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Latest News


June 2018

Can Testosterone Affect My Cholesterol Levels?

By: Epoch


Research on testosterone and cholesterol has produced mixed results, however.


Some researchers have found that testosterone lowers both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. Others have found testosterone doesn’t affect either of them.

Studies on the effect of testosterone on total cholesterol are also contradictory. On the other hand, several studies have found testosterone has no effect on triglyceride levels. So, testosterone can’t lower triglyceride levels, but researchers don’t know how or even if it affects total, HDL, and LDL cholesterol.

What’s the connection?


Why testosterone therapy?


Testosterone therapy is usually given for one of two reasons. First, some males have a condition known as hypogonadism. If you have hypogonadism, your body doesn’t make enough testosterone. Testosterone is an important hormone. It plays a key role in the development and maintenance of male physical traits.

The second reason is to treat the natural decline of testosterone. Testosterone levels start to decline in males after age 30, but the decline is gradual. Some want to make up for the lost muscle mass and sex drive that results from this decrease in testosterone.


Cholesterol 101


Cholesterol is a fatlike substance found in the bloodstream. We need some cholesterol for healthy cell production. A buildup of too much LDL cholesterol, however, leads to the formation of plaque in the walls of arteries. This is known as atherosclerosis.

When a person has atherosclerosis, plaque inside the artery wall slowly builds up and bulges into the artery. This can narrow the arteries enough to significantly reduce blood flow.

When that happens in an artery of the heart called a coronary artery, the result is chest pain called angina. When the bulge of plaque suddenly ruptures, a blood clot forms around it. This can completely block the artery, leading to a heart attack.

Testosterone and HDL


HDL cholesterol is often referred to as the “good” cholesterol. It takes LDL cholesterol, the “bad” cholesterol, and other fats (like triglycerides) from your bloodstream to your liver.

Once LDL cholesterol is in your liver, it can eventually be filtered out of your body. A low HDL level is considered a risk factor for heart disease. A high HDL has a protective effect.

A 2013 review notes that some scientists have observed males who take testosterone medications may have a decrease in their HDL levels. However, results of studies haven’t been consistent. Other scientists found testosterone didn’t affect HDL levels.

The effect of testosterone on HDL cholesterol may vary depending on the person. Age may be a factor. The type or dose of your testosterone medication may also influence its effect on your cholesterol.

The review also notes other researchers found that males who had normal HDL and LDL cholesterol levels had no significant changes in their cholesterol levels after they took testosterone. But those same researchers found that males with chronic disease saw their HDL levels drop slightly.

Currently, the effect of testosterone on cholesterol isn’t clear. As more and more people consider taking testosterone supplements, it’s encouraging to know that there’s a lot of researchers looking into the safety and value of this type of hormone replacement therapy.

The takeaway


Unfortunately, researchers have yet to provide a definitive answer about testosterone and cholesterol. It’s important to understand that there may be a connection. If you decide to use testosterone therapy, make sure you consider all of the risks and benefits.

Follow your doctor’s advice about a heart-healthy lifestyle, and take any prescribed medications. This can help keep your cholesterol, blood pressure, and other manageable risk factors under control.

Assume there may be a connection between testosterone and cholesterol. Be proactive about keeping your cholesterol levels in a safe range.

Source: HealthLine











April 2018

Battle of the Bulge: Low T and Weight Management

By: Epoch

Men depend on the male hormone testosterone for everything from helping to build muscle to giving facial hair and a deeper voice. Research also shows that weight control can be added to that list.

“Testosterone has a critical role in metabolism,” says Abraham Morgentaler, MD, an associate clinical professor of urology at Harvard Medical School and director and founder of Men’s Health Boston. “Multiple studies have shown men with low testosterone have a higher percentage of body fat than men with higher testosterone.

Further evidence: Men who take medication to severely depress testosterone levels as treatment for advanced prostate cancer rapidly gain weight and increase body fat, according to Dr. Morgentaler.

The testosterone-weight connection also goes the other way. A 2013 review of weight loss and its effects on testosterone published in the European Journal of Endocrinology found that weight loss alone — without testosterone therapy — was associated with increases in testosterone levels.

Also, a 2013 German observational study published in the journal Obesity found that weight loss was an added bonus for men with low testosterone who were taking testosterone replacement therapy. The men took testosterone supplements for five years and lost an average of 36 pounds and 3.5 inches off their waists.

The Low Testosterone-Weight Gain Mystery

Low testosterone causes increases in body fat, especially in the midsection.

But why does this happen? “The exact biochemical mechanism by which testosterone causes this change is unknown,” Morgentaler explains.

However, it turns out that not only does low testosterone seem to cause weight gain in men, the reverse also seems to be true: Obesity is one of the risk factors for lower than normal levels of testosterone. Physiologically, the relationship between low testosterone and weight gain in men can become a vicious cycle.

“Body fat contains an enzyme that converts testosterone into estrogens,” says David Samadi, MD, chairman of the urology department at Lenox Hill Hospital in New York City. “Having extra estrogens triggers the body to slow its production of testosterone. The less testosterone you make, the more belly fat you accumulate, and so on.”

For men who already have low testosterone, excess body fat can worsen the condition: “Fat speeds up the metabolizing of testosterone,” Dr. Samadi says. “Therefore, the more fat you carry around, the faster you’ll burn through the already low testosterone levels in your body.”

However, not all men with low testosterone are overweight, and the symptoms vary from man to man. “Being overweight can worsen your ability to produce testosterone and can lower already low testosterone, but you don’t need to be overweight to be affected by low testosterone,” adds Samadi.

Regardless of weight, men with low testosterone are more likely to have less muscle than those with normal levels. “Even in men with low testosterone who are not overweight, it is likely they will have an increased percentage of body fat,” Morgentaler says.

A Recipe for Couch Potatoes

Another important reason low testosterone is tied with weight gain in men is the symptoms can take away incentive to exercise. “One of the subtle symptoms of low testosterone is that it often reduces motivation,” Morgentaler says. “Men describe this feeling as if they have become a couch potato. Staying fit and trim requires energy and drive, and if these are lacking, it is easier to gain weight.”

Even if you are able to drag yourself to the gym, low testosterone could mean you have less stamina to get through your workout and see results, which can be discouraging.

Tips for Managing Weight With Low Testosterone

To fight weight gain with low testosterone, the advice is the same as for others trying to drop pounds: Eat less and exercise more.

Weight lifting or another form of resistance exercise is particularly important. “This type of workout helps build more muscle faster and triggers testosterone production,” Samadi says. “Additionally, your body burns more fat for energy during resistance exercise, helping promote healthy weight and fat distribution.”

Treating low testosterone can boost overall energy, easing fatigue and prompting you to get moving and lose weight. Although testosterone supplements shouldn't be used to help men with symptoms of low testosterone drop pounds, if you have measurably low testosterone, treating it should make weight loss easier. “Normal levels of testosterone encourage fat loss, increased muscle mass and strength, and stamina,” Morgentaler says. “Also, workouts are better, and men feel encouraged by this, so they do them more often.”

Source: Everyday Health

Author: Elizabeth Shimer Bowers



April 2018

Study finds testosterone replacement therapy reduces cardiovascular risk

By: Epoch

Men who used testosterone replacement therapy to treat symptoms of androgen deficiency had a 33 percent lower risk of cardiovascular events such as heart attacks and stroke compared to those who did not receive any hormone therapy. The findings from the Kaiser Permanente study were published in JAMA Internal Medicine today.

Androgen deficiency in men is characterized by lower levels of male sex hormones, specifically testosterone, as well as symptoms that include loss of sexual desire, erectile dysfunction, breast enlargement or tenderness, hot flashes, reduced energy, irritability and depressed mood. Similar to women, men experience a normal decline in sex hormone levels beginning in their 30s. The decline in men is gradual and occurs over a number of years. It is estimated that approximately one in 200 men under the age of 60 has testosterone levels below normal, but as many as two in 10 men over the age of 60 have low levels. Not all men with low testosterone levels have symptoms of androgen deficiency.

Symptoms related to androgen deficiency can be treated with testosterone replacement therapy given by injection, orally or topically. Some recent studies, however, have raised concerns that testosterone replacement therapy may increase the risk for cardiovascular events such as heart attacks and strokes. Other studies report that low testosterone levels in older men are associated with increased cardiovascular risk and that testosterone replacement therapy may have cardiovascular benefits.

"Our study found no indication of an increased risk for cardiovascular events for men with androgen deficiency," said T. Craig Cheetham, PharmD, MS, study lead author, Kaiser Permanente Southern California Department of Research & Evaluation. "Our hope is that these findings help alleviate the concerns that patients with androgen deficiency and their doctors may have had about prescribing and taking testosterone replacement therapy."

The study evaluated 44,335 male patients at Kaiser Permanente medical centers in Northern and Southern California who had been diagnosed with androgen deficiency between January 1, 1999 and December 31, 2010. Of these, 8,808 men were treated with testosterone replacement therapy, while 35,527 were never dispensed testosterone. The men were followed for a median of 3.4 years and researchers found:

  • Of the men who never received testosterone, 10.2 percent had a heart attack or stroke during the study period.
  • Of those who received testosterone replacement therapy, 8.2 percent had a heart attack or stroke during the study period.

Source: Medical Press

Author: Kaiser Permanente




March 2018

What to Expect During Your First Colonoscopy

By: Epoch

Not that many people get excited about the prospect of having a doctor put a scope up their bum, but consider the alternative: 50,000 people die of colorectal cancer each year. If everyone got screened, that number could be cut in half, says Dr. Jordan Karlitz, an associate professor of gastroenterology at Tulane University and a member of the National Colorectal Cancer Roundtable. Tragically, many people (some 28%, or 1 in 3 people, according to the Centers for Disease Control and Prevention) do not get screened—some because they lack access to information and healthcare, and others who know they should get screened and have access but are squeamish about anything poop-related, or fearful that it will be painful or embarrassing.

(According to Dr. Patricia Raymond, a practicing gastroenterologist and assistant professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk, Virginia, men are generally more reluctant than women to get screened, possibly because men are less likely to have had invasive procedures.)

Aren’t There Other Tests?

There are other tests, but because little research has been done comparing how the various forms of screening stack up against each other in terms of finding cancerous or pre-cancerous polyps and preventing death, major organizations including the United States Preventive Services Task Force and the American Cancer Society recommend only that you get screened, leaving the choice of the screening method up to you and your doctor. In their latest recommendationsthe U.S. Multi-Society Task Force of Colorectal Cancer, a group made up of gastroenterologists, state that colonoscopy is the preferred test for colorectal cancer. They say that when it comes to detecting polyps—in all stages of development—a colonoscopy is the most sensitive and offers a two-for-one deal: it allows a doctor to see polyps and remove them all at once. Plus, if your first one is normal, and you don’t have high risk factors, you don’t need to get another for 10 years.

Doctors also recommend the fecal immunochemical test (FIT), in which small amounts of stool are smeared on cards or collected in tubes and tested for the presence of blood. This test has to be done once a year and might not detect tumors that aren’t bleeding. If you test positive on the FIT, you’ll need to get a colonoscopy.

Less frequently used options include CT colonography, the FIT–fecal DNA test, and flexible sigmoidoscopy. All three of these are less sensitive than a colonoscopy and the FIT and must be done more often (once every five, three, and five to ten years respectively). You might have one of these tests if colonoscopies are not available in your area or you are uninsured (all insurance plans that are ACA compliant are required to follow the Task Force’s recommendations for cancer screening). “People should understand that these less invasive tests are not a way out of a colonoscopy,” says Dr. Durado Brooks, vice president of cancer control interventions at the American Cancer Society. “If those tests are abnormal, you’re going to have to have a colonoscopy.”

Dr. Brooks says it’s also important to know that if you opt to have a test other than a colonoscopy, get positive results, and are then sent to have a colonoscopy, that colonoscopy might be classified as a diagnostic rather than screening test, meaning that you might be responsible for a co-pay or deductible to cover it. This is not the case if the colonoscopy is the first test you get.

If you are colonoscopy-bound, know this: the procedure itself is a breeze, the prep has gotten a lot simpler, and the payoffs enormous. Below, what to expect—and how to prepare—for your first colonoscopy:

What Is a Colonoscopy and Why Get One?

During a colonoscopy, your doctor uses a very thin and flexible scope equipped with a light to inspect the lining of your colon for polyps. Most polyps are benign, but some are capable of becoming cancerous if they are not removed, and others are malignant. If the doctor finds a polyp, it can be immediately removed and sent to a lab for analysis.

Colorectal cancer is really common (it’s the third most common cancer in men and women) but it’s also very preventable. Death rates from colorectal cancer have been dropping in recent years, which the American Cancer Society attributes to increased screening and removal of polyps which, if left in place, might have turned into cancer. It can take as many as 10 to 15 years for a polyp to develop into colorectal cancer, and during this time it’s possible not to have any symptoms that might reveal its existence. As with most cancers, if colorectal cancer is found early, it’s much more likely to be curable.

“Average risk Americans—those without a family history—have a 6% chance of colorectal cancer. That is a huge chance,” says Dr. Raymond. “Just think how excited you would be if you had a 6% chance of winning the Powerball lottery—you’d be excited by the high odds. A colonoscopy with removal of polyps prevents up to 95% of colorectal cancer.”

Who Should Get a Colonoscopy?

The short answer is everyone; it’s a matter of when, not if, you need to take care of business. For starters, if you’re currently experiencing symptoms like a change in bowel habits, or seeing blood in your stool, see your doctor right away—regardless of your age—and inquire about getting a colonoscopy.

If you have a personal history of colorectal cancer or adenomatous polyps (the ones most likely to become cancerous), or a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) you should definitely be seeing your doctor on the regular and getting frequent colonoscopies. The same goes for those of us who have a family history (and “family” includes not just parents, grandparents, and siblings, but uncles, aunts, children, and half-siblings)* of colorectal cancer or polyps or a family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome. If this is you, don’t wait until you’re 45 or 50 to get screened. Bring it up with your doctor ASAP. 

If you’re African-American, aren’t having symptoms, and don’t have any of the risk factors above*, starting at age 45, you should get a colonoscopy every 10 years. For reasons that are unclear (but may involve lack of access to and awareness of screenings plus so-called “lifestyle factors” like smoking and obesity), African-Americans tend to be diagnosed with colorectal cancer at younger ages with cancers that are more advanced, and have worse survival rates than other groups in this country.

If you’re not African-American, aren’t having symptoms, and don’t have any other risk factors above*, starting at age 50 you should have a colonoscopy every 10 years.

*When was the last time you called your mom? Or your grandma? Do it. Not just to be kind or assuage your guilt; do it so you can grill them about your family’s health history. It’s so important and not something you want to put off (sorry to bring it up, but you want to have this conversation while they’re still around and have all their marbles).

I’m Way Under 45. Why Should I Think About Colorectal Cancer?

Recent studies have shown that while colorectal cancer rates are going down overall, people in their 20s, 30s, and 40s have been getting diagnosed with colorectal cancer and dying at higher rates than in previous decades. Dr. Jordan Karlitz, an associate professor of gastroenterology at Tulane University and a member of the National Colorectal Cancer Roundtable, says no one is sure why this is happening but that multiple studies hoping to answer this question are currently underway.

“The most important thing you can do is take any symptoms you might be having very seriously and see your physician to discuss the possibility of having a colonoscopy even if you’re younger,” says Dr. Karlitz, who also points out that it’s very important to know your family health history because clusters of certain kinds of cancer in a family could signal an increased risk of getting colorectal cancer at a young age.

When You Make Your Appointment

Different doctors use different types of sedation for a colonoscopy and you should discuss the options with them and decide on the level of sedation that’s right for you. The most common choice is propofol, which is fast-acting and offers a sedation level comparable to general anesthesia without its long recovery time. For most people propofol takes effect within seconds, renders you unaware of what’s going on during the procedure and unable to remember it afterwards. It’s very common to wake up in the recovery area wondering how you got there and when your procedure is going to happen. (Because it’s deeply sedating, you’ll likely encounter an anesthesiologist or sedation team in the procedure room who will monitor you.) Other drugs leave you awake but groggy. Some patients opt to have the procedure wide awake.

Your doctor will give you very specific instructions and you should read them when you get them, because you might need to follow a special diet (to avoid things that are hard to digest and will leave residue in your colon) for the days leading up to the procedure and you might have to pick up prescription preparations (you also might want to pick up some special wipes, if that’s your thing). If you normally take prescription medicines in the mornings, talk with your doctor about how to manage them on the day of your procedure. If anything’s unclear, ask.

Because you’ll be sedated during the procedure, you’ll have to arrange for someone to pick you up afterwards or, depending on the rules of the facility doing the procedure, arrange for a taxi or rideshare to collect you. Some facilities don’t want you going home alone because you might be light-headed. If you think transportation might be a problem, talk to your doctor; this is totally common and most facilities have work-arounds.

Colonoscopy Prep: Not That Bad, Really

Have you ever had serious diarrhea? I’m sorry. The good news is, colonoscopy prep isn’t remotely as bad as that. Yes, it’s yucky, and yes, you will be spending some quality time on the toilet the night before your screening and possibly the morning of, but you’re not sick. You shouldn’t experience painful cramping, nausea, or that feeling that you’re a complete idiot for eating whatever it was that you’ve decided made you sick. (If you share a bathroom, plan accordingly; you will be monopolizing the place for a stretch and you probably will want some privacy.)

The Day Before

Most likely you will be instructed to have only clear liquids the day before the test. This means clear sodas like Sprite, lemon Jell-O, apple juice (not cider) and water. As Dr. Karlitz says, “if you hold it up in glass you should be able to read a newspaper through it. It shouldn’t be opaque.” The clear liquids and the diet modifications and the special drink you’ll be enjoying (more on that below) all work to ensure that your colon is clean and sparkly so that when your doctor peeks inside, they get a really clear picture of what’s going on.

The Night Before

Your doctor might instruct you to drink a prescription liquid to get things started. The good news is that the liquids are generally less icky than they used to be and there is a lot less of it to drink than in years past; some doctors also now use something called “split prep” where you drink half the night before the procedure and half the morning of. The liquids vary and so do the people drinking it; some people find the liquid gross and some people just find it not that great.

Results vary, but typically it takes about an hour of drinking a set amount at specific intervals to finish your ration. In another hour or so you will likely start feeling a strong urge to “evacuate,” as the professionals say. You will spend the next couple of hours evacuating pretty regularly, and eventually you will just be passing clear liquid which is the goal (congratulations!).

And then, we promise, it will stop. You won’t be up all night waiting for it to end, and you won’t be getting up in the middle of the night for a surprise evacuation. If you have followed the doctor’s instructions you will have plenty of time to get to bed at your usual time and have a normal night’s sleep. It’s likely you will be instructed not to drink or eat anything (other than the prep liquid) after midnight. If you are doing the split prep, you will get up in the morning at a set time before the procedure and drink the rest of the liquid but by that point you will know what to expect (plus, you will only have the prep liquid to evacuate) and then it’s off to the procedure.

When You Arrive at the Facility

Your colonoscopy might take place in an ambulatory surgical center, hospital, or the doctor’s office. When you arrive, you’ll likely fill out some paperwork, including consent forms for the sedation medication you’ll be given (you’ll agree to not drive, operate machinery, or sign any documents for the rest of the day following the procedure). You’ll change into a gown and your vitals will be taken; you might answer questions from intake staff, nurses, or an anaesthesiologist (don’t be alarmed—you’re not going to be given general anaesthesia!), be briefed on the procedure and given a chance to ask questions.

Before The Procedure Begins

Along with the doctor, there might be a nurse, attendant, or anaesthesiologist in the procedure room. You might be asked to turn on your side and draw your knees up; a drape will cover you. Through an IV you’ll be given sedating medication.

The procedure takes 30 minutes on average, says Dr. Karlitz but can take up to an hour, depending on whether a polyp (or polyps) are detected and removed. The colonoscope is very thin (about the thickness of a finger) and is equipped with a camera, a light, and a channel through which air is passed, which slightly inflates the colon in order to allow a clearer view of its lining. The colonoscope begins its journey at the far end of the colon and travels its length, during which time the doctor follows what it sees on a large, high-definition TV screen. If polyps are encountered, they are removed via tiny instruments passed up through the scope and sent to a lab for analysis. If there’s bleeding, other tiny tools are passed up through the scope to stanch it. Any bleeding is typically minor, though, and complications from colonoscopies are uncommon. Your blood pressure, heart rate, and respiration are monitored throughout the procedure.

After the Procedure

You might feel sleepy or out of it until the sedation meds wear off; this can happen in a matter of matter of minutes or take up to a couple of hours. If you have arranged for someone to accompany you home, they might be in the recovery room with you as you wake up.

It’s not uncommon to feel a little bloated from the air that was piped into your colon and it’s possible that you’ll pass a little residual gas (sorry, friend who came to pick you up!). Once the doctor ascertains that you’re mentally clear, they will explain to you what they found, how soon you’ll get results, and possibly show you still images taken during the procedure. They’ll explain what’s normal to encounter over the next couple of days (a little bit of blood in your stool if polyps were removed) and what isn’t (pain, fever, serious bleeding). You’ll be given instructions on what to do if you encounter any problems, told how and how soon you’ll get results on any specimens taken; you’ll also be told when to get your next screening.

The doctors will also advise you to take it easy for the rest of the day and you might be offered some juice or crackers. Once you’re rested up, you’ll be ready to get dressed and go out into the world and, most likely get yourself something to eat that isn’t a clear liquid.

Source: LifeHacker

Author: Deb Schwartz




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