June 17, 2008
Supplemental Testosterone Helps Against Metabolic Syndrome
For men who are looking for a medical reason to justify becoming more masculine and less of a girly man:
In older men with low testosterone levels, testosterone replacement therapy improves their risk factors for cardiovascular disease and diabetes, according to two new studies. The results will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco.
Testosterone deficiency becomes more common with age, occurring in 18 percent of 70-year-olds, said a coauthor of both studies, Farid Saad, PhD, of Berlin-headquartered Bayer Schering Pharma. Low testosterone levels are linked to the metabolic syndrome—a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke, and type 2 diabetes—and other health problems, including loss of bone and muscle mass, depression, and decreased libido.
Yet the risks and benefits of hormone replacement therapy are unclear in older men, he said.
Saad's research showed that restoring testosterone to normal levels in hypogonadal, or testosterone-deficient, men led to major and progressive improvements in features of the metabolic syndrome. Furthermore, men older than 63 benefited as much as younger men, they found. Treatment lasted a year and used a slow-release, injectable form of the hormone (testosterone undecanoate) that is not yet available in the United States.
All the men in this study have the metabolic syndrome that is correlated with high risk of heart disease and other diseases related to problems with the cardiovascular system. So if you do not have the metabolic syndrome these results do not mean that testosterone replacement will help you. It might not help you even if you do have metabolic syndrome.
All 95 men in the studies (ages 34 to 69 years) had the metabolic syndrome. To receive this diagnosis, patients must have three of the following five risk factors: increased waist circumference (abdominal fat), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure, and high blood sugar.
The testosterone improved an assortment of markers.
The first study showed that testosterone treatment significantly reduced waist circumference, total cholesterol, LDL ("bad") cholesterol, triglycerides, and body mass index (a measure of body fat). Treatment also increased "good" cholesterol. Improvements were progressive over 12 months, indicating that benefits may continue past a year, Saad said.
In the second study, the researchers divided the patient population into three groups by age: less than 57 years, 57 to 63 years, and more than 63 years. They found that the oldest men had similar improvements in metabolic risk factors to the youngest men.
Additionally, the investigators looked at the degree of testosterone deficiency before treatment. This beginning level of testosterone deficiency did not predict the beneficial outcome, they found. Men whose subnormal testosterone levels were not as low as the others had similar improvements in metabolic risk factors to men with the lowest levels, according to Saad.
"We conclude that if elderly men have a deficiency of testosterone, it is worthwhile to treat them with testosterone," he said.
What I wonder: If testosterone replacement is so beneficial why is it necessary in the first place?
My worry is that testosterone might drop in order to reduce the risk of prostate cancer and perhaps other cancers and diseases. One of the reasons various aspects of metabolism get turned down as we get older is probably an evolutionarily selected for risk reduction against cancer. Cells that divide less often are less prone to becoming cancerous because each cell division runs the risk of a mutation that makes the cell divide out of control.
But it is possible that medical researchers will be able to identify subsets of the population which could see a net decrease in mortality risk from a hormone replacement therapy. A more precise and custom tuning of metabolic function based on a scientific method of assessing the sizes of various risks for each person might turn up people who can benefit from testosterone replacement or some other hormone replacement. Not saying this is possible now. But it might become possible later.
A German study finds that men with lower testosterone have a greater risk of dying. But note this study does not demonstrate the direction of cause and effect. Maybe illness and faster aging lower the testosterone levels and that faster aging might precede the lowering of testosterone.
Men may not live as long if they have low testosterone, regardless of their age, according to a new study. The results will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco.
The new study, from Germany, adds to the scientific evidence linking deficiency of this sex hormone with increased death from all causes over time—so-called "all-cause mortality."
The results should serve as a warning for men with low testosterone to have a healthier lifestyle, including weight control, regular exercise and a healthy diet, said lead author Robin Haring, a PhD student from Ernst-Moritz-Arndt University of Greifswald, Institute for Community Medicine.
"It is very possible that lifestyle determines levels of testosterone," he said.
In the study, Haring and co-workers looked at death from any cause in nearly 2,000 men aged 20 to 79 years who were living in northeast Germany and who participated in the Study of Health in Pomerania (SHIP). Follow-up averaged 7 years. At the beginning of the study, 5 percent of these men had low blood testosterone levels, defined as the lower end of the normal range for young adult men. The men with low testosterone were older, more obese, and had a greater prevalence of diabetes and high blood pressure, compared with men who had higher testosterone levels, Haring said.
Men with low testosterone levels had more than 2.5 times greater risk of dying during the next 10 years compared to men with higher testosterone, the study found. This difference was not explained by age, smoking, alcohol intake, level of physical activity, or increased waist circumference (a risk factor for diabetes and heart disease), Haring said.
In cause-specific death analyses, low testosterone predicted increased risk of death due to cardiovascular disease and cancer but not death of any other single cause.
The fact that low testosterone levels are linked not only to cardiovascular but also to cancer is very interesting. Does testosterone strengthen the immune system to beat down cancer at an early stage? What would explain this result?
Perhaps evolution does not positively select for lowering testosterone levels (and that of other hormones for that matter), but a purely 'engineering' effect (aging hormone secreting cells perhaps) causes a slow decline unless counteracted. The counteraction is not selected strongly for after the age of significant reproductive activity. Thus, youthful testosterone levels are always helpful (to the individual) but decline later because that helpfulness has no evolutionary effect.
Interesting. Treatment for the metabolic syndrome has traditionally been directed at its manifestations, not the underlying syndrome itself (i.e., lower blood pressure with drugs, life style changes, salt restriction, etc, lose weight, use drugs to reduce total cholesterol and maybe raise HDL cholesterol, etc.). Even if testosterone works as claimed, it is a fairly dangerous drug in older men. The two major risks are prostate cancer and liver disease. A lot of men harbor so-called smoldering prostate cancers - tumors that are sitting in the prostate but not really causing any harm. Exposing these tumors to testosterone may cause them to take off. Liver disease is also worrisome in older men, even if they don't drink too much. Perhaps a more targeted testosterone-like drug could be developed to address the metabolic syndrome but leave the liver and prostate alone.
Everything goes entropic unless there's a strong selection *in favor* of keeping it working. That's basic. You don't need an evolutionary explanation for something going wrong, it doesn't have to be protective of anything. Dudes old enough to suffer from dropping testosterone levels just aren't contributing to the gene pool often enough on average for mother nature to care if they croak.
That's interesting Randall. There also seem to be links between metabolic syndrome, premature baldness, and polycystic ovarian disease.
About low testosterone and early death, could that be a status effect? Lower status men have lower testosterone and die younger, but low testosterone does not necessarily cause early death.
Andrew, there is a fair amount of evidence that males reproducing later in life led to longer lifespan. Older men are not out the Darwinian stuggle. Though in the EEA, most men probably died so young that the effect is weak.
Off topic, but this may be something you're interested in. Two common alleles of SSADH are associated with IQ. I don't have access to the whole article, but I think they mean that homozygous(T) increases IQ 3 pts, hetero 1.5 points.
An Italian study showed that the T allele increases lifespan and reduces cognitive decline. Popular version, Abstract.
This afternoon I'll plug it into the hapmap and see about population variance. It seems that this is an excellent candidate for an r-K selected allele. It increases IQ and lifespan, but is not universal. There must be a drawback. I'm thinking that people with the T allele don't develop as quickly. It is plausible that by slowing brain aging the allele slows the entire process, and they hit puberty later. If the allele follows Rushton's Rule, it is worth looking into.
I'm quite tired, and probably didn't explain myself very well.
"My worry is that testosterone might drop in order to reduce the risk of prostate cancer and perhaps other cancers and diseases".
I think the opposite is true. Nature wants you dead at 60 to make room for people who can reproduce.
So it reduces your testosterone and removes your ability to make Vitamin D from sunlight. This will cause cancer and heart disease and kill you.
I suspect nature is unconcerned with both reducing cancers in old age and making room for fertile people. I understood that natural selection has to do with reproduction success. Traits of individuals who reproduce a lot will increase in the population, is pretty much it. In other words, nature doesn't give a rip whether you live or die.
Does anyone know what definition of "low testosterone level"
is being used in these studies?
Since these metabolic changes all occur well past the age of reproductive "usefulness", I can't help but wonder why there would be ANY evolutionary advantage to point to...
It's been widely believed for decades that increasing testosterone levels also increases the incidence and growth rate of prostate cancer. Castration has been a treatment of last resort for some patients. However, there are now some oncologists who are using large doses of testosterone to treat prostate cancer and reporting positive results. So, I guess you could say the jury's still out. Another reason why prostate cancer is the most controversial of cancers.
I had borderline low testosterone in the past. In a series of three tests, I was below the line in one test, and just above in the other two. My doctor, who is a male health specialist, decided to give me testosterone anyway. I went on Sustanon 250, which is basically the same stuff a lot of bodybuilders use. I took the opportunity to get fit, and another aspect of the testosterone was a positive attitude, a kind of "can do" feeling.
I don't know about testosterone and diseases, but I bet a lot of men with depression would be suffering from low testosterone levels.
Did taking Sustanon 250 help you? How long you were on Sustanon 250? Did you stop taking it once your level got back?
I have been on Sustanon 250 for about a year (I inject 1 vail per month). Regardless of all the hoo haa, surrounding steroids, as far as my health goes, I have been feeling a lot better for having used the affore mentioned as a HRT.
As with any medication, used accordingly, it more often than not will be of benefit, given that steroids are widely abused, I feel there is an undue "negative" attitude focusing on all the BAD affects this medication can have.
All medications (as with many other things in life, including walking down the street) carry a risk.
For me, I am feeling less depressed, more vital, over all, have a good zest for life.
Before using Sustanon 250, I was suffering from depression, everything seemed to be a drag.
Antidepressants alone were NOT the complete answer for me.
The treatment I am now recieving is working fine, I am being supervised by my local GP.
Quality of life, rather than quantity is what I am looking for.
As for all this rubbish in this blog about being able to be a stud and reproduce, been there done that, rather superficial arguement !
For those of you who are seeking a bit of a lift, go and have a talk to a Doctor, if you come up against a NEGATIVE Doctor, find one who is a bit more open minded and have a good chat with him/her, weigh up whether this is an option for you, don't listen to some dodo, who is worrying about whether or not you should be sexually reproductive, what a load of rubbish.
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