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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Testosterone for prevention and reversal of diabetes in men with low T
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<blockquote data-quote="madman" data-source="post: 201199" data-attributes="member: 13851"><p><strong>Box 1. The bidirectional link between low testosterone, obesity and type 2 diabetes. </strong></p><p></p><p><em>The bidirectional link between TD and obesity/T2D on the one hand, and between obesity/T2D and TD on the other hand, is well established. Observational studies suggest that low testosterone is associated with both current and future IR, obesity, metabolic syndrome, and T2D [20]. Importantly, the risk of T2D seems to increase at a higher testosterone threshold than previously thought. The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study found a significantly increased incidence of T2D in men with testosterone levels below 16 nmol/L (461 ng/dL) during a follow-up of 5 years, independent of T2D risk prediction models used in routine clinical practice [21]. The MAILES study concluded that screening for low testosterone in addition to risk factors included in T2D risk assessment tools would identify a large subgroup of distinct men who might benefit from targeted preventive interventions [21]. </em></p><p><em></em></p><p><em>A meta-analysis showed that men with testosterone levels above 15.5 nmol/L (447 ng/dL) had a 42% reduced risk of T2D compared to men with testosterone levels below 15.5 nmol/L [22]. Another large meta-analysis of 13 prospective population studies including 16,709 men showed that higher testosterone levels were associated with a significantly reduced risk of T2D by 38% [23]. A 14-year follow-up study collected health record data of 550 men with T2D to evaluate the influence of baseline testosterone levels on T2D outcomes [24]. Mean baseline total testosterone for the entire cohort was 13.7 nmol/L (395 ng/dL). Lower baseline total testosterone levels were significantly associated with a higher BMI and increased risk of stroke at follow-up. The mortality rate was nearly twice as high in patients with lower total testosterone compared to normal baseline total testosterone (5.0% vs 2.8% per year). During the 14-year follow-up period, 36.1% of men with normal baseline testosterone died vs. 55.8% of men with TD at baseline. The age-adjusted hazard ratio for higher mortality associated with low total testosterone corresponded to 3.2 years reduced life expectancy for men who have both hypogonadism and T2D, compared to men who only have T2D. </em></p><p><em></em></p><p><em><strong>A topic of scientific debate is the relative strength of the bidirectional link between low testosterone and <u>diabesity</u>, i.e., whether obesity (and to a lesser extent T2D, especially if poorly controlled) has a greater effect on reducing testosterone, or whether low testosterone has a greater effect on body fat accumulation and IR [20]. <u>However, this is irrelevant for clinical practice</u>. <u>The bidirectional link between low testosterone and diabesity creates a vicious cycle, in which one condition worsens the other, regardless of which came first</u>. </strong></em><strong><em><u>In clinical practice, the important question is how to most effectively and sustainably break this vicious cycle</u></em></strong><em><strong>.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 201199, member: 13851"] [B]Box 1. The bidirectional link between low testosterone, obesity and type 2 diabetes. [/B] [I]The bidirectional link between TD and obesity/T2D on the one hand, and between obesity/T2D and TD on the other hand, is well established. Observational studies suggest that low testosterone is associated with both current and future IR, obesity, metabolic syndrome, and T2D [20]. Importantly, the risk of T2D seems to increase at a higher testosterone threshold than previously thought. The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study found a significantly increased incidence of T2D in men with testosterone levels below 16 nmol/L (461 ng/dL) during a follow-up of 5 years, independent of T2D risk prediction models used in routine clinical practice [21]. The MAILES study concluded that screening for low testosterone in addition to risk factors included in T2D risk assessment tools would identify a large subgroup of distinct men who might benefit from targeted preventive interventions [21]. A meta-analysis showed that men with testosterone levels above 15.5 nmol/L (447 ng/dL) had a 42% reduced risk of T2D compared to men with testosterone levels below 15.5 nmol/L [22]. Another large meta-analysis of 13 prospective population studies including 16,709 men showed that higher testosterone levels were associated with a significantly reduced risk of T2D by 38% [23]. A 14-year follow-up study collected health record data of 550 men with T2D to evaluate the influence of baseline testosterone levels on T2D outcomes [24]. Mean baseline total testosterone for the entire cohort was 13.7 nmol/L (395 ng/dL). Lower baseline total testosterone levels were significantly associated with a higher BMI and increased risk of stroke at follow-up. The mortality rate was nearly twice as high in patients with lower total testosterone compared to normal baseline total testosterone (5.0% vs 2.8% per year). During the 14-year follow-up period, 36.1% of men with normal baseline testosterone died vs. 55.8% of men with TD at baseline. The age-adjusted hazard ratio for higher mortality associated with low total testosterone corresponded to 3.2 years reduced life expectancy for men who have both hypogonadism and T2D, compared to men who only have T2D. [B]A topic of scientific debate is the relative strength of the bidirectional link between low testosterone and [U]diabesity[/U], i.e., whether obesity (and to a lesser extent T2D, especially if poorly controlled) has a greater effect on reducing testosterone, or whether low testosterone has a greater effect on body fat accumulation and IR [20]. [U]However, this is irrelevant for clinical practice[/U]. [U]The bidirectional link between low testosterone and diabesity creates a vicious cycle, in which one condition worsens the other, regardless of which came first[/U]. [/B][/I][B][I][U]In clinical practice, the important question is how to most effectively and sustainably break this vicious cycle[/U][/I][/B][I][B].[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Testosterone for prevention and reversal of diabetes in men with low T
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