Latest Advances in Men`s Health Objectives

9/29/2011
Latest Advances in Men’s Health
Nelson Vergel
PoWeRUSA.org
TestosteroneWisdom.com
Copyright © 2011 by Nelson Vergel
Objectives
To Review:
– The most common causes of erectile
d f
dysfunction
i (ED) and
d its
i treatment options
i
– Best ways to diagnose and treat
testosterone deficiency
– Best ways to increase lean body mass and
decrease fat
– Supplements backed by data
– Nutrition and Exercise tips
Questions and answers
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9/29/2011
This information (and any accompanying printed
material) is not intended to replace the attention or
advice of a physician or other health care professional.
professional
Anyone who wishes to embark on any dietary, drug,
exercise, or other lifestyle change intended to prevent
or treat a specific disease or condition should first
consult with and seek clearance from a qualified health
care professional.
Copies of these slides
are available free online at
TestosteroneWisdom.com
on the “Lectures” page
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Testosterone and Aging
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Signs and Symptoms of Low
Testosterone







Loss of muscle mass and strength
Loss of libido and erectile dysfunction
Depression
Lethargy (fatigue, lack of focus)
Bone loss
Some regression of secondary sexual
characteristics (body hair loss, etc)
Low or no sperm count
Tenover JL. Endocrinol Metab Clin North Am. 1998;27:969-987
Petak SM, et al. AACE Clinical Practice Guidelines. Available at: http://www.aace.com/clin/guides/hypogonadism.html
Testosterone Deficiency
(Hypogonadism)
• Normal levels in blood:
Men...
Total test. 300-1100 ng/dL,
Free test. 5 - 21 ng/dL
Women Total test.
Women...
test 10-50
10 50 ng/dL
Free test. 0.10-0.85 ng/dL
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Testosterone
Replacement Benefits
Mental
focus
Stamina and Bone Strength
Sexual function
Lean
Body
Mass
Testosterone and The Body
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The HPT Axis
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Testosterone Fractions in the Blood
Bioavailable T
Free T
2%
Albumin-bound T
38%
T = testosterone
Only 2% is free
testosterone
and 98% is bound
Sex Hormone Binding Globulin
SHBG-bound T
60%
Finasteride
Anastrozole
Tamoxifen
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(binds
testosterone)
Conditions associated with alterations in
SHBG concentrations
Conditions associated with decreased SHBG
concentrations
–
–
–
–
Moderate-severe obesity
ModerateHypothyroidism
Type 2 Diabetes mellitus
Nephrotic syndrome
Conditions associated with increased SHBG
concentrations
–
–
–
–
–
Aging
Hepatic cirrhosis
Hyperthyroidism
Use of anticonvulsants
HIV infection
Bhasin, S. et al. J Clin Endocrinol Metab 2006;91:1995-2010
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Potentially Approved in the Next 12-24 Months
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Effects of Physiologic Testosterone
Supplementation on Fat Mass and
Distribution in HIVHIV-Infected Men
with
ith Abdominal
Abd
i l Obesity
Ob it
CM Shikuma1, RA Parker2, F Sattler3, B Alston4, R
Haubrich5, T Umbleja2, S Bhasin6, for the AIDS
Clinical Trials Group Protocol A5079 Study Team
1 University of Hawaii, Honolulu, HI; 2 Harvard School of
P bli Health,
Public
H l h Boston,
B
MA;
MA 3 University
U i
i off Southern
S h
California, Los Angeles, CA 4 Division of AIDS, NIAID,
Bethesda MD; 5 University of California, San Diego, San
Diego, CA; 6 Boston University, Boston MA
Percent Change over 24 weeks
in CT Measures (ITT)
10
P<0.001
8
*
6
4
2
0
P=0.04
P=0.76
8.1%
4.3%
3.1%
-1.5%
0.3%
-2
2
Active
Placebo
-7.2%
-4
-6
*
-8
VAT
SAT
Total Abd Fat
Entries within bars are median values of change; *Change in within arm differences p<0.05
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Percent Change over 24 Weeks
in DEXA Measures (ITT)
6
p=<0.001
*
4
p=<0.001
*
P<0.001
4.6%
2
4.5%
3.8%
-0.3%
-2
-9.9%
-10.1%
-8
-12
Active
Placebo
-7.9%
-4
-10
*
1.3%
0
-6
p=0.02
*
*
Trunk
Fat
*
Extremity
Fat
Total
Fat
Lean
Tissue
Entries within bars are median values of change; *Change in within arm differences are p<0.05
Side Effect: Gynecomastia (breast enlargement in men)
Treatment: Estrogen Blocker Medications or surgery (in worst cases)
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Side Effect: Increased number of red blood cells (polycythemia)
Watch out for
hematocrit over 52 !
Solution: Donate blood
or therapeutic phlebotomy
(4-5 units every 3-4 months)
Side Effect: Testicular Shrinkage (atrophy)
Dosing protocols vary
Treatment:
Human Chorionic Gonadotropin
(hCG) – It mimics LH to jump
start testicles
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Side Effect : Increased prostate size
(benign prostatic hypertrophy)
Potential treatments:
Finasteride etc
Finasteride,etc
Or alpha blockers to increase
urinary flow
Prevention:
Digital Rectal Exam (DRE)
Prostatic Specific Antigen (PSA)
blood test
Side Effect: Acne
Treatment: Bezoyl Peroxide, salicilic acid lotions, soaps,
showering after exercising, 20 min of sun a day, Zinc supplements
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Oral Steroids : Oxandrin
(Oxandrolone)
Only anabolic approved for weight loss
Mild - can be used by
y women and children
(low virilizing)
virilizing)
Does not stunt growth in children
Several studies in HIV/AIDS
Men need higher doses - 20 -40 mg/day with
testosterone; women 5 - 20 mg/d
Potential liver burden over 20 mg (adults)
Expensive - $1100/month at 20 mg
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Exercise ± Oxandrolone in Patients
on HAART
Anabolic Steroid Use in HIV
Over 17 HIV studies show they are effective to
increase muscle mass and strength in men and
women
Orals:: Anadrol
Orals
Anadrol,, Oxandrin
Injectable:: Testosterone Cypionate and Enanthate,
Injectable
Enanthate,
nandrolone decanoate
Steroids should be given with testosterone since
they tend to lower the body’s own testosterone
production
Side effects:
effects: acne, high blood pressure, prostatic
inflammation, liver dysfunction (orals), polycythemia
(too many red blood cells), sleep apnea, etc
Illegal for those with no medical conditions
More information in www.medibolics.com
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Anabolics Used in HIV
Steroid
Anabolic
Properties
Androgenic
Properties
Reported Doses
Side Effects
Nandrolone Decanoate
Deca Durabolin
(injections)
Available in the U.S.
High
Low to Medium
Men 100-200 mg/wk
Women 25 mg/wk
Some water retention,
HTN
Stanozolol
Winstrol™ (Oral)
Available in the U.S.
Low
Very Low
Men 6-18 mg/day
Women 4-12 mg/day
Slight chance of virilizing
for women. Watch liver
function.
Oxandrolone Oxandrin™
(Oral)
Available in U.S.
Low to Medium
Very Low
Men 15-20 mg/day
Women 10-40 mg/wk
Children 2.5-5 mg/day
Slight chance of virilization
for women. Watch liver
function. Women report
water retention.
Oxymetholone Trade
name Anadrol™ 50
( l)
(oral)
Available in the U.S.
Very High
Very High
Men 50-100 mg/day
Testosterone
Cypionate or Enanthate
(Injections)
Available in the U.S.
High
Medium to High
Men 100-200 mg/wk
Women 25 mg/wk
Balding in men, high blood
pressure, water retention,
body hair growth in women
and breast enlargement in
men. Watch liver function.
Water retention, balding in
men, acne, breast
enlargement in men, may
virilize women.
All can cause (depending on the person and if not managed properly):
increased hematocrit, acne, BPH, gynecomastia, increased blood pressure/edema
Compounding Pharmacies
• Make customized pharmaceuticals and nutraceuticals with
expired patents or abandoned by pharmaceutical companies
(i.e. nandrolone,etc)
• Most products require a prescription
• Depending on the state, many can ship products to your home
• Products are usually 2-10 times cheaper than buying
commercially available pharmaceutical medications
• Products can be formulated in different delivery forms
• Common products related to hormone treatments, erectile
dysfunction, pain gels/creams, hair growth gels, side effect
management products, and quality of life related formulations.
• Most do not take insurance but provide info for your own filling
• I have been using APSMeds.com for the past 4 years since
they have the best pricing and a specialized patient support
person for HIV+ and HIV- patients.
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For More Information:
TestosteroneWisdom.com
Protecting Your Sexual Function
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9/29/2011
Causes of ED
Risk Factors
Massachusetts Male Aging Study¹
Study¹
Treated heart disease
39%
Treated diabetes
28%
Treated hypertension
15%
¹Feldman Ha, J Urol 1994; 151:54151:54-61
Causes of ED
Medications (cont
(cont.))
Anti--hypertensive drugs
Anti
– All capable
– Common: thiazides and beta blockers
– Uncommon: calcium channel blockers,
alpha--adrenergic blockers, and ACE
alpha
inhibitors
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Causes of ED
Medications (cont
(cont.))
CNS drugs:
– Antidepressants, tricyclics, SSRIs
– Tranquilizers
– Sedatives
– Analgesics
H1 and H2 receptor blockers
Causes of ED
Organic Causes
– Cardiovascular disease
– Diabetes mellitus
– Surgery on colon, bladder, prostate
– Neurologic causes (lumbar disc, MS, CVA)
– Hormonal deficiency
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Cause of ED
Psychogenic Causes:
– Anxiety
– Depression
– Fatigue
– Guilt
– Stress
– Marital Discord
– Excessive alcohol consumption
– Street drugs
How to Treat Sexual Dysfunction
•
•
•
•
•
Avoid excessive alcohol and smoking
Balance your testosterone‐ injection/cream /gel/patch g
Viagra, Levitra, Cialis
DHEA ‐ men 50 ‐ 500 mg, women 25 ‐ 100 mg
Trimix (prescription)‐ Injection of 0.1‐0.2 cc in the penis. Less expensive than Caverject. See an Urologist. Visit apsmeds.com, gotocompoundingshop.com, etc
• Yohimbe ‐ stimulant, concerns about hypertension (Prescription: Yocon)
• Counseling may help those with psychologically induced sexual dysfunction
• Talk to an Urologist for other tests!
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Sexual Dysfunction Oral Drugs
Drug
Viagra
g
Levitra
Cialis**
Cialis
Onset of
Action
60 minutes
30 minutes
15 minutes
Duration
of Activity
4-5 hours
4-5 hours
36 hours
* No food effect
Medication Side Effects
(PDE Inhibitors)
Side effects:
Headache
Flushing
Dyspepsia
Nasal congestion
Visual disturbances
Back ache ((Cialis
Cialis))
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Penile Injection Therapy
Caverject, Edex, Tri/Bi
Tri/Bi--Mix
Mechanism of action: smooth muscle
vasodilator
Monotherapy (protaglandin E1) or combination
of 2 or 3 agents (Papaverine
(Papaverine+
+ Phentolamine +
Alprostadil )
Administration: 10, 20, 40ug
I j t di
Inject
directly
tl into
i t corporeall bodies
b di off the
th penis
i
Results: 70%
70%--90%
Dropout rates: 25%25%-60%
Side effects: pain (36%), priapism (4%),
fibrosis
Trimix
(Papavarine+ Phentolamine + alprostadil)
Available by prescription from compounding
pharmacies
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Stages of Change
© 2010 ProPro-Change Behavior Systems, Inc.
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COMPREHENSIVE APPROACH TO
WELLNESS
S
Stress
Reduction
i
Medications
Nutrition
Exercise
Protecting Your Heart
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How To Minimize Heart Disease
Do not smoke!
Exercise and low animal fat/sugar diet
Lose weight if you are overweight
Manage stress and keep blood pressure in check
Decrease triglycerides with Omega 3 fatty acids (cold
water fish oils),
oils), low sugar intake, exercise.
Improve HDL with Niacin 300300-500 mg 3 x day. Start with
lower dose to minimize “flushing” and take an aspirin 20 min before
(Niaspan is the prescription grade)
Soluble Fiber (oats
(oats, fiber supplemengts
supplemengts,, etc)
etc)
If everything else fails, use prescription lipid lowering
agents (statins
statins,, fibrates
fibrates,, etc)
etc)
A baby aspirin a day (81 mg
mg))
Keep healthy blood levels of testosterone and thyroid
hormones.
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Insulin Resistance: A Silent Health Threat
Pre diabetes
Keeping a healthy weight, exercising, low glycemic load diet, certain supplements
and medications can decrease Insulin resistance and glucose intolerance
Visceral Fat and Health
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Potential Interventions for Decreasing
Abdominal Fat (visceral adipose tissue
tissue--VAT)
Diet- Lower carbohydrate diets, Mediterranean diet
DietExercise-- cardiovascular and resistance training
Exercise
training-- Some pilot
data with good results
Anti--diabetic drugs: Metformin (Glucophage
Anti
Glucophage))- conflicting
and inconclusive data
Testosterone gel
gel-- subcutaneous fat loss only
Anabolic steroidssteroids- Oxandrin
Oxandrin,, nandrolone?
nandrolone?- limited VAT
data
Human Growth Hormone
Human Growth Hormone Releasing HormoneHormone- Sermorelin
and Tesamorelin
Tesamorelin-- Approved for the treatment of HIV
related visceral fat accumulation
Surgery-- Liposuction of visceral fat very difficult and risky
Surgery
How to Increase Lean Body Mass
Higher protein intake (whey, egg white protein
supplements lean meats,
supplements,
meats nuts,
nuts fish,
fish eggs,
eggs etc)
and more frequent snacking with right balance.
More in nutrition section
Resistance exercise. More in exercise section
Testosterone Replacement if needed
Growth Hormone replacement
Medical use of oxandrolone and nandrolone
Creatine Supplementation
Healthy sleep habits
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Supplements- Snake Oil?
Supplements-- What Works?
Supplements
Niacin 1000-3000 mg/day
– Increases good cholesterol (HDL). Caution with
“flushing”. Take a baby aspirin 20 min before taking
niacin
Selenium
– Glutathione production (anti-oxidant.) A study
showed people who took 200 mcg/day had better
immune function
Calcium Carbonate- 500-2000 mg/d
– Bone
B
protection,
t ti
di
diarrhea
h control
t l
Vitamin D- Bone protection and other emerging
benefits (2000-4000 IU/d)
SAMe (S-Adenosyl-L-Methionine) – energy,
depression, liver detox
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Supplements -Any data?
Whey Protein 20-100 grams/day
– Popular with bodybuilders. HIV study found compensatory response.
People ate less food and no increased LBM was found
Creatine 5-15 grams/day
– Muscle voluminizer, strength enhancer. Caution with diarrhea
and kidney overload.
Omega 3 oils (fish oils) 3000- 6000 mg/day
– Decreases cholesterol/triglycerides, anti-inflammatory, mood
stabilizer?
L-Carnitine 1000-3000 mg/day
g/ y
– Helps use fat for energy, cell protection, lowers lipids, anticatabolic, heart muscle protection, N-Acetyl Carnitine may
restore nerve damage in neuropathy
B Vitamins (100 mg each/day)- whole body processes,
possible prevention of mitochondrial toxicity
Great Web Site to Find Out
What Supplements to Trust
ConsumerLabs.com
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What Your Plate Should Look Like….
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Modified Atkins
The
ZONE
&
South
Beach
Diets
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Low- Fat vs Mediterranean vs Low-Carbohydrate
Diets- Effect on Weight Loss
More Nutritional Tips
• Shop the perimeter of the store
• Do not skip breakfast (keep an eye on sugar and
refined flower products!)
• Try to eat several smaller meals or snacks instead of
2-3 large ones
• Eat more almonds, walnuts, pecans and pistachios
(good cholesterol lowering fats)
• Eat fruits and vegetables of all colors
• Avoid sweet drinks and fruits juices. Eat the fruit!
• Eat a high protein, complex carbohydrate- rich meal
after work outs
• Get a slow cooker
• Cook for the week and freeze
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Nutritional Considerations
• Reduce saturated (animal) fats, fried foods
and hydrogenated oils
• Eat omega-3 fish oil-rich foods- salmon, tuna,
sardines or flax seed oil (alternative)
• Use good fats: olive oil, nuts, avocados,
flaxseed
• Minimize sugar, fructose (sweets, sodas,
foods with high fructose corn syrup )
• Eat adequate amounts (0.7-1 gm/lb/day) of
protein (fish, eggs, cottage cheese, lean
meats, chicken, whey, yogurt, nuts, etc)
Best Protein Sources
Building block of muscle mass and food for the
immune system
Dairy proteins - best is cottage cheese (casein),
whey,
y, yogurt…
y g
made to make mammals g
grow
bigger . Be careful with milk allergies/lactose
intolerance
Whole eggs are better than egg white
Fish - cold water fish like salmon and tuna
Lean beef
Chicken (no skin)
Natural almond butter (no added hydrogenated oils
and fillers)
Beans, rice - vegetarian diet requires good
knowledge of protein sources
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Good Carbohydrates
Bad Carbohydrates
Provide energy and nutrients
Bad carbs can worsen insulin resistance and
triglycerides
Bad: Avoid/reduce high glycemic,
glycemic, high calorie
carbs – refined flour, especially milled grains,
sugar, high fructose corn syrup
Good: Eat more fiber, nutrient, and fluidfluid-rich,
low calorie, low glycemic carbs like: oatmeal,
multi--grain breads, vegetables, fruits, roots,
multi
greens, wild rice and beans
Fat is not a Four Letter Word
Fats are needed for energy, immune
function, vitamin absorption, and hormones
Good FatsFats- monounsaturated
monounsaturated-- Olive Oil
Essential Fatty AcidsAcids- polyunsaturated
Omega 3’s3’s- cold water fish (salmon)
Omega 6’s6’s- high oleic sunflower oil, walnuts,
almonds, pecans, avocado
Omega 3’s and 6’s6’s- Flaxseed meal
Bad FatsFats-processed/hydrogenated
oils,margarine,, artificial creamers, any manoils,margarine
manmade oil, burned oils, rancid oils, lard
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Grocery Shopping List
Almonds and other nuts
Beans and other legumes
Spinach and other green leafy vegetables
Low fat dairy
dairy, yogurt
Hummus
Whey protein
Oatmeal
Eggs
Lean meats
Whole grain breads and pasta
P
Peanut,
t almond
l
d , cashew
h
b
butters
tt
Olive oil and avocados
Raspberries and all berries. Fruits (avoid fruit juices)
One or two glasses of red wine per day (optional)
Flaxseed , pumpkin and sunflower seeds
Sweet potatoes and wild rice
Green tea (optional)
Exercise, the Best Therapy for Most Health Problems
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9/29/2011
Exercise: The Best Medicine
Benefits:
 total and abdominal fat
improves insulin sensitivity
improves glucose tolerance
increases HDL cholesterol
 triglycerides and LDL
increases muscle mass
improves endurance
improves strength
improves bone density
improves mood
EXERCISE FOR BEST RESULTS
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Aerobic (Cardiovascular)
Exercise
Start with a brisk walk every day if tired
Concentrate in low impact or no impact
exercises (e.g. Elliptical Trainers)
Do what you enjoy (bicycling, roller
skating, etc)
Good for burning fat, triglycerides, blood
sugar but it may decrease muscle mass
sugar,
20 - 30 minutes 33-4 times a week is
enough for many people
Resistance Exercise
Exercise using weighs, machines, your own
body
Warm up by doing a light set
Lift maximum weight for muscular failure
(exhaustion) at 8-12 repetitions
One body part per week
One hour sessions 33-4 times a week
Three sets per body part
If no access to a gym, start with crunches,
push ups, and squats at home
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Resistance Exercise Principles
Safety First - Stop if if hurts!
High Intensity
Intensit - Momentary
Momenta muscular
m sc la
failure to stimulate growth
Recovery = Rest, nutrition, and time
2 - 3 warmup,
warmup, 22- 3 heavy sets per
exercise
45 to 60 minutes per session, 3 - 4
sessions per week.
DO NOT OVERTRAIN!
Resistance Exercise Principles
(continued)
Major muscle group first when energy is
highest
Do compound exercises first while energy
is up. They affect the most tissue/mass
for quickest growth (squats, bench press)
Secondary/ancillary muscles follow
Important: Full range of motion recruits/builds the most muscle mass
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Resistance Exercise Principles
(continued)
Warm up sets: 50 - 60 % of the
heavy weight you can lift 6-12 times
Heavier sets: Weight you are capable
of lifting 6 - 12 times to momentary
muscular failure
Wh
When
strength
t
th increases
i
so you can
do 12 reps, increase weight 5 – 10
lbs so you can only lift about 6-8
reps to momentary muscular failure
Best Exercise Sites with
videos, etc
www.exrx.net
www.MyFit.ca
Ipod exercise routine downloads:
http://www.menshealth.com/download/
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Final Words
There are several life style modifications in your control
to stay healthy and in shape as you age to prevent
lean body mass and bone loss, sexual dysfunction, and
h
heart
disease.
d
You do not have to accept sexual dysfunction as a
reality of aging. There are several treatment options!
Find out your free testosterone and thyroid function if
you have fatigue, sexual dysfunction, etc. Supplement
if needed. Readjust the dose if you do not achieve
optimum levels.
Final Words
Do not waste your money and risk liver or medication
interaction problems with unproven supplements
supplements.. Support
the New York buyers’ club.
Combat loss of lean mass and increased fat with resistance
and cardiovascular exercise 3 to 4 times a week for an
hour
Diet: Avoid sweets
sweets, hydrogenated oils,
oils high fructose corn
syrup, animal fats and consume more fruits, vegetables,
fish, lean meats, yogurt and nuts.
An informed man helps his doctor to give him the best care
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9/29/2011
For More Information
More details in ”Testosterone”Testosterone- A Man’s Guide” on
www.amazon.com
Nelson Vergel – nelsonvergel@yahoo.com
TestosteroneWisdom.com
Mesomorphosis.com
The New York Buyers Club (supplements) newyorkbuyersclub.org
Questions?
42