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      Roli L, et al. J Endocrinol Invest. 2017.

      The steroid response to human chorionic gonadotropin (hCG) stimulation in men with Klinefelter syndrome does not change using immunoassay or mass spectrometry.

      Abstract

      PURPOSE: Liquid-chromatography tandem mass-spectrometry (LC-MS/MS) was developed in parallel to Immunoassays (IAs) and today is proposed as the "gold standard" for steroid assays. Leydig cells of men with Klinefelter syndrome (KS) are able to respond to human chorionic gonadotropin (hCG) stimulation, even if testosterone (T) production was impaired. The aim was to evaluate how results obtained by IAs and LC-MS/MS can differently impact on the outcome of a clinical research on gonadal steroidogenesis after hCG stimulation.

      METHODS: A longitudinal, prospective, case-control clinical trial. (clinicaltrial.gov NCT02788136) was carried out, enrolling KS men and healthy age-matched controls, stimulated by hCG administration. Serum steroids were evaluated at baseline and for 5 days after intramuscular injection of 5000 IU hCG using both IAs and LC-MS/MS. ...
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      We're talking anabolic doses, 10 or 20 mg/kg, which is 800 mg or 1600 mg for the average weight man. It looks like the toxic effects of trans fats are increased by testosterone. The abstract says:

      We investigated the impact of AS on gene expression, lipid profile, redox status and the development of nonalcoholic fatty liver disease (NAFLD) in mice treated with a diet rich in trans fatty acids. Seventy-two mice were equally randomized into six groups and treated with a standard diet (SD) or high-fat diet (HFD) alone or combined with testosterone cypionate (10 or 20 mg/kg) for 12 weeks. When combined with a HFD, AS reduced plasma HDL cholesterol levels. It also upregulated SREBP-1, PPARα, SCD-1 and ACOX1 gene expression; plasma and hepatic triglyceride levels; oxidative stress; circulating hepatic transaminase levels and NAFLD severity.
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      The standard predictor of cardiovascular disease (CVD) risk is the Framingham Risk Score. The Framingham Score predicts the 10 year risk of heart disease and is based on age, smoking, total cholesterol, HDL cholesterol, and blood pressure. This study added testosterone levels to the Framingham Score and found that it did not improve the prediction of heart disease. The abstract says:

      Among 816 men, 30-70 years/old, without prevalent CVD, from a community-based cohort (Tehran Lipid and Glucose Study), we assessed the predictive value of testosterone with incident CVD, using three multivariate Cox proportional-hazards models. Model I: FRS variables; model II: Model I plus total testosterone; model III: Model II plus Systolic blood pressure (SBP) * total testosterone (the best fit interaction-term between testosterone and FRS variables). During 12 years of follow-up, 121 CVD events occurred.
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      Excellent article to read if you know anyone thinking about using any of these clinics.

      "The treatments are not covered by insurance. Many of the clinics’ patients are old, sick and already struggling with medical bills. Some clinics urge individuals who can’t afford their steep fees — which range from $1,800 to more than $20,000 — to launch GoFundMe pages or take out loans, according to patients and former employees."

      "Stem cell clinics have exploded in number across the United States. In 2009, there were two; today, there are at least 700 and likely hundreds more, according to Leigh Turner, a University of Minnesota bioethicist, and Paul Knoepfler, a stem cell biologist at the University of California at Davis, who have compiled a database. In the past four years, at least 150 new facilities have opened every year." ...
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      [PDF] MP85-13 ERECTILE FUNCTION IN 478 HYPOGONADAL MEN WITH MODERATE TO SEVERE ED WITH AND WITHOUT TESTOSTERONE THERAPY FOR UP TO …

      A Haider, KS Haider, G Doros, A Traish - The Journal of Urology, 2018
      METHODS 478 men with testosterone≤ 350 ng/dL and hypogonadal symptoms had
      moderate to severe ED according to IIEF-EF (5+ 1, maximum score: 30). 246
      received testosterone undecanoate injections (TU) 1000 mg/12 weeks following an …



      [PDF] MP85-15 TESTOSTERONE TREATMENT IN MEN WITH CLASSICAL VS FUNCTIONAL HYPOGONADISM: RESULTS FROM A 9-YEAR-REGISTRY

      M Zitzmann, E Nieschlag, A Traish, S Kliesch - The Journal of Urology, 2018
      METHODS Registry data of max. 9 years comprising 650 patients with
      hypogonadism including 266 men with primary (mean age 34.0±11.7 years), 196
      with secondary (mean age 31.9±12.0 years) and 188 with functional hypogonadism …


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      Earlier this week, Senators Orrin Hatch (R-UT) and Sheldon Whitehouse (D-RI) introduced the SARMs Control Act of 2018. If passed and signed by the President, the Act would amend the Controlled Substances Act to list SARMs as Schedule III controlled substances, meaning they would be regulated by the DEA the same as anabolic steroids.
      .
      https://www.govtrack.us/congress/bil...utm_medium=rss
      .
      https://www.hatch.senate.gov/public/...ation-of-sarms
      .
      The Act defines "SARM" as "any drug or other substance that is a selective androgen receptor agonist chemically unrelated to tesosterone, estrogens, progestins, corticosteroids, and dehydroepiandrosterone . . ." Specifically scheduled (but not an exclusive list if the substance otherwise fits the definitions) are ostarine, LGD-4033 (ligandrol), RAD-140, andarine, and several other common SARMs products. ...
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      An article recommends treating obese men with hypogonadism for obesity first.

      Obesity, increasing in prevalence globally, is the clinical condition most strongly associated with lowered testosterone concentrations in men, and presents as one of the strongest predictors of receiving testosterone treatment. While low circulating total testosterone concentrations in modest obesity primarily reflect reduced concentrations of sex hormone binding globulin, more marked obesity can lead to genuine hypothalamic-pituitary-testicular axis (HPT) suppression. Although the obesity-hypogonadism relationship is bi-directional, the effects of obesity on testosterone concentrations are more substantial than the effects of testosterone on adiposity. In markedly obese men submitted to bariatric surgery, substantial weight loss is very effective in reactivating the HPT axis.
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      The Journal of Urology
      Volume 199, Issue 4, Supplement, April 2018, Page e1171

      Sexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II

      MP85-06 TOREMIFENE CITRATE IMPROVES HIGH-DENSITY LIPOPROTEIN LEVELS IN MEN ON TESTOSTERONE REPLACEMENT THERAPY

      INTRODUCTION AND OBJECTIVES
      Decreases in high-density lipoprotein (HDL) levels have been observed in men on testosterone therapy (TTh). Niacin is commonly used as a therapy for low HDL, although its side effect (SE) profile often leads to frequent discontinuation. Toremifine citrate is an oral selective estrogen modulator (SERM) that is well tolerated and can improve lipid profiles by raising HDL levels in both breast and prostate cancer patients. Here we assess the role of toremifene in the management of HDL abnormalities in men on TTh.
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      Reference: Clinical Endocrinology. 2018;1–8.

      Summary

      Objective: A label change in testosterone (T) products in March 2015 followed a highly publicized FDA advisory committee meeting in September 2014. Changes included a warning of possible increased cardiovascular (CV) risks and restriction of indicated populations to younger men with a limited set of known aetiologies of testosterone deficiency (TD). These changes greatly impacted clinical practice and public perception of T therapy (TTh). Our aim was to review these changes in the light of subsequently published studies.

      Design: We identified 23 studies through June 2017, including 12 clinical trials and
      11 observational studies. The Testosterone Trials included 790 men aged 65 years and older with TD without known aetiology, assigned to 1-year T gel or placebo. Results: Demonstrated benefits of T included sexual activity and desire, physical activity and mood. ...
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      A small randomized controlled trial of testosterone therapy showed testosterone improved quality of life, but did not improve survival times. The abstract says:

      A randomized, double-blind, placebo-controlled phase II clinical trial was undertaken to assess the potential therapeutic role of adjunct testosterone to limit loss of body mass in patients with squamous cell carcinoma of the cervix or head and neck undergoing standard of care treatment including chemotherapy and chemoradiation. Patients were randomly assigned in blocks to receive weekly injections of either 100 mg testosterone enanthate or placebo for 7 weeks.
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      Sounds like this is an argument for increased health insurance coverage of testosterone therapy. The abstract says:

      In this retrospective cohort study using a large US administrative claims database, adult males with primary or secondary HG were selected from 2010-2014. Non-HG controls had no evidence of HG from 2009-2014 and were matched on age, insurance type and geographic region to HG patients. Outcomes included absenteeism and associated costs. HG (vs non-HG) patients had a significant 15% increase in non-recreational absenteeism hours and associated costs ($2,152 vs $1,172) post-index after adjusting for pre-period differences.
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