The Truth about Testosterone Therapy

Transcription

1 Mid-South Men s Health September 2014 The Truth about Testosterone Therapy In this Issue, we will cover All Aspects of Testosterone Replacement Therapy, including the published studies and links. U.S. Food and Drug Administration concluded that FDA-approved testosterone treatment does not increase the risk of stroke, heart attack, or death. Pg Sysmptoms of Low Testosterone Benefits of Testosterone Therapy Potential Side effects

2 Don t Quite Feel 100%? Do You Want: -More Energy! -Increased Sex Drive! -Better Sleep -More Confidence -Fat Loss If you just don t feel 100%, you may have Low-T? Symptoms of Low Testosterone: Low Energy Level Poor Sleep Fewer Erections Softer Erections Low Sex Drive Loss of Motivation Moody or Sadness Weight Gain We can reverse Low-T Symptoms and help you feel 100% again. Services: Testosterone Estrogen Blocker PSA (prostate) HCG Shots B12 Shots LIPO Shots Sinus Cocktail Flu Shots Pneumonia Shots Hemoglobin Erectile Dysfunction Cholesterol Testing (Testosterone Replacement Therapy is covered by most Insurance Carriers) W lk (WALK-INS WELCOME No Appointment Needed) 8950 Hwy 64 STE: 109 Ph:

3 In This Issue: pg 4 Average Testosterone Levels for Men pg 5 Testosterone and Heart Health pg 7 Prostate pg 8 Libido and Sex pg 9 Mental Health pg 10 Energy pg 11 Weight Loss pg 13 Diabeties pg 15 Possible Side Effects pg 16 FDA Drug Safety Communication MID-SOUTH MEN S HEALTH Publisher CoramDeo Publishing. Executive Editor Heather Meredith Editor@coramdeopub.com Send articles and photos to Editor@coramdeopub.com Copyright 2014 pg 4 2

4 Ask a Physician Men s Health advice from a local Physician Q: How Long have you been in the medical field? A: I have been the medical Industry for over 7 years Q: Why did you decide to become a Nurse Practitioner? A: Q: What is the biggest complaint you hear from men? A: Low Energy, tired all the time. Falling asleep as soon as they get home from work Q: Since the beginning of this year, there have been a lot of attorney ads on tv, facebook etc regarding cardiovascular issues and testosterone. Testosterone has been around for decades, why the sudden outcry? A: It started in November of 2013 when the now infamous Vigen Study came out. Q: What percentage of men have erection problems? A: It depends on the age but over 35, 75% have some form of issue. The erections aren t as firm, have erections less often, shorter in duration Q: Will TRT help with erection issues? A: Q: Do men have a problem talking to a female physician about these types of problems? A: Q: What do you like most about your job? A: Christina Brown FNP Christina is the Nurse Practitioner at New Life Testosterone Clinic. If you would like to send a question to Christina, you can your question to the editor at editor@coramdeopub.com

5 What Should Your Testosterone Level Be? 3 Although it seems straightforward, there are a number of variables that confound the question, "What are normal testosterone levels?" The lack of a standard or a baseline makes this a particularly difficult question answer because 'normal' is always a relative term. As a result, the generally accepted answer comes in the form of age-specific averages. However, laboratories, doctor's offices, and internet (especially hormone-related websites) are littered with charts that claim to depict average male testosterone levels. So with a plethora of seemingly credible sources, and an abundance of conflicting information, who's wrong, who's right, and how do we know? Generally Speaking In general, a testosterone level above 600 ng/dl (nanograms per deciliter) is considered healthy. Unfortunately, labs have varying ranges for what they consider normal with values ranging from the low 200s to over 1200 ng/dl. However, most seem to agree on, and at least consider the normal range for men to be between 350 and 1000 ng/dl This is based largely on the results of men (both ailing and healthy, years old) from numerous testosterone-related studies, wherein measures at or above 600 can still be symptomatic of low testosterone because remember as a men ages the total testosterone binds more and more to SHBG (sex hormone binding globulin) which will go up with age making free testosterone less available. This is the hallmark of most andropausal aging patients. There are many men in the range that are symptomatic of low testosterone and their free testosterone level will reflect this. Again that s why free testosterone is the main number to look at when making the diagnosis along with symptoms, health history, ect. Labs are only used as a guideline and well trained physicians know how to look at the big picture and treat your symptoms.

6 Testosterone and Cardiovascular Health Reprinted from WebMD News from HealthDay By Mary Elizabeth Dallas 4 HealthDay Reporter Although recent research has linked testosterone therapy with a higher risk for heart attack and stroke, a new study involving more than 25,000 older men suggests otherwise. The study, funded by the U.S. National Institutes of Health, may help ease some fears about testosterone therapy for patients and their families, the study authors said: "Our investigation was motivated by a growing concern, in the U.S. and internationally, that testosterone therapy increases men's risk for cardiovascular disease, specifically heart attack and stroke," lead researcher Jacques Baillargeon, an associate professor of epidemiology at the University of Texas Medical Branch at Galveston, said in a university news release. "This concern has increased in the last few years based on the results of a clinical trial and two observational studies," he said. "It is important to note, however, that there is a large body of evidence that is consistent with our finding of no increased risk of heart attack associated with testosterone use." According to background information supplied by the researchers, the market for testosterone has grown significantly in recent years. Every year, $1.6 billion is spent on these products, with the aim of boosting muscle tone and sex drive for men with so-called "low T." However, investigations into the safety of testosterone therapy have revealed conflicting results, Baillargeon's team said. Some studies suggested testosterone was tied to a higher risk of heart attack. For example, as reported in January by HealthDay, one study looked at the medical records of 56,000 American men who were prescribed testosterone supplements. The research, published in the journal PLoS One, tracked the men for 90 days after they started the therapy. The study found that heart attack risk doubled for men over 65 once they were taking the supplements. The same effect was found in testosterone supplement users

7 who were younger than 65 but had a history of heart disease. No such effect was seen for men under 65 years of age without a history of heart disease, the researchers said. To further explore this issue, the Galveston team of researchers examined data collected on more than 25,000 men over the age of 65. The men, who were all Medicare beneficiaries, received testosterone therapy for up to eight years. The study also included a "control group" of similar men who were not treated with testosterone therapy. The findings, which were published July 2 in the Annals of Pharmacotherapy, found that testosterone therapy was not linked with any increased risk for heart attack. In fact, men at greater risk for heart problems who used testosterone actually had a lower rate of heart attacks than similar men who did not receive this treatment, the researchers said: "This is a rigorous analysis of a large number of patients," noted Baillargeon. "Our findings did not show an increased risk of heart attack associated with testosterone use in older men," he said WebMD, LLC. All rights reserved /latest-study-finds-no-link-between-testosterone-supplements-heart-attack html More Links: Testosterone replacement for men with low testosterone improves liver function, metabolic syndrome In middle-aged and older men with low testosterone levels, long-term testosterone replacement therapy greatly improves their fatty liver disease and their risk factors for cardiovascular disease and diabetes, a new study found. The results will be presented Friday at The Endocrine Society s 91st Annual Meeting in Washington, D.C.

8 Testosterone and Prostate Health There is no evidence that the risk of either prostate cancer or benign prostatic hypertrophy increases with Testosterone Therapy. This myth about Testosterone Replacement being linked to prostate cancer has been rooted deep in medical consciousness for over 60 years, however recent studies have dispelled these myths and the data is actually showing that testosterone therapy is good for your prostate. It should be noted there is no evidence that men with higher Testosterone levels are at higher risk of prostate cancer or that supplementing Testosterone increases this risk. In fact, it should be recognized that prostate cancer becomes more prevalent exactly at a time in a man's life when testosterone begins declining. Testosterone treatment is actually beneficial for the prostate, not bad. 6 No clear relationship has been demonstrated between testosterone replacement and the risk of incident prostate cancer in any recent and carefully designed studies. There is no definitive evidence currently of any link between increased prostate cancer risk and short-term androgen replacement for symptomatic hypogonadism. Randomized trials studying TRT in men with a history of prostate cancer have not been conducted and comparative trials have shown no impact on prostate disease outcomes. There remains a need for long-term randomized trials to address the issue of TRT in men with a history of prostate cancer. There is no evidence of benefit from exogenous testosterone administration in men with normal endogenous testosterone levels. However, benefit has been shown with TRT in men who have symptomatic hypogonadism. Additionally, the potential role of TRT in reducing cardiovascular risks cannot be ignored. As with any form of therapy, clinicians should thoroughly discuss the anticipated risks and benefits of TRT before starting a patient on this treatment. Men receiving TRT should continue to have regular PSA and DRE screenings and abnormalities should be evaluated. Provided that proper monitoring is carried out, TRT can be an appropriate and effective treatment for men with symptomatic hypogonadism. More Links: Testosterone replacement in older men does not increase risk of prostate cancer 7

9 Libido and Testosterone Testosterone isn't the only fuel for a man's sex drive and performance. But low testosterone can reduce your ability to have satisfying sex. Lack of sex drive and erectile dysfunction are sexual problems that can result from low testosterone. If low testosterone is the cause, treating it can help. Testosterone and the Causes of Low Libido Low testosterone symptoms don't always include feeling like you have no sex drive. Some men maintain sexual desire at relatively low testosterone levels. For other men, libido may lag even with normal testosterone levels. Low testosterone is one of the possible causes of low libido, however. If testosterone is lowered far enough, virtually all men will experience some decline in sex drive. In a large study of men in Massachusetts, about 11% overall said they had a lack of sex drive. The researchers then tested all the men's testosterone levels. About 28% of men with low testosterone had low libido. These men were relatively young, with an average age of 47; older men might have worse sexual symptoms. Low testosterone is only one of the causes of low libido. Stress, sleep deprivation, depression, and chronic medical illnesses can also zap a man's sex drive. Low Testosterone and Erectile Dysfunction Surprisingly, low testosterone by itself rarely causes erectile dysfunction, or ED. Low testosterone alone -- with no other health problems -- accounts for a small minority of men with erectile dysfunction. Erection problems are usually caused by atherosclerosis -- hardening of the arteries. If damaged, the tiny blood vessels supplying the penis can no longer dilate to bring in the strong flow needed for a firm erection. Diabetes, high blood pressure, and high cholesterol are the three main causes of atherosclerosis and erectile dysfunction. At the same time, low testosterone is a frequent accomplice to atherosclerosis in creating erectile dysfunction. In studies, as many as one in three men mentioning ED to their doctor have low testosterone. Experts believe that in men with other factors causing erectile dysfunction, low testosterone can strongly contribute, making a difficult situation even worse. Testosterone therapy improves sex drive and satisfaction with sex in many men. Research trials on testosterone replacement in men are ongoing, although results are years away. WebMD Medical Reference 2012 WebMD, LLC. All rights reserved 8

10 Testosterone Levels and Your Mood The relationship between testosterone levels and your mood is something that might be thought of as more of an issue of energy levels. The perception might be that testosterone levels can impact mood because people with lower testosterone levels have decreased energy, which causes them to feel sad or depressed. The reality, however, is that the connection between testosterone levels and your mood can be important not only in terms of how a person feels, but also in terms of the consistency and stability of a person's mood (Can Low Testosterone Cause Mood Swings?). In this way, the impact of testosterone levels and your mood can be about more than simply feeling energetic or feeling vibrant with age. Instead, testosterone levels and your mood can be a serious issue that can impact the entire lifestyle of a person. Depression One of the important issues that should be considered with regards to testosterone levels and your mood is the way in which decreases levels of testosterone can make you feel. Decreased levels of testosterone in the body can have an important negative impact on mood. For example, people with decreased levels of testosterone can begin to feel sadness or depression. The reason for this is that the brain contains testosterone receptors. When testosterone is produced and travels to the brain, it finds these receptors. The impact of testosterone when it attaches to the receptors in the brain is a feeling of enhanced mood and happiness. Research has shown that men who report feelings of depression actually have testosterone levels that are 20% lower as compared to men who do not report feelings of depression. This statistic provides a way of understanding the importance of testosterone levels and your mood. While the perception may be that testosterone is something that only impacts energy or sexual desire, the reality is that reduced testosterone levels in the body have been shown to result in an increased likelihood of depression. In addition, in studies in which people were given testosterone therapy to increase the levels of testosterone in the body, the result was that feelings of happiness increased and feelings of depression decreased. This information provides further evidence of the connection between testosterone levels and your mood. Reduced levels of testosterone levels in the body certainly do not always cause depression. However, a person who has feelings of depression may need to check their testosterone levels. 9

11 Testosterone and Energy As men age, the connection between testosterone and energy levels become more important because testosterone levels in the body begin to decrease with age. In fact, testosterone production actually peaks in the period being adolescence and early adulthood. After this period, testosterone levels in the body begin to decrease at a rate of about 1% per year after the age of 30. With the decrease in testosterone production in the male body, a variety of changes can occur in the body from decreases in bone density to decreases in red blood cell production. However, the one symptom of the decline in testosterone levels in the body that is often most noticeable for men is a decrease in energy level. However, the connection between testosterone and energy levels can be about much more than just having the energy to take part in sports or other physical activities. Instead, the decrease in energy levels that are experienced can impact everything from sleep patterns to sex drive. Impact of Testosterone and Energy Levels The larger impact of testosterone and energy levels on the body can be about more than simply not wanting to take part in physical activities. Instead, the impact of testosterone and energy levels can be related to larger issues of sleep, changes in emotion, and changes in sexual function. It is not something that should be viewed as simply a sign of old age that has to be tolerated. Another impact related to testosterone and energy levels is changes in sleep patterns. Low testosterone can cause insomnia. For other men, however, low levels of testosterone can change sleep patterns causing men to have the desire or need to sleep at times when they may have previously been awake and engaged in various types of activities. The importance in this information is that it shows that testosterone and energy levels is not just about being tired. Instead, changes in normal routines can be disrupted because of changes in processes within the body. These disruptions can then have their own negative impacts. The end result is that these disruptions can sometimes be traced back to the level of testosterone production that occurs within the body. Finally, The general feeling of fatigue that some men can experience in relation to reduced levels of testosterone production in the body is something that should be taken seriously. In addition, the change in testosterone and energy levels can cause men to have difficulty concentrating, as well as problems with memory. 10

12 Testosterone and Weight Loss Testosterone and weight loss are not the first thing that is thought of by the average person who is either considering losing weight or gaining weight. Testosterone is a major hormone in the human body that is produced in abundance in males. The testicles are the primary site of production for testosterone in males; for women, testosterone is produced in smaller amounts in the ovaries and adrenal glands as well. The relationship between testosterone and weight loss is not as cut and dried as drawing a simple line from point A to point B. In fact, like most hormones of the human body, the impact of hormones on body systems involves a complex set of interactions with other chemical messengers that, when working correctly, help the body achieve homeostasis, or balance of body systems. This article helps the reader understand how testosterone and weight loss are related, and explains how testosterone and weight loss may impact overall health functioning. Testosterone and Weight Loss - Medical Conditions In order to understand the relationship between testosterone and weight loss, we can look at medical conditions to illustrate the concept. Remember we said that testosterone is the major growth hormone in the body, this is specific to growth of sexual characteristics, including muscle mass. Testosterone does not increase one's adipose (fat) tissue, however, and should not be construed to mean that more testosterone means more body fat; as a matter of fact, a rise in body fat signals a decrease in testosterone levels. Testosterone and weight loss can be thought of in two major categories: addition of body fat, and loss of muscle mass. Additionally, a loss of muscle mass can mean that clinically low levels of testosterone are manifesting; this could indicate sarcopenia and/or hypogonadism. But what should you do? Let's explore these conditions to find out more about testosterone and weight loss. Medical Condition #1: Obesity Obesity is defined as having a body mass index (BMI) of 30 or greater. BMI really only tells us the approximated ratio of muscle mass to body fat, given a person's height and weight. For a true body muscle mass to fat ratio, other methods should be used. However, for these purposes we will consider that a BMI over 30 indicates the medical condition of obesity. So what is the relationship between testosterone and weight loss when a person has the medical condition of obesity? Guay and Traish (2011) stated that metabolic syndrome, which includes excessive adipose tissue in the abdomen, has testosterone deficiency as an underlying condition, with a further underlying condition of that being insulin resistance. Meaning, insulin resistance is one factor involved in testosterone and weight loss (and gain). In a study on erectile dysfunction due to metabolic syndrome, found that testosterone deficiency underlies endothelial dysfunction (a core symptom of erectile dysfunction) and metabolic syndrome, with the key culprit being insulin resistance. So what is the relationship between testosterone and weight loss, and obesity? Insulin resistance. To put it simply, insulin resistance causes an imbalance in glucose metabolism, contributing to fat storage on the body. But how are insulin and testosterone related, and why is this important to testosterone and weight loss? New FlexDieting Program Guaranteed to get You Eating Better or Your Money Back! FlexDieting promises to help you make lasting dietary changes that can last a lifetime while dramatically improving your body composition and health. Get your assessment, detailed meal-plan with alternate meals and snacks for only $59. Then, get a personal follow-up once a month that addresses your concerns and includes new meal ideas, recipes, and fatloss tips and tricks for only $29.99/month*. *Cancel Anytime. Satisfaction Guaranteed! Call Matt at (901) Or FlexDieting@gmail.com 11

13 The story begins in the brain, where the master endocrine gland, the pituitary gland, secretes a messenger chemical to tell the testes to make more testosterone. The messenger chemical is called luteinizing hormone. The following diagram offers a visual guide: If for some reason either pituitary output of LH is impaired, or LH receptors in the testes are dysfunctional, less testosterone will be produced. Low circulating testosterone contributes to insulin resistance, likely due to decreased glucose metabolism. Testosterone and weight loss, and weight gain, are linked through the mechanism of insulin resistance and glucose metabolism. And that begins the next discussion on testosterone and weight loss, and muscle mass. Medical Condition #2: Sarcopenia Sarcopenia literally means poverty of the flesh and is where a person progressively loses muscle mass, due to factors usually associated with aging. Muscle mass is replaced with fat tissue, due to cellular level changes in the muscles. These changes are most often related to aging, where testosterone levels fall as a natural consequence of the aging process as well. When a man ages, and testosterone levels fall, age-induced Hypogonadism results; this is simply clinically low testosterone levels. Hypogonadism contributes to sarcopenia, and testosterone and weight loss are related in this manner in terms of the loss of muscle mass and the potential increase of fat tissue. Hypogonadism does not only affect the maturing population of adult men; when Hypogonadism affects younger men, sarcopenia can also result. The important part to remember about testosterone and weight loss is that low circulating testosterone levels contribute to insulin resistance, which leads to decreased glucose metabolism; all this can mean a decrease in lean muscle mass and an increase in adipose tissue. Summary The main points here are that testosterone and weight loss are related in a complex body system management schema, that low testosterone can impact insulin and glucose which can lead to weight gain through loss of muscle mass, and that testosterone and weight loss cannot simply be managed through testosterone supplementation. If you are experiencing decreased muscle mass, or are obese and concerned about your testosterone levels, see your doctor. Together you can work out a treatment plan that is designed for you. Men s Hybrid Strength & Conditioning Combining the most effective techniques to get Lean, Strong and in the best cardiovascular shape of your life. 20 classes - $ Travis Woodberry Testosterone and Diabetes 12

14 Testosterone replacement therapy increases insulin sensitivity among men with type 2 diabetes, an ongoing clinical trial shows. Preliminary results were presented Tuesday at The Endocrine Society s 95th Annual Meeting in San Francisco. Our studies have shown that having low testosterone also impacts insulin action, and that can be corrected by testosterone replacement, said study lead author Paresh Dandona, DPhil, distinguished professor and chief of endocrinology at the State University of New York at Buffalo. Testosterone replacement increases efficiency of insulin action in men with type 2 diabetes. Since testosterone is the main male sex hormone, insufficient production affects many aspects of men s health, including sexual functioning, bone and muscle health, and energy level. One of the many causes of low testosterone production is obesity, and approximately 25 percent of obese men produce insufficient amounts of the hormone. Insulin is a hormone secreted by the pancreas that acts to reduce the level of sugar, or glucose, in the blood. In the most common form of diabetes, type 2, the pancreas does not produce enough insulin. The disease is also characterized by insulin resistance, which means that the cells that normally convert glucose into energy ignore the insulin that is produced. One-third of men with type 2 diabetes have low testosterone levels. One of the main indications for testosterone replacement therapy is the treatment of sexual dysfunction. Previous research by the current study s investigators showed that low levels of testosterone are associated with greater insulin resistance, and that hormonal replacement can increase the body s sensitivity to insulin. The precise relationship between low testosterone and insulin sensitivity, however, is unclear. Preliminary results from this study show that men with type 2 diabetes who also have low testosterone levels were more resistant to insulin than men with normal testosterone concentrations. Furthermore, hormone replacement therapy decreased their insulin resistance. Other findings show that testosterone replacement therapy is associated with an increase in muscle mass and a corresponding decrease in fat tissue. Specifically muscle mass increased by 2 kilograms, or 4.4 pounds, among men who received testosterone therapy, while fat-tissue mass 13

15 decreased by the same amount. In addition, testosterone replacement therapy was associated with less tissue inflammation, which indicates a decrease in insulin resistance. After enrolling, participants are assigned to one of four groups: type 2 diabetes + low testosterone; type 2 diabetes + normal testosterone; obesity + low testosterone; or obesity + normal testosterone. Each group receives testosterone replacement therapy for six months. Investigators then measure participants insulin sensitivity, and their percentage of muscle- and fat-tissue mass. They are assessing inflammation in blood, muscle and fat samples. Their work also shows that testosterone replacement in patients with low levels of this hormone suppresses inflammatory factors which are responsible for interfering with the action of insulin and thus explains the mechanisms responsible for resistance to the action of insulin in such patients.so far, 50 men are participating in the study. Their average age is 53, and they are either diabetic, obese or both. Investigators plan to enroll another 150 participants for the study, which will conclude a year from now. The National Institutes of Health is funding the study. 14

16 Possible Side Effects of Testosterone Therapy Just like any drug, there can be possible side effects that a small fraction of the population can experience. Some patients could experience one or more of the following side effects: Increase in red blood cells o This can be beneficial if you have anemia. However, it can be potentially dangerous, since an increase in red blood cells can lead to blood clots, heart attack, or stroke. The body usually adjust after a short time on TRT, in some cases the patient will need to donate blood or have it drawn off by a physician. Prostate effects o If you have a history of prostate cancer, you cannot receive testosterone therapy, without prior clearance from the urologist who is overseeing your care. Skin reactions o Acne, oily skin, increased body hair and flushing have been reported. These side effects are not very common, but when/if they occur, often are transient. Infertility o Testosterone therapy down regulates production of a man s sperm. Ensure you are upfront with your desire for children with your medical provider, and be sure to discuss the situation with your spouse/partner if appropriate. Sleep apnea o This is a condition that disrupts breathing during sleep, and if already present, may be worsened by the use of testosterone therapy. If you snore, or suspect you may have sleep apnea, be sure to talk to your medical provider about the situation. Considering a sleep study for further evaluation may be appropriate prior to starting therapy. Fluid retention o Although uncommon, you must use caution if you have a history of heart failure or kidney disease. In what cases should I avoid testosterone replacement therapy? Only your physician can fully answer this question; however, in general testosterone replacement therapy is not recommended and/or is prohibited for patients with: Breast or prostate cancer A palpable prostate nodule Erythrocytosis Hyperviscosity Untreated obstructive sleep apnea Severe benign prostatic hyperplasia symptoms (AUA prostate symptom score > 19) Uncontrolled severe heart failure Unexplained PSA elevation Severe lower urinary tract symptoms associated with benign prostatic hypertrophy Unstable severe congestive heart failure (class III or IV) 15

17 FDA Drug Safety Communication: FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products Reprinted from Safety Announcement [ ] The U.S. Food and Drug Administration (FDA) is investigating the risk of stroke, heart attack, and death in men taking FDA-approved testosterone products. We have been monitoring this risk and decided to reassess this safety issue based on the recent publication of two separate studies that each suggested an increased risk of cardiovascular events among groups of men prescribed testosterone therapy. We are providing this alert while we continue to evaluate the information from these studies and other available data, and will communicate our final conclusions and recommendations when the evaluation is complete. At this time, FDA has not concluded that FDA-approved testosterone treatment increases the risk of stroke, heart attack, or death. Patients should not stop taking prescribed testosterone products without first discussing any questions or concerns with their health care professionals. Health care professionals should consider whether the benefits of FDAapproved testosterone treatment is likely to exceed the potential risks of treatment. The prescribing information in the drug labels of FDA-approved testosterone products should be followed. Testosterone is a hormone essential to the development of male growth and masculine characteristics. Testosterone products are FDAapproved only for use in men who lack or have low testosterone levels in conjunction with an associated medical condition. Examples of 16

18 these conditions include failure of the testicles to produce testosterone because of reasons such as genetic problems or chemotherapy. Other examples include problems with brain structures, called the hypothalamus and pituitary, that control the production of testosterone by the testicles. None of the FDA-approved testosterone products are approved for use in men with low testosterone levels who lack an associated medical condition. FDA-approved testosterone formulations include the topical gel, transdermal patch, buccal system (applied to upper gum or inner cheek), and injection. The first publication that prompted FDA to reassess the cardiovascular safety of testosterone therapy was an observational study of older men in the U.S. Veteran Affairs health system published in the Journal of the American Medical Association (JAMA) in November The men included in this study had low serum testosterone and were undergoing imaging of the blood vessels of the heart, called coronary angiography, to assess for coronary artery disease. Some of the men received testosterone treatment while others did not. On average, the men who entered the study were about 60 years old, and many had underlying cardiovascular disease. This study suggested a 30 percent increased risk of stroke, heart attack, and death in the group that had been prescribed testosterone therapy. A second observational study reported an increased risk of heart attack in older men, as well as in younger men with pre-existing heart disease, who filled a prescription for testosterone therapy. 2 The study reported a two-fold increase in the risk of heart attack among men aged 65 years and older in the first 90 days following the first prescription. Among younger men less than 65 years old with a pre-existing history of heart disease, the study reported a two- to three-fold increased risk of heart attack in the first 90 days following a first prescription. Younger men without a history of heart disease who filled a prescription for testosterone, however, did not have an increased risk of heart attack. We urge health care professionals and patients to report side effects involving prescription testosterone products to the FDA MedWatch program, using the information in the "Contact FDA" box at the bottom of the page. Laura Sparks Classic Haircutting and Coloring Latest Techniques and Styles for Thinning Hair Schedule Online: colormelaura901@yahoo.com Empire Hair Studio 615 S. Cooper St. - Memphis, TN

19 Be the King of Your World Again Ever Wondered if Your Testosterone was Low? You probably have wondered if your Testosterone Level was Normal or Low. All men do.your First Step is to have your Testosterone Level checked. We have a Special Offer for New Patients to help you with making that first step: Free Testosterone Level Test We will check your Testosterone Level at NO cost to you! NO office visit, NO co-pay, NOTHING out of pocket. It s very simple and only takes a couple of minutes. We will have your results the next morning. No appointment necessary, just drop in between the hours of 8-6 M-F or 9-1 Sat. You must mention this ad to receive the FREE Testosterone Level Test. Also, ask about a FREE 30 Day prescription for Erectile Dysfunction 8950 hwy 64 STE: 109 Lakeland, TN Ph: