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What makes things more confusing is that the usual commercial tests that physicians use to measure testosterone levels are notoriously unreliable. The andropause movement has made laboratory assays a lucrative business, and all kinds of patented kits have come on the market. But, as Swerdloff's panel discovered, the results tend to be inconsistent. "It's really a big problem," Swerdloff says.( Joe Langer genetic disorders)
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Joe Langer => The AACE guidelines evaluate testosterone replacement methods (injection, patch, gel, and oral agents) and stress that patients on testosterone replacement need to be carefully monitored for possible adverse effects. Careful monitoring of prostate-specific antigen is particularly important, and men with known prostate cancer should never use testosterone replacement therapy.Testosterone therapy was associated with a 95-meter improvement on the shuttle walk test in a double-blind study of 20 heart failure patients, Dr. T. Hugh Jones said at the annual meeting of the Endocrinology Society.
The study found that DHEA supplementation appeared to have little adverse effect. There was a slight decrease in HDL cholesterol early, which was transitory, the authors commented. No other measures of lipoproteins, coagulation proteins, glucose metabolism, or liver function were significantly impacted by use.Any discussion of estrogen must begin with the controversial, highly publicized cessation of the estrogen/progestin arm of the Women's Health Initiative during the summer of 2002. Results from the halted phase of the National Heart, Lung, and Blood Institute�sponsored initiative linked the study medication with an elevated risk of breast cancer, thromboembolic disease, and cardiovascular disease.
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"It's nice to see this change in philosophy that's saying we can make public-health recommendations based on this really compelling set of data," said Dr. Jeffrey Blumberg, chief of antioxidant research at Tufts University's Jean Mayer USDA Human Nutrition Research Center on Aging. Blumberg said the JAMA recommendations underscore a growing concern among nutrition experts that the recommended daily allowances, or RDAs, for many vitamins are set too low.
�Lots of physicians don't delve into the matter too deeply, either for lack of time or because of the level of discomfort,� he said. A thorough evaluation is important because hypogonadism may arise from problems with the testes, pituitary, or hypothalamus, or by a genetic disorder. The AACE guidelines are aimed at three target populations: Men with primary testicular failure who require hormone replacement.
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What makes things more confusing is that the usual commercial tests that physicians use to measure testosterone levels are notoriously unreliable. The andropause movement has made laboratory assays a lucrative business, and all kinds of patented kits have come on the market. But, as Swerdloff's panel discovered, the results tend to be inconsistent. "It's really a big problem," Swerdloff says.
No studies have clearly indicated that a particular testosterone level is associated with pituitary tumors. But a total testosterone level of less than 150 ng/dL should trigger a pituitary imaging study, even in the absence of other symptoms, the guidelines state. The treatment goal is the same in each target population�to restore sexual function (including fertility, if desired and possible), libido, behavior, and physical well-being.
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Joe Langer Endocrinology => The decline in skin collagen that coincides with aging is known to occur at a greater rate during the first few years after menopause. One study found that within the first 5 years after the onset of menopause, roughly 30% of skin collagen is lost, with an average decline of 2.1% per postmenopausal year over a period of 20 years (Br. Med. J. [Clin. Res. Ed.] 287[6402]:1337-38, 1983). Patients in this study who were treated with ERT experienced an increase in skin collagen. In fact, women on HRT had a skin collagen content 48% higher than those not on HRT.
The estradiol patch therapy was well tolerated. Like depressive symptoms, menopausal symptoms also showed significant improvement with transdermal estradiol therapy as evidenced by improved scores on the Blatt-Kupperman Menopausal Index. However, somatic complaints increased in frequency and intensity during the 4-week post treatment washout phase of the study, unlike depressive symptoms (Arch. Gen. Psychiatry 58[6]:537-38, 2001).( Joe Langer research)
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Conclusions Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis.
Men with gonadotropin deficiency or dysfunction who may have received testosterone replacement therapy or treatment for infertility. Aging men whose could benefit from testosterone therapy. Diagnostic criteria are based on physical assessment, hormone levels, dynamic testing (GnRH and clomiphene stimulation tests), and semen analysis. Additional diagnostic studies include bone densitometry, pituitary imaging, genetic studies, testicular biopsy, and scrotal exploration.
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The response to transdermal estradiol was �quite rapid,� compared with conventional antidepressants, Dr. Hensley said. Depressive symptoms improved noticeably within the first 2-4 weeks. Moreover, transdermal estradiol's antidepressant effect remained significant during the 4-week washout period at the end of the 12-week study period.
More research with topical estrogen: Research shows that topical estrogen acts like oral HRT in preserving skin thickness and increasing collagen and glycosaminoglycans content of the skin. Dr. J.B. Schmidt and colleagues examined the effects of topical 0.01% estradiol and 0.3% estriol, and after 6 months of treatment, the investigators found improvements in skin elasticity, firmness, and wrinkle depth similar to that seen in studies using oral or transdermal HRT (Int. J. Dermatol. 35[9]:669-74, 1996).
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Joe Langer cardiovascular disease => A secondary objective was to discuss the new Dietary Reference Intakes released by the Institute of Medicine (IOM) for these nutrients. DATA SOURCES: IOM reports on the use of antioxidant vitamins were reviewed for nutrient recommendations. In addition, a MEDLINE search was performed to identify recent research and review articles on the topic, which were analyzed to identify key research findings in the area. DATA SYNTHESIS: The review discusses the biologic processes of oxidation reactions and antioxidants in biologic systems, provides an overview of information on selected antioxidant nutrients, and explores their role in the prevention and treatment of cancer, cardiovascular disease, ocular disorders, and respiratory disorders. CONCLUSION: There appear to be significant health benefits from dietary antioxidants, as can be found in fruits and vegetables.
What makes things more confusing is that the usual commercial tests that physicians use to measure testosterone levels are notoriously unreliable. The andropause movement has made laboratory assays a lucrative business, and all kinds of patented kits have come on the market. But, as Swerdloff's panel discovered, the results tend to be inconsistent. "It's really a big problem," Swerdloff says.
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"Each pharmaceutical company wants to get up and say, 'This is the magic bullet for aging,' " Crowley says. "But it's overly simplistic to attribute such a complex process as aging to the change in the level of a single hormone like estrogen or testosterone." If the benefits of treating "andropause" are in doubt, so, more worrisomely, is the safety. The known side effects of testosterone therapy include gynecomastia (abnormal enlargement of the breasts) and testicular shrinkage (as gonads compensate by making less of the hormone).
A recent study showed that HRT in postmenopausal women limited the number and depth of wrinkles, measured by optical profilometry and computerized image analysis (J. Am. Geriatr. Soc. 45[2]:220-22, 1997). Research also shows that topical estradiol (17--estradiol and 17--estradiol) can promote the development of new connective repair areas in photodamaged skin as effectively as all-trans-retinoic acid (Arch. Dermatol. Res. 294[5]:231-36, 2002).( Joe Langer therapy)
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Conclusions Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis.
"I can't thank you enough," the patient said. When the F.D.A. decides to permit the sale of a new drug, it specifies a list of "indications"�particular medical conditions for which the drug has been approved. "The F.D.A. never approved AndroGel for andropause," says Dr. Dan Shames, the director of the Division of Reproductive and Urological Drug Products at the F.D.A. "We're not sure what 'andropause' is. The intention was that AndroGel would be for people with conditions like Klinefelter's and pituitary dysfunction."
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Joe Langer laboratory findings => The response to transdermal estradiol was �quite rapid,� compared with conventional antidepressants, Dr. Hensley said. Depressive symptoms improved noticeably within the first 2-4 weeks. Moreover, transdermal estradiol's antidepressant effect remained significant during the 4-week washout period at the end of the 12-week study period.
After 4 months of coenzyme Q ( 10 ) therapy, functional class improved 20% (3.0 +/- 0.4 to 2.4 +/- 0.6, p < 0.001) and there was a 27% improvement in mean CHF score (2.8 +/- 0.4 to 2.2 +/- 0.4, p < 0.001). Percent change in the resting variables included the following: left ventricular ejection fraction (LVEF), +34.8%; cardiac output, +15.7%; stroke volume index, +18.9%; end-diastolic volume area, -8.4%; systolic blood pressure (SBP), -4. 4%; and E (max), (SBP / end-systolic volume index [ESVI]) +11.7%.
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"Fix the energy thing." "I have good news for you," Dr. Morgentaler said. "There is an excellent chance that giving you testosterone will help to restore your energy. And, in terms of being foggy, I can't promise, but I have several men in my practice who are professors. They take testosterone, and they say it makes their brains much sharper."
For years, doctors had prescribed hormone replacement therapy to prevent heart disease in postmenopausal women. These treatment decisions were based on observational studies showing that women who took estrogen had fewer heart attacks. But, these assumptions were called into question with studies such as WHI.
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"All of us grew up believing that if we ate a reasonable diet, that would take care of our vitamin needs," Fletcher said. "But the new evidence, much of it in the last couple of years, is that vitamins also prevent the usual diseases we deal with every day - heart disease, cancer, osteoporosis and birth defects."
The National Institute on Aging has begun work on a 1-year study to evaluate the feasibility of conducting clinical trials of testosterone replacement therapy in older men. A task force will report on the known benefits and risks of the therapy, its potential public health impact, and the ethical issues involved in conducting such a clinical trial. The report is expected by November, said Dr. Stanley Slater, deputy director of the institute's geriatrics and clinical gerontology program.( Joe Langer long-term safety)
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Joe Langer the symptoms of hypogonadism => Cholesterol. In Dr. Snyder's 3-year study, testosterone replacement did not change high-density lipoprotein cholesterol or triglyceride levels. Low-density lipoprotein levels dropped 16 mg/dL in patients given gel or placebo. Dehydroepiandrosterone, which many women take as an antiaging supplement, may indeed produce thicker, suppler skin, according to a double-blind, randomized trial of therapy for women with severe androgen deficiency due to hypopituitarism.
Some prospective assessment of the effect of supplemental antioxidants also suggests benefit, especially for vitamin E; however, there are conflicting results in this area. Overall, it appears that antioxidant nutrients, especially those from food sources, have important roles in preventing pathogenic processes related to cancer, cardiovascular disease, macular degeneration, cataracts, and asthma, and may enhance immune function.
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Men with gonadotropin deficiency or dysfunction who may have received testosterone replacement therapy or treatment for infertility. Aging men whose could benefit from testosterone therapy. Diagnostic criteria are based on physical assessment, hormone levels, dynamic testing (GnRH and clomiphene stimulation tests), and semen analysis. Additional diagnostic studies include bone densitometry, pituitary imaging, genetic studies, testicular biopsy, and scrotal exploration.
Clarkson, a professor of comparative medicine, and Richard H. Karas, M.D., Ph.D., director of the preventive cardiology center at Tufts, reviewed numerous studies of postmenopausal women and monkeys that evaluated the cardiovascular effects of HRT. Their evaluation included the Women's Health Initiative (WHI), which showed an increased risk of heart attacks in women taking HRT and led to recommendations that women not begin hormone replacement therapy for the purpose of preventing heart disease.
Joe Langer cardiovascular disease
The response to transdermal estradiol was �quite rapid,� compared with conventional antidepressants, Dr. Hensley said. Depressive symptoms improved noticeably within the first 2-4 weeks. Moreover, transdermal estradiol's antidepressant effect remained significant during the 4-week washout period at the end of the 12-week study period.
Acne was reported by 2% of the patients using testosterone 5 g/day and by 12% of those using testosterone 10 g/day. Application site reactions occurred in 6% of those on the 5-g dosage and in 3% on the 10-g dosage. Mean serum prostate-specific antigen levels rose by 0.3 ng/mL for all patients, but there were no progressive increases after the initial increase.
Joe Langer the symptoms of hypogonadism
Joe Langer genetic disorders => There are also several generic forms of estradiol available. In all cases, they're made from plant sources (phytoestrogens) and micronized. With an increasing number of women from the baby boom generation entering menopause, it is safe to assume that pharmaceutical manufacturers with an already significant stake in hormone and estrogen replacement therapies are expanding research efforts to find safer, more effective estrogen therapies. It is likely that the positive effects that topical estrogens may confer on facial skin will achieve greater prominence in the coming years.
Data Sources and Study Selection We searched MEDLINE for English-language articles about vitamins in relation to chronic diseases and their references published from 1966 through January 11, 2002. Data Extraction We reviewed articles jointly for the most clinically important information, emphasizing randomized trials where available.( Joe Langer gonadotropin deficiency)
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MAIN OUTCOME MEASURES--Nonfatal myocardial infarctions and deaths attributable to CHD ascertained from hospital records, autopsy reports, and death certificates and reviewed by a panel of cardiologists. RESULTS--After adjustment for known CHD risk factors including smoking, serum carotenoids were inversely related to CHD events. Men in the highest quartile of serum carotenoids had an adjusted relative risk (RR) of 0.64 (95% confidence interval [CI], 0.44 to 0.92) compared with the lowest quartile. For men who never smoked, this RR was 0.28 (95% CI, 0.11 to 0.73).
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