Lowell

Will testosterone make women happier?

Jane Fonda gave a candid interview three years ago in which she admitted that her sex life needed some artificial help and she had been taking testosterone to boost it, from the age of 70. She attributed her youthful looks and happy demeanor to a healthy love life. “If you want to remain sexual and your libido has dropped, taking a small dose of the libido-boosting hormone testosterone makes a huge difference,” she said.

Evidence that women can also become testosterone-deficient is largely ignored. Only levels of the “female” hormones progesterone and estrogen were thought to be important for a woman’s health and well-being. But many experts now believe that it’s the loss of testosterone, not estrogen, that causes women in midlife to gain weight, feel fatigue and lose mental focus, bone density and muscle tone.

Many women reaching menopause are scared off by the belief that hormone replacement therapy (HRT) can cause breast cancer. In 2002 a Women’s Health Initiative study in the United States was halted when researchers noticed an unexpectedly high rate of breast cancer among older women taking HRT. This alarming finding frightened millions of women, and their doctors, away from hormone therapy at menopause.

A decade later, medical professionals agreed that the 2002 findings were flawed and hormone replacement therapy is not as risky as once believed. Unfortunately, many women still believe hormone replacement is not safe and, too often, uninformed GPs advise women against taking HRT. Controlled studies show that slightly increasing testosterone levels in aging women can restore libido, increase arousal and the frequency of sexual fantasies. Low testosterone levels in women of all ages is a key factor in female sexual dysfunction, especially diminished desire and libido. Administering a low dose of testosterone has also been shown to improve mood and overall well-being.

Film Review: Will Sugar Bankrupt Healthcare?

Three documentaries point to sugar as the great destroyer

With apologies to Pogo, we have met the enemy and it is sugar.

That message may now be playing in a theater near you, so consider skipping the super size drink at the concession stand.

Here’s the trailer: Sugar — not dietary fat, not cholesterol, not sodium, not red meat, not carbohydrates — that is the fundamental threat to good health in this country. It drives obesity, which promotes type 2 diabetes, which leads to heart disease. Oh, and yes, there is always tooth decay.

Yet, for more than four decades now, almost the entire nutritional community has been focused on dietary fat. Nutrition fell prey to the vices of politics and popularity, and it is only now barely starting to recover.
This isn’t just a minor problem requiring a small course correction. It is a scandal, and the whole field must be overturned.

That, at least, is how some people see nutritional science. It’s a view that was recently propagated in two films: That Sugar Film, from Australia, and Sugar Coated, from Canada. In a third film — sugar is clearly having its day in the spotlight as the culprit in a whole host of chronic diseases — titled Sugar Rush, British celebrity chef Jamie Oliver shows the toll sugar is taking in Great Britain and urges the country to adopt a sugar tax and use the proceeds for health education.

Of the three movies, That Sugar Film is most entertaining. It is the lightest on the science, but it’s also the funnest and most watchable. Its strength is visual: It is one thing to hear that the average child in the U.S. eats about 32 teaspoons of sugar per day, but it’s stunning to see on the screen just how much sugar that actually is.
Hell Hath No Fury Like Industry Scorned

Nonetheless, the data are piling up, and it increasingly looks like critics of sugar got it right.

There are signs that the critics of sugar may soon be moving from contrarian to mainline status: the upcoming U.S. Dietary Guidelines are expected to take a much harsher stand against added sugars. It appears that the medical establishment is no longer standing naked in Times Square.

From here, it looks as if the contrarian view made sense all along, and we should laud the writers and the researchers that warned us long ago. But to think that way is to forget what a difficult fight against sugar it has been, and in some ways still is. And it is also to forget that the early scientists that fought for their viewpoint were often viewed as crackpots, were personally smeared, and their research was discounted.

In this sense, the films are a good reminder that science is a thoroughly human endeavor.

To do science is to do politics. And politics, like nutrition, is messy.

American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the Association of Testosterone and Cardiovascular Risk

Neil Goodman, MD, FACE; Andre Guay, MD, FACE; Paresh Dandona, MD, PhD, FACE; Sandeep Dhindsa, MD; Charles Faiman, MD, MACE; Glenn R. Cunningham, MD

Conclusion

Testosterone therapy can provide significant benefits for hypogonadal men. As recently concluded in an extensive review of literature, there is no compelling evidence that testosterone therapy increases cardiovascular risk

Most of my patients know I make a big deal about vitamin D. (Which is really more like a hormone).  Here is another reason to keep your levels up.

Preserving Muscle in Menopause

New research suggests that taking vitamin D supplements can help women to significantly increase their muscle strength and reduce the loss of muscle mass for at least 12 years after menopause. Dr LM Cangussu, from the Botucatu Medical School at Sao Paulo State University (Brazil), and colleagues conducted the double-blind, placebo-controlled trial over a nine-month period. Muscle mass was estimated by total-body DXA (dual energy X-ray absorptiometry), as well as by handgrip strength and through a chair-rising test. Results showed that women receiving the supplements exhibited a significant increase (+25.3%) in muscle strength at the end of the study, whereas those assigned to a placebo actually lost an average of 6.8% of muscle mass. Women not receiving Vitamin D supplements were also nearly two times as likely to fall. “We concluded that the supplementation of Vitamin D alone provided significant protection against the occurrence of sarcopenia, which is a degenerative loss of skeletal muscle,” said Cangussu.

Cangussu LM, Nahas-Neto J, Orsatti CL, Dias FB, Schmitt EB, Nahas EA. A randomized study on the effect of vitamin D3 supplementation on skeletal muscle function in fallers postmenopausal women. Abstract presented at the North American Menopause Society Annual Meeting 2015. 30th September – 3rd October, 2015. Las Vegas, United States of America.

How Athletes Can Stay ‘Fast After 50’

A celebrated triathlete argues that high-intensity interval training can reduce the effects of aging on performance.

As we get older, most of us get slower. But aging athletes may be able to stave off those changes more successfully than most people realize.

That’s the conclusion that Joe Friel, a celebrated triathlete, coach and author, reaches in his new book, “Fast After 50.” As he approached his 70th birthday, Mr. Friel began researching how aging affects athletic performance.

Among his primary findings: Many older adults are capable of pursuing high-intensity workouts well into later life. Put simply, “to be fast, one needs to train fast,” Mr. Friel says.

“If we do this, our aerobic capacities decline at a slower rate,” he says. In fact, “people will live longer with high-intensity training than if they adopted a long-slow-distance approach to exercise, which is what most of us do.”

It’s the hormones

WSJ: At what age do we start to slow down, and what happens, in a nutshell?

MR. FRIEL: Most endurance athletes will begin to notice a change in performance by their late 30s. The change is mostly the result of decreasing hormone production.

When we’re young we release lots of anabolic—tissue-building—hormones: testosterone, growth hormone, insulin-like growth factor, etc. These have a lot to do with recovery and damage control. As we age, the body gradually produces less and less. That means even slower healing of injuries and slower recovery as we move into our 40s, 50s and later.

WSJ: How would you sum up your research? How do we keep from slowing down?

MR. FRIEL: The best way to maintain health and performance for the dedicated but aging athlete is by doing high-intensity interval training, doing strength training with heavy loads, including adequate protein in the diet, and getting lots of sleep.

BAREKMED: I would add that hormone supplementation is a remarkable antidote that most people including most of my MD friends are clueless about its benefits.

Do you remember all the lawyer ads on TV about the risks of testosterone?

Guess what?

Multiple studies have been published recently showing no increased cardiovascular risk and likely a benefit with the use of testosterone.

Studies Show Little to no Effect on Cardiovascular Health from Testosterone Replacement Therapy

July 28th, 2015 | Andrew Smith

At least 5 studies indicating that testosterone replacement therapy either has no effect on cardiovascular health — or tends to improve it —appeared during the 3-week period immediately after the US Food and Drug Administration’s controversial decision to mandate warnings about the potential cardiovascular risks of such treatment.

The new research comes on the heels of at least half a dozen other trials, analyses and meta-studies that have popped up over the last year to contradict the 2 studies that precipitated the FDA’s investigation of testosterone’s safety and underpinned its decision to mandate the new warnings.

The first of the new studies, which was presented at the American College of Cardiology’s (ACC’s) 2015 Scientific Sessions, analyzed the records of 7,245 men with testosterone levels

The research team compared cardiovascular outcomes for men who did and did not treat their hypogonadism with testosterone replacement over an average follow-up of 1.78 years and found that testosterone therapy was associated with fewer cardiovascular events (unadjusted hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.51-0.98; p=0.038). When they adjusted for potential confounding factors, however, the statistical strength of the benefit was no longer significant (p=.54). The effects of testosterone supplements on cardiovascular outcomes were also non-significant when adjusted through 1:1 matching in 3,115 matched-pairs (adjusted HR, 0.86; 95% CI, 0.57-1.29).

The second of the new studies, which was also presented at the ACC’s 2015 Scientific Sessions, was actually a meta-study that included data from 122,889 men from 29 different studies and used the random-effect model to calculate that testosterone therapy does not cause statistically significant adverse cardiovascular events among men (relative risk [RR], 1.168; 95% CI, 0.794-1.718; p=.431).

The third of the new studies, which was presented at the Endocrine Society’s Annual Meeting, compared the cardiovascular outcomes of 102,650 hypogonadal men who received testosterone replacement with 102,650 similar men who did not. Retrospective cohort analysis revealed a hazard ratio for idiopathic venous thrombotic events that was 1.08 for all testosterone-treated patients, but the difference was not significant (95% CI, 0.91-1.27; p=0.378). Subgroup analysis that looked at different testosterone forms (gel vs. injection) and different patient ages found similarly insignificant results.

The fourth of the new studies, which was also presented at the Endocrine Society’s Annual Meeting, was a retrospective analysis of data on nearly 30,000 patients enrolled in 2 randomized trials that evaluated the effect of the lipoprotein phospholipase A2 inhibitor darapladib on ischemic events. Researchers pulled the data on major adverse cardiovascular events in men who used testosterone replacement therapy and comparable men who did not. Men exposed to testosterone replacement for less than or equal to 12 months had a hazard ratio of 0.48 (95% CI, 0.15-1.49; p=0.21) compared to those not exposed to testosterone. Men who used testosterone replacement for more than 12 months had a hazard ratio of 0.47 (95% CI, 0.25-0.87; p=0.02) compared to those who did not.

The fifth study, which was also presented at the Endocrine Society’s Annual Meeting, was the only prospective trial of the lot, and,although it used mice rather than people, the findings were interesting enough to take home the Endocrine Society’s presidential award.

British researchers used testosterone-deficient mice to show that higher levels of testosterone allowed both the liver and the body’s muscles to absorb more sugar and to store fat relatively harmlessly under the skin. Testosterone deficiency forced the body to break down more sugar and thus contributed to diabetes. It also forced fat towards the liver and into the arteries, where it can cause cardiovascular events.

These findings not only gel with the observed association between low testosterone and cardiovascular disease in human men; they also indicate that lack of testosterone causes the problem (at least partially) and that appropriate testosterone replacement should mitigate it. The 5 new studies, along with the many similar studies that preceded them, have convinced many researchers that the balance of evidence, at present, suggests that testosterone replacement therapy is more likely to protect the heart than harm it — and that the FDA’s new warnings are a mistake — but there is even more widespread agreement that only a major randomized trial will settle the matter definitively.