provides some of the EPA and DHA in phospholipid form, which has been suggested to be absorbed more effectively.
 
- Krill oil contains astaxanthin, a carotenoid with health promoting effects.
 
- Krill oil contains the essential nutrient choline.
 
- There are supposedly fewer contaminants in krill oil than fish oil.
 
- Krill oil supposedly does not cause any fishy burping or other gastro-intestinal side effects.
 
In this article I will summarize the research on each of these points, and critically evaluate the related marketing claims...
 
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Got Elevated Liver Enzymes? - Here's How To Interpret Your Liver Function Tests

 

Both exercise, supplements, medications and drugs may cause blood elevations of enzymes that are commonly included in liver function and/or liver disease testing - alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP).[1-6]
 
Elevations in these enzymes are one of the most common "problems" encountered in everyday clinical practice.[7] 
 
But how does one distinguish pathological elevations vs. those caused by intense exercise?
 
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Niacin - How to Beat the Flush

In a previous articles I covered the tremendous health benefits of niacin supplementation, mediated via both lipid (cholesterol and blood fat) and non-lipid mechanisms, and what you need to know about niacin products:
 
Here I will explain what the notorious niacin flush is all about, and give you hands-on practical tips on how to beat it.
 
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Niacin Supplements - what you need to know about niacin products

In a previous article I presented the wide array of health benefit of niacin – a.k.a vitamin B3 – supplementation, related to both its lipid and non-lipid effects "Niacin – a.k.a vitamin B3 – the Neglected Broad Spectrum Cholesterol Drug! "
 
In this article you will get critical information about the different niacin products and names, and what to look for when shopping niacin supplements…
 
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Biological Aging in Young Adults - Can it be measured? Does it matter?

Typically, research on aging is done in older people. The problem with studying aging in old people is that most of them already have age-related diseases, which anti-aging interventions aim to prevent. 
 
Age-related changes in the body start to accumulate early in life and affect physiological function years before disease diagnosis; atherosclerosis is a prime example.[1] Thus, intervention to reverse or delay the development of age-related diseases must be done while people are still young [2], before aging-related diseases become established. 
 
Up to this point, the main obstacle to studying aging before old age and before the onset of age-related diseases has been the absence of methods to quantify the pace of aging (i.e. aging rate) in young people. However, a recent study shows that aging processes can be measured in people still young enough for prevention of age-related disease, and that physical manifestations of aging are already present in young adults.[3]
 
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Effects of Testosterone Therapy for 3 Years on Subclinical Atherosclerosis Progression in Older Men

Clinical practice guidelines rely heavily on results from randomized controlled trials (RCTs), which is the gold standard for medical research. RCTs produce evidence considered to be of the highest quality. Because RCTs are resource intensive and costly, they are typically of relatively short duration, commonly lasting for around one year. 
 
Currently there are only a few placebo-controlled RCTs investigating the effects of testosterone therapy for a duration of 3 years [1-4], and medical societies have long been urging for more long-term trials evaluating the safety and efficacy of testosterone therapy.[5-7]
 
On August 11th 2015 a notable 3-year long RCT was published in JAMA (Journal of the American Medical Association), which attracted a lot of attention.[8] While interpreted by many as showing that testosterone therapy does not confer any benefits on atherosclerosis, sexual function and quality of life, a closer look at the data actually shows two important positive results…
 
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Normalization of testosterone level is associated with reduced risk of heart attack, stroke and mortality in men

The effect of testosterone replacement therapy on cardiovascular outcomes such as heart attack and stroke are controversial and have been generating heated discussions among clinicians as well as researchers. This, coupled with biased media sensationalism blowing up the supposed “dangers” of testosterone therapy has created great confusion among suffering men, who could gain tremendous health benefits from testosterone therapy.[1]
 
Here I report the results of a new study that examined the relationship between normalization of total testosterone levels with testosterone therapy and cardiovascular events as well as all-cause mortality, in patients without a previous history of heart attack and stroke.[2] This notable study was published in the European Heart Journal on August 6th, 2015.
 
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Niacin – a.k.a vitamin B3 – the neglected broad spectrum cholesterol drug!

 

Niacin - vitamin B3 - when taken in high dose acts as a powerful cholesterol drug. Niacin is unique among all available cholesterol drugs because it has beneficial effects across the entire lipid/lipoprotein spectrum, including the three components of atherogenic dyslipidemia. 
 
To learn the basics about atherogenic dyslipidemia, see my previous article "Why you need to look beyond your LDL - “bad cholesterol” - level". 
 
Niacin is especially noteworthy because it is the most potent drug available for raising HDL levels.[1, 2] Besides boosting  HDL levels, niacin also markedly lowers triglyceride levels while reducing LDL to a smaller degree.[1]
 
The table below provides an overview of the effects of popular drugs and supplements on blood lipids.[3]
 
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Long-term testosterone treatment with different testosterone preparations - provocative results on diagnosis and adherence

Due to lack of consistent clear-cut guidelines for diagnosis and treatment of testosterone deficiency, there is a lot of confusion among both health professionals and suffering men. The multiple different testosterone preparations available further add to the complexity of testosterone treatment.

This article presents the intriguing results from a notable study that analyzed effects of testosterone therapy with seven different testosterone preparations in symptomatic men who had previously been denied treatment because of “normal” baseline testosterone levels.[1]
 
The results are quite provocative and highlight several important practical issues relating to diagnosis and treatment of hypogonadism…
 
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Dr. Pierce's Medical Organization Affiliations

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