2 Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome By Aly A. Abbassy, MD, FACE Professor of Medicine (Endocrinology) Alexandria University
3 My Talk will include: 1-Types of Men sexual dysfunction 2-Introduction 3-Pathophysiuology of Sexual dysfunction 4-Low testosterone.cvd and T2D 5-Clinical studies of testosterone replacement in men with obesity,ms,t2d and low testosterone concentration 6-Conclusions 7-Take Home Message
4 Types of Sexual Dysfunction 1. Loss of Libido (low sex desire) 2. Erectile Dysfunction (ED) -Poor morning erection -Weak erection -Impotence -Premature ejaculation -Retrograde ejaculation
6 In the European Male Aging Study database (2007) of 3,369 men between the ages of 40 and 79 years, three sexual symptoms (poormorning erections, low sexual desire, and ED) had a syndromic relationship with decreased testosterone levels. Wu FC, et al. N Engl J Med 2010
7 Moreover, in the European Male Aging Study (2007), low serum testosterone was more frequent in men with comorbidities such as obesity, metabolic syndrome, and type 2 diabetes.
8 Hypogonadism in men with type 2 diabetes was associated with decreased sexual desire, more symptoms of depression, and lower luteinizing hormone levels. Kapoor D, et al. Int J Androl 2007.
9 Men with obesity, the metabolic syndrome, and type 2 diabetes have low total and free testosterone and low sex hormone binding globulin (SHBG). Christina Wang, et al. Diabetes Care, 2011.
10 Conversely, the presence of low testosterone and/or SHBG predicts the development of metabolic syndrome and type 2 diabetes. Christina Wang, et al. Diabetes Care, 2011.
11 Visceral adiposity present in men with low testosterone, the metabolic syndrome, and/or type 2 diabetes acts through proinflammatory factors. Christina Wang, et al. Diabetes Care, 2011.
12 These inflammatory markers contribute to vascular endothelial dysfunction with adverse sequelae such as increased cardiovascular disease (CVD) risk and erectile dysfunction. Christina Wang, et al. Diabetes Care, 2011.
13 Low serum total testosterone predicts the development of central obesity and accumulation of intra-abdominal fat. Allan CA & McLachlan RI. Curr Opin Endocrinol Diabetes Obes 2010 MacDonald AA et al. Hum Reprod Update 2010 Brand JS et al. Int J Epidemiol 2011
14 Also, low total and free testosterone and SHBG levels are associated with an increased risk of developing the metabolic syndrome, independent of age and obesity. Allan CA & McLachlan RI. Curr Opin Endocrinol Diabetes Obes 2010 MacDonald AA et al. Hum Reprod Update 2010 Brand JS et al. Int J Epidemiol 2011
15 Conversely, high BMI, central adiposity, and the metabolic syndrome are associated with and predict low serum total and to a lesser extent free testosterone and SHBG levels. Allan CA & McLachlan RI. Curr Opin Endocrinol Diabetes Obes 2010 MacDonald AA et al. Hum Reprod Update 2010 Brand JS et al. Int J Epidemiol 2011 Laaksonen DE, et al. J Clin Endocrinol Metab 2005
16 BMI Central obesity MS Total, F. testosterone & SHBG Allan CA & McLachlan RI. Curr Opin Endocrinol Diabetes Obes 2010 MacDonald AA et al. Hum Reprod Update 2010 Brand JS et al. Int J Epidemiol 2011
17 Obesity SHBG Total T Low total T Or SHBG Associated with T2D Corona G et al. Int J Androl Colangelo LA et al. Diabetes Care 2009.
18 Total T FT SHBG Stronger predictor of T2D FT is higher in diabetic men in comparison to non diabetic men. Corona G et al. Int J Androl
19 Bilateral orchidectomy or GRH agonist In old men with cancer prostate risk of T2D and CVD Keating NL, et al. J Natl Cancer Inst 2010.
20 Several studies confirmed association of Obesity T2D MS with sexual dysfunction including erectile dysfunction Diaz-Arjonilla M, et al. Int J Impot Res 2009
21 Pathophysiology of Men sexual Dysfunction
22 Angiotensinogen Adiponectin PAI-1 Metabolic syndrom e vascular damage Clinical relevance: Insulin resistance/ Endothelial Dysfunction Diabetes mellitus type2 Cardiovascular disease Stroke Erectile dysfunction Classical Hypogonadism Visceral obesity T- deficiency Hypothalamuspituitary GnRH LH - - IL-6 TNF Insulin Leptin - Lyedig Cell funtion Estradiol levels Aromatase activity in adiposity Complex multidirectional interactions between testosterone and obesity, metabolic syndrome, and type 2 diabetes mediated by cytokines and adipokines leading to comorbidities such as ED and increased CVD risk. FFA, free fatty acids; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone; PAI-1, plasminogen activator inhibitor-1.
23 The clinical observation that ED occurs at an earlier age and with greater frequency in men with diabetes compared with non diabetic men is supported by multiple population-based epidemiological studies. Lindau ST, et al. Diabetes Care 2010
24 In the Look Ahead Study, 49.8% of men with diabetes reported mild or moderate ED. Rosen RC et al. J Sex Med 2009
25 There are few studies evaluating the prevalence of reduced libido in men with diabetes. Decreased sexual desire is primarily affected by the presence of ED and by depression.
26 These investigators found significantly lower serum bioavailable testosterone (P<0.006) and free testosterone (P<0.027) in men with ED. Kapoor D, et al. Int J Androl 2007.
27 ED in the past was ascribed to autonomic neuropathy or obliterative vascular disease; more recent studies identify endothelial dysfunction as an early abnormality that is potentially more amenable to therapy. Traish AM, et al. FEBS J 2009.
28 Men with T2D can have other causes of ED. In a study of 8,373 men with type 2 diabetes, ED was associated with: 1. Poor metabolic control 2. Smoking 3. Alcohol 4. Antidepressants 5. Anti-hypertensives 6. CVD medications 7. Histamine 2 receptor antagonists. Fedele D, et al. Int J Epidemiol 2000.
29 There are multiple causes for low libido in the general population and in men with type 2 diabetes in addition to testosterone deficiency, including medications: - SRI - Anti-androgen and Alcoholism Fedele D, et al. Int J Epidemiol 2000
30 Low testosterone, CVD risks, and type 2 diabetes
31 Low serum testosterone is associated with an increase in all-cause mortality that is independent of the metabolic syndrome and diabetes. Shores MM, et al. Arch Intern Med Khaw KT, et al. Circulation Haring R, et al. Eur Heart J Laughlin GA, et al. J Clin Endocrinol Metab 2008.
32 Low testosterone is associated with increased mortality in older men
33 Testosterone deficiency and CVD are both associated with visceral fat accumulation, metabolic syndrome, type 2 diabetes, increased inflammatory cytokines, hyperlipidemia, and abnormalities of coagulation. Maggio M, et al. Int J Impot Res 2009.
34 Low testosterone predicted the increased risk of CVD independent of age, obesity, hyperlipidemia, and lifestyle in men with or without type 2 diabetes. Khaw KT, et al. Circulation Haring R, et al. Eur Heart J Laughlin GA, et al. J Clin Endocrinol Metab 2008.
35 Insulin resistance commonly occurs in chronic heart failure, and it has been shown to improve with testosterone replacement therapy. Malkin CJ, et al. Eur J Heart Fail 2007.
36 A randomized double-blind crossover trial demonstrated a significant reduction in insulin resistance in hypogonadal men with type 2 diabetes. Kapoor D, et al. Eur J Endocrinol 2006.
37 The mechanisms by which testosterone improves insulin sensitivity is multifactorial and likely to be due to a combination of testosterone effects on liver, muscle, and adipose tissues and by reducing the production of inflammatory cytokines (e.g., TNF-a, IL-1b, and IL-6), which cause insulin resistance. Jones TH & Saad F. Atherosclerosis 2009.
38 This finding was confirmed in three further studies in men with metabolic syndrome and/or type 2 diabetes. Jones TH, et al. Diabetes Care Heufelder AE, et al. J Androl Kalinchenko SY, et al. Clin Endocrinol (Oxf) 2010.
39 Some beneficial effects of testosterone on important CVD risk factors, which include insulin resistance, glycemic control, lipid profile, central adiposity, body composition, and inflammatory state in hypogonadalmen with type 2 diabetes, as well as sexual health. Jones TH, et al. Diabetes Care 2011.
40 Clinical studies of testosterone replacement in men with obesity, metabolic syndrome, type 2 diabetes, and low testosterone concentrations
41 It is well known that testosterone replacement reduces body fat mass and waist circumference in hypogonadal men with and without obesity. Mårin P, et al. Obes Res Jones TH & Saad F. Atherosclerosis 2009.
42 The Look Ahead study reported that weight loss and increased physical activity were mildly beneficial in maintaining erections or improving ED in men with type 2 diabetes. Wing RR, et al. J Sex Med 2010.
43 Evidence from several studies demonstrated that testosterone promotes insulin sensitivity in hypogonadal men with and without type 2 diabetes. Mårin P, et al. Obes Res 1993.
44 The Testosterone Replacement in Older Men with either Metabolic Syndrome or Type 2 Diabetes (TIMES 2) trial recruited hypogonadal men with total testosterone <318 ng/dl (11 nmol/l) or free testosterone <6.5 ng/dl (225 pmol/l) and either metabolic syndrome or type 2 diabetes. Testosterone treatment improved libido Jones TH, et al. Diabetes Care 2011.
45 Leptin levels correlate with body fat content and have been shown to decrease with testosterone replacement in type 2 diabetes and the metabolic syndrome. Kalinchenko SY, et al. Clin Endocrinol (Oxf) Kapoor D, et al. Eur J Endocrinol 2007.
46 Testosterone treatment moderately improved the number of nocturnal erections, sexual thoughts and motivation, number of successful intercourse sessions, scores of erectile function, and overall sexual satisfaction in men with baseline serum testosterone <346 ng/dl (<12 nmol/l). Rochira V, et al. J Androl 2006.
47 Testosterone replacement can restore nocturnal erections in hypogonadal men, but the effects are greater when testosterone and a phospho-diesterase (PDE)-5 inhibitor are administered together.
48 ED in many men with diabetes is improved by one of the PDE-5 inhibitors when used on demand. Hatzichristou D, et al. Diabet Med 2008.
49 Testosterone replacement therapy has been reported to improve erections in men who did not respond satisfactorily to a PDE-5 inhibitor alone. Rochira V, et al. J Androl 2006.
50 Testosterone therapy results in a small but significant fall in total cholesterol and in some LDL cholesterol. HDL cholesterol may fall, rise, or remain unchanged. There is some evidence that after an initial decrease, HDL cholesterol levels then return to baseline. Jones TH, et al. Diabetes Care Kapoor D, et al. Eur J Endocrinol Jones TH & Saad F. Atherosclerosis 2009.
51 Conclusions Obesity is accompanied by increased adipokines, cytokines, and other proinflammatory factor production from adipocytes and macrophages mainly in visceral fat. These factorsmay alter insulin responsiveness in fat, liver, muscle, and endothelial function resulting in metabolic syndrome, type 2 diabetes, ED, and CVD.
52 Conclusions Many men with type 2 diabetes, especially those who are obese, have low serum total testosterone and SHBG levels. Small-scale studies of testosterone treatment in men with metabolic syndrome or type 2 diabetes and borderline low or normal testosterone levels showed small improvement in glycemic control
53 Conclusions It is important for the clinician to recognize that low testosterone and sexual dysfunction are commonly found in patients with obesity, metabolic syndrome, and type 2 diabetes.
54 Take Home Message : It should be known to all medical specialists that obesity,ms and type 2 diabetes is associated with sexual dysfunction due to decreased total and free testosterone Testosterone replacement, in addition to diet, exercise, glycemic control, and PDE-5 inhibitors, should be considered in symptomatic hypogonadal men with type 2 diabetes and serum testosterone below the reference range.
CARDIOMETABOLIC DISEASE AND TESTOSTERONE DEFICIENCY: IS THERE A LINK? Abraham Morgentaler, MD Founder and Director, Men s Health Boston Associate Clinical Professor of Urology Beth Israel Deaconess Medical
Testosterone Treatment in Older Men J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships to disclose.
Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Jody Dushay, MD MMSc Beth Israel Deaconess Medical Center Boston, MA Session 445 No disclosures Disclosure Jody Dushay,
Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS The faces of Low Testosterone What your patients are seeing Pharmacy Industry Testosterone
Testosterone in Old(er) Men Disclosure Information J. Bruce Redmon, M.D. Associate Professor Division of Endocrinology I have no financial relationships to disclose. I will not discuss off label use and/or
Testosterone: Is Just for the GOP? Brad Anawalt, MD Vice Chair and Professor of Medicine University of Washington May 1, 2015 email@example.com Testosterone continuum Severe hypogonadism
26 Low testosterone and the metabolic syndrome: a high-risk combination MIKE KIRBY Hypogonadism and the metabolic syndrome commonly coexist, and when combined, pose a high cardiovascular risk and can have
Are Men Losing Their Gonads? Andre B. Araujo, Ph.D. Director, Epidemiology New England Research Institutes Watertown, MA 02472 USA firstname.lastname@example.org NIA R01AG020727 Endocrine Society Annual Meeting
1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome
The epidemiology and burden of male hypogonadism Professor Siegfried Meryn Definitions of hypogonadism Hypogonadism in men is a clinical syndrome that results from failure of the testis to produce physiological
February 1, 2014 RESTORING STRENGTH AND VITALITY THROUGH HORMONES FACTS, FANTASIES, POSSIBILITIES, AND PITFALLS Calvin Hirsch, MD Professor of Clinical Internal Medicine (Geriatrics) UC Davis School of
Testosterone Replacement Therapy Craig Ensign, MPAS, PA-C University of Utah School of Medicine Urology Division Lecture Outline 1. Anatomy and physiology 2. Definition and etiology 3. Signs and symptoms
Diabetes and Obesity Frank B. Diamond, Jr. M.D. Professor of Pediatrics University of South Florida College of Medicine The diabesity epidemic Prevalence of diabetes worldwide was over 135 million people
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
Anti-Aging Aging g Medications What is the Evidence? Sixth Annual Family Medicine Conference Crown Plaza November 11, 2007 Presented by : Jad J. Sakr, Pharm.D. Outline Introduction Oidti Oxidative damage
Current Data and Considerations Novel Testosterone Formulations 1 Diagnosis and Assessment Module 2 2 Objectives Identify clinical manifestations and symptoms of hypogonadism Describe components of comprehensive
UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 The cardiometabolic risk syndrome is increasingly recognized
Continuity Clinic Educational Didactic December 8 th December 12 th MKSAP Question 1 A 60-year-old man is evaluated for a 1-year history of generalized fatigue and lack of energy. He has had erectile dysfunction
Dr Tan & Partners MMM Vol. 1 No. 3 Morbidity & Mortality Meeting 12 th December 2014 Topic Diagnosis and Testosterone Replacement Therapy for Androgen Deficiency in the Aging Male (ADAM) Introduction Androgen
Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency in File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency_in_men
PS ABCD hypogonadism_layout 1 10/11/2010 16:59 Page 1 ABCD position statement on the management of hypogonadal males with type 2 diabetes K Dhatariya*, D Nagi, TH Jones; on behalf of the Association of
Us TOO University Presents: Estrogen Deficiency Side Effects Due to Androgen Deprivation Therapy Today s speaker is Samir Taneja, MD Program moderator is Pam Barrett, Us TOO International Made possible
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
Low T and The Heart: Testosterone Therapy & CVD Risk Kevin L. Billups, MD Director, Men s Health & Vitality Program The James Buchanan Brady Urological Institute Associate Professor of Urology & Medicine
1 University of Papua New Guinea School of Medicine and Health Sciences Division of Basic Medical Sciences Discipline of Biochemistry and Molecular Biology PBL SEMINAR INSULIN RESISTANCE, POLYCYSTIC OVARIAN
Obesity and the Menopause Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology Educational Objectives Review normal menopausal transition Review health risks of obesity
FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke
Varicocele: To Fix or Not to Fix? That is the Question. Edmund S. Sabanegh, MD Professor and Chairman, Department of Urology, Cleveland Clinic Lerner College of Medicine; Cleveland, Ohio Objectives: Review
COULD IT BE LOW TESTOSTERONE? By Dr. Lauren M. Bramley For thousands of years women have been recognized for their sensitivity to hormones. PMS, post partum depression, menopause have long been plights
Talk to your doctor about low testosterone Maybe he doesn t find me attractive any more? Maybe he needs to lose some weight? Maybe he s lost his spark? Bayer Pharma AG Müllerstraße 178 13353 Berlin Germany
MALE HYPOGONADISM Mark Sigman Krishnamurthi Family Professor and Chief of Urology Warren Alpert Medical School of Brown University Chief of Urology Rhode Island and the Miriam Hospitals 1 Topics What is
Chapter 2 Pathophysiology of Late-Onset Hypogonadism and Risks and Benefits of Replacement Therapy Peter Huat Chye Lim Introduction The testosterone molecule is depicted below (Fig. 2.1 ). Testosterone
Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation
Hypoglycemia: A Complication When Targeting Type 2 Diabetes Jeffrey S. Freeman DO FACOI Professor of Internal Medicine Chairman Division of Endocrinology and Metabolism Philadelphia College of Osteopathic
Cholesterol a biomolecule Bad cholesterol a strange tale Good cholesterol - indeed Thomas B. Kuhn: University of Alaska, Cereon Biotechnology LLC This document is protected by copyright Dr. Thomas B. Kuhn
Original Article Heart Metab. (2015) 66:7-12 Testosterone and cardiovascular disease T. Hugh Jones, MD, FRCP Robert Hague Centre for Diabetes and Endocrinology, Barnsley Hospital and Department of Human
Management of Erectile Dysfunction and Cardiovascular Disease Princeton III Consensus Recommendations Reptile Dysfunction This is a talk about sex, and contains potentially offensive images Men Avoid Doctors
Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus
HDL Cholesterol Subfractions and the Effect of Testosterone Replacement in Hypogonadism E. Bolu 1, A. Sonmez 1, S. Tapan 2, A. Taslipinar 1, A. Aydogdu 1, C. Meric 1, Y. Basaran 1, G. Uckaya 1, M. Serdar
Med. J. Cairo Univ., Vol. 77, No. 1, June: 351-357, 2009 www.medicaljournalofcairouniversity.com Plasma Testosterone Level in Male Patients with Metabolic Syndrome NASHWA EL-SARRAF, M.D. and AMR EL-HADIDY,
0022-5347/04/1722-0658/0 Vol. 172, 658 663, August 2004 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000132389.97804.d7 RANDOMIZED STUDY
TESTOSTERONE The Future? Martin M. Miner MD Co-Director Men s Health Center The Miriam Hospital Clinical Professor of Family Medicine and Urology Warren Alpert School of Medicine of Brown University Providence,
THE ROLE OF TUMOUR NECROSIS FACTOR ALPHA (TNFa) IN OBESITY Alison Mary Morris, B.Sc (Hons) A thesis submitted to Adelaide University for the degree of Doctor of Philosophy Department of Physiology Adelaide
Understanding the long-term risks and benefits of testosterone replacement Nathan Hale, DO Samuel Deem, DO SHUTTERSTOCK.COM Male hypogonadism, also called andropause and androgen deficiency of the aging
Prevalence Diagnosis and Treatment of Hypogonadism in Primary Care Practice by Culley C. Carson III, MD, Boston University Medical Campus Hypogonadism is defined as deficient or absent male gonadal function
Page 1 of 61 Accepted Preprint first posted on 18 December 2013 as Manuscript JOE-13-0393 1 2 3 Mathis Grossmann 1,2 Testosterone and Glucose Metabolism in Men: Current Concepts and Controversies 4 5 6
Baskets of Care Diabetes Subcommittee Disclaimer: This background information is not intended to be a comprehensive scientific discussion of the topic, but rather an attempt to provide a baseline level
ORIGINAL ARTICLE Hypogonadism and Subnormal Total Testosterone Levels in Men with Type 2 Diabetes Mellitus Okeoghene Anthonia Ogbera 1, Chinenye Sonny 2, Fasanmade Olufemi 3 and Ajala Wale 4 ABSTRACT Objective:
THE ROLE OF FREE TESTOSTERONE COMPARATIVE WITH TOTAL TESTOSTERONE IN MALE PATIENTS WITH ERECTILE DYSFUNCTION Porav-Hodade Daniel 1, Coman Ioan 2, Boja Radu M 1, Todea Ciprian 1, Georgescu Carmen 2, Crisan
Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions IMPORTANCE OF HORMONE BALANCE Importance of Hormone Balance Help you live a long, healthy life Help you
Functional Medicine University s Functional Diagnostic Medicine Training Program INSIDER S GUIDE Interpretation and treatment: male hormone profile By Ron Grisanti, D.C. & Dicken Weatherby, N.D. http://www.functionalmedicineuniversity.com
Aging Well - Part V Hormone Modulation -- Growth Hormone and Testosterone By: James L. Holly, MD (The Your Life Your Health article published in the December 4th Examiner was a first draft. It was sent
Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Prevalence of OSA and diabetes Prevalence of OSA Five
DIETARY ISSUES IN DIABETES Elizabeth J Mayer Davis, PhD Department of Nutrition, Gillings School of Global Public Health Department of Medicine, School of Medicine University of North Carolina at Chapel
Male New Patient Package The contents of this package are your first step to restore your vitality. Please take time to read this carefully and answer all the questions as completely as possible. Thank
Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke General and Abdominal Adiposity and Risk of Death in Europe Tobias Pischon Department of Epidemiology German Institute of Human Nutrition Potsdam-Rehbruecke
AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division
An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance Gerald Reaven, M.D., is Professor Emeritus (Active) of Medicine at Stanford University. He has served as director of the Division
Major Scientific Studies Reveal... Fall 2008 Testosterone Levels in Men Decline Over the Past Two Decades Causing Millions to Suffer Depression, Lack of Energy, Erectile Dysfunction AND... Low Testosterone
Isagenix Clinical Research Summary Suk Cho, Ph.D., Eric Gumpricht, Ph.D., David Despain, M.Sc. UIC study finds subjects on Isagenix products lost more body fat, lost more visceral fat, showed greater adherence,
SEXUAL HEALTH & TESTOSTERONE -- DC ACP CHAPTER -- Michael S. Irwig, M.D. Associate Professor of Medicine, Director, Center for Andrology Division of Endocrinology & Metabolism Disclosures Pharma-Free Presentation
Contact: Louis DeLuca, MD: (561) 998-3333 Thomas Fiala, MD: 407-339-3222 Yehuda Handelsman, MD: 818-708-9942 Richard Baxter, MD: 206-349-3944 Headline: Metabolic syndrome: As American as Apple Pie Dek:
TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type
CONCORD INTERNAL MEDICINE TESTOSTERONE DEFICIENCY PROTOCOL Douglas G. Kelling, Jr., MD Carmella Gismondi-Eagan, MD, FACP George C. Monroe, III, MD Revised April 29, 2012 The information contained in this
Male Health Do Men Value Their Health? The ancient Greek physician Hippocrates once said, A wise man ought to realise that his health is his most valuable possession. It is believed that Hippocrates lived
X-Plain Low Testosterone Reference Summary Introduction Testosterone is the most important male sex hormone. It helps the body produce and maintain adult male features. Low levels of testosterone affect
King s Diabetes Research Group Is hypoglycemia an issue in type 2 diabetes? Stephanie A Amiel RD Lawrence Professor of Diabetic Medicine King s College London Conflicts of interest None! (Currently working
Dietary Composition for Weight Loss and Weight Loss Maintenance Bridget M. Hron, MD Instructor in Pediatrics, Harvard Medical School Staff Physician in Gastroenterology & Nutrition and New Balance Foundation
Diabetes and Stroke Understanding the connection between diabetes and the increased risk of stroke Make the Connection Almost 26 million people in the U.S. roughly 8 percent of the population have diabetes.
Cardiovascular Disease Risk Factors Part XII By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005 As we approach the end of our extended series on cardiovascular disease risk factors,
Introduction Type 2 diabetes mellitus (t2dm) is the most prevalent form of diabetes worldwide. It is characterised by high fasting and high postprandial blood glucose concentrations (hyperglycemia). Chronic
The role of TRT in the management of hypogonadism and TRT: Dispelling the myths Dr Geoff Hackett Safety concerns over testosterone replacement therapy (TRT) Concerns over the safety of testosterone may
Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität
AMBIENT AIR POLLUTION EXPOSURE AND VASCULAR DYSFUNCTION Robert D. Brook, MD Assistant Professor of Internal Medicine Division o off Cardiovascular Medicine University off Michigan Cardiovascular Effects
european urology supplements 6 (2007) 847 857 available at www.sciencedirect.com journal homepage: www.europeanurology.com Testosterone Associations with Erectile Dysfunction, Diabetes, and the Metabolic
Information from your Patient Aligned Care Team What is Erectile Dysfunction or ED? Erectile dysfunction (also known as impotence) is the inability to get and keep an erection firm enough for sex. Having
The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke
GUIDELINES ON MALE HYPOGONADISM G.R. Dohle (chair), S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely