Every week I am posting about everything you need to know about hormones. This weeks topic is about metabolic health
Did you know …
- There is no official definition of the term metabolic health
- But it is the opposite of Metabolic Dysfunction or Metabolic Syndrome
- Metabolic refers to the word metabolism which I talked more about in this blog.
- Metabolism is the set of cellular mechanisms that produce energy from our food and or internal ‘stored’ nutrients like fat, to power every process in the human body.
- So metabolic health describes how well we generate and process energy.
- And looking after metabolic health is important for overall health, especially as we age.
- Metabolic dysfunction is a natural part of aging, but lifestyle choices can increase and speed up the development of the dysfunction
- It is estimated that approx. 25% of the world population – ie. over 1 billion people in the world have metabolic syndrome.
- It is estimated that 1 – 3 UK adults have metabolic syndrome
- Approx. 88% of the American population are displaying some level of metabolic dysfunction.
- Metabolic dysfunction plays an important role in the risk of disease states like heart disease, type 2 diabetes, stroke, kidney disease, liver disease and obesity.
- A number of factors influence your metabolic health, some you can change, like diet, sleep and activity level and some you can’t, like your age, sex, or genes.
- The 2 major influencers are nutrition and exercise
- Basically when glucose regulation becomes impaired metabolic health is at risk
- The drop in Estrogen and Testosterone play a crucial role in the development of Metabolic Syndrome
- Consider this – what worked for your body at one age will most probably not work for you at a later stage in life.
Meet Sally and get to know all about metabolic health
Risk factors for poor metabolic health
Eliminate these for optimal metabolic health
Aging Male Health Risks
- Type 2 Diabetes
- Metabolic Syndrome
- Cardiovascular and Coronary Heart Disease
- Abdominal Aortic Aneurysms – AAA
- Osteoporosis and osteoarthritis
- Cognitive decline and dementia
- Prostate problems such as:
- Erectile dysfunction
NB! – While every man faces unique risks based on genetics and other factors, it’s a good idea to be mindful of how to protect yourself against these common health conditions that can increase in risk after the decline in testosterone.
Low Testosterone and heart Disease
- Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes.
- Reduced T levels in men with congestive heart failure (CHF) predicts a poor prognosis and is associated with increased mortality.
- Studies in T-deficient men who underwent T replacement therapy versus untreated men have reported
– a reduced CV risk with higher endogenous T concentration
– improvement of known CV risk factors with T therapy
– reduced mortality
- In a 2014 study, researchers found that men who increased their levels of testosterone through TRT (testosterone replacement therapy) had a 55 % reduced risk of heart attack and stroke
- Also in men with pre-existing heart disease
- BUT – Higher-than-normal testosterone levels can increase the risk for heart attack and or stroke
- Men under 55, the risk of heart attack and stroke was reduced by 25%
- Men over 60, the risk was reduced by 15%
- Blood testing before and after TRT is imperative
- TT (total testosterone) serum levels between 500-800ng/dl for optimal affect
- Always check Estradiol levels
– There is no credible evidence at this time that TRT increases cardiovascular risk, BUT there is substantial evidence that it does not.
– Many studies have indicated that low serum T concentrations are associated with increased cardiovascular risk and mortality and that TRT may have clinically relevant cardiovascular benefits.
– Studies have reported
1. reduced CV risk with higher endogenous testosterone concentration
2. improvement of known CV risk factors with TRT
3. reduced mortality in testosterone-deficient men who underwent TRT versus untreated men.
For more information see the article – Studies and TRT in this blog.
Factors that Drive Atherosclerosis – Hardening of the Arterial Wall
- Glucose spikes
- Insulin resistance
- High blood pressure
- Oxidative stress
- Nutrient deficiencies
- Iron overload
- Heavy metals
- Autoimmune issues
Heart Attack Predictor Tests
- CAC – coronary artery calcium score is a powerful measure of cardiac disease risk.
– a very low risk of 1.4% of heart attack within the next 10 years
- Between 1 and 100
– a 4.1% risk of heart attack within the next 10 years
- Between 101 and 400
– raises risk to 15% of heart attack within the next 10 years
- Between 400 and 1,000
– puts the risk at 26% of heart attack within the next 10 years
- Above 1,000
– the risk of a heart attack within the next 10 years is 37%
- While age is typically seen as the primary risk factor for CVD, the CAC score takes precedence when it comes to identifying the real risk
- High inflammation, such as CRP
- High blood pressure
- High blood sugar / Insulin
- High iron, such as , s.Ferritin
- High LDL particle count can be a significant risk factor for CVD, but other factors play a role in determining whether high LDL particle count is contributing to atherosclerosis. These include
– oxidized LDL
– endothelium damage
– low HDL
– high triglycerides
- Low testosterone.
Low Testosterone and Abdominal Aortic Aneurysm – AAA
- 4:1 male to female ratio
- The reason for this gender disparity is unknown
- Risk factors include:
– Increasing age
– Two or more drinks per day
– Recent epidemiologic studies have shown that men with AAA have lower serum testosterone compared to men without AAA, suggesting the preventive roles of testosterone in decreasing inflammation in blood vessel walls
– Higher levels of Estradiol and Progesterone
READ MORE HERE
- Often asymptomatic and fatal
- A ruptured aneurysm can cause massive internal bleeding, which is usually fatal.
- Around 8 out of 10 people with a rupture either die before they reach hospital or don’t survive surgery.
- Easily identified through an ultrasound screening
- If the aneurysm is >5.5 cm, it can be surgically repaired to prevent a life-threatening rupture.
- Current AAA screening recommendations focus on men between the ages of 65 and 75 years, who have ever smoked
- Recent evidence suggest men of ages 50 to 80 years, regardless of smoking status, may also be at risk for and should be screened.
5 warning signs and symptoms
· Chest tenderness or chest pain
· Dizziness or light-headedness
· Back pain
· Coughing up blood
· Loss of consciousness due to the rupture
NB! – Women with AAAs are older, have faster growing aneurysms, a 3–4 fold higher rupture risk, and rupture at smaller diameters than men.
The Aging Male and Cancer
- Approx. 50% of all diagnosed cancers
– Prostate cancer – 451 per 100,000
– Lung cancer – 449 per 100,000
– Colon cancer – 176 per 100,000
- Elderly men have an almost double cancer incidence rate compared with elderly women.
Low Testosterone and Prostate Cancer
- A paradox
- For years clinicians have been concerned that providing testosterone replacement therapy (TRT) could cause and increase the risk of developing prostate cancer.
- This idea was born from the current treatment of prostate cancer
– Men with metastatic prostatic cancer are treated by medical castration – medication used to stop testosterone production by the testicles and or by blocking the androgen receptor.
– (NB! – the effect of this treatment is time limited as the cancer cells become castrate resistant and grow without testosterone)
– Leading to the conclusion – the treatment for prostate cancer is to lower testosterone levels
– And TRT would be counterproductive even dangerous
– BUT is this true?
- We know today, after years of research and clinical trials there is no evidence that links any increased risk of developing prostate cancer in men undergoing TRT.
- There is no evidence that normal levels of testosterone have any relationship to prostate cancer.
- In fact, we know today that men who have low testosterone actually have a higher risk of developing prostate cancer.
- Having low testosterone level is a significant risk factor for developing prostate cancer.
- In fact, under clinical investigation at John Hopkins Kimmel Cancer centre is the use of high dose testosterone therapy to treat metastatic prostate cancer.
- There has also been a myriad of studies that have documented treating patients who have or had prostate cancer with TRT and there has not been any association or increased risk of prostate cancer development, prostate cancer spread or continued rise in prostate specific antigen (PSA)
- We know today that frequency of prostate cancer development in men on TRT is the same as men not being treated with testosterone.
- There has been no association between the level of testosterone, free testosterone or DHT levels and risk of developing prostate cancer.
- Men with very low levels of testosterone who did get prostate cancer were more likely to develop an aggressive form of the disease
- Low testosterone levels pre-treatment are related to a poor prognosis in prostate cancer
- Prostate cancer is around 22 times more frequent among elderly men than among younger men (where testosterone is lower)
- More information here – https://www.regenxhealth.com/post/does-testosterone-replacement-therapy-trt-cause-prostate-cancer-no
- Estrogen levels must be checked as increased Estrogen / Estradiol does increase prostate cancer
- Keeping Estradiol levels between 20-40 pmol/L is optimal
- Prostate cells produce testosterone and estrogen
- Important to check liver detoxification of Estrogens as the problem may be in the liver – SEE PRODUCT
Update from Tony Collier with Stage 4 Metastatic Prostate Cancer who was on the Prostate show – SEE HERE
- He still has cancer cells trying to find a way of surviving and growing without testosterone
- He also says the doctors never measure either Testosterone or Estrogen levels
Testing for Prostate Cancer
- Common practice to screen with a digital rectal examination and PSA level
- Should also include a serum testosterone levels – READ MORE
- There is a significant association between a low testosterone level and an increased detection of prostate cancer
- Therefore when prescribing TRT for men above 40, a PSA level should be coordinated with the testosterone level to ascertain any increased risk of prostate cancer.
- Low serum testosterone level was an independent risk factor for upgrading prostate cancer stage – READ MORE
- Should also include Estradiol levels
Low Testosterone and Benign Prostate Hyperplasia / BPH
- BPH is common in men older than 50 years
- Testosterone levels have and continue declining
- Classically it is the concern of clinicians and men that testosterone can increase prostate growth and therefore exacerbate symptoms such as
– frequency of urination
– urinary urgency
– staining to urinate
– waking up at night to urinate
– weak urinary stream
Dilemma – is it a logical conclusion that Testosterone causes BPH as it is an aging disease where Testosterone levels have declined?
- In fact, there is evidence to support just the opposite – READ MORE
- Testosterone can improve lower urinary tract symptoms
- Testosterone can improve Nitric Oxide (NO) and Nitric Oxide Synthase (NOS) in the bladder and prostate, causing smooth muscle relaxation and easing the passage of urine during voiding.
- Men with low Testosterone may have lower levels of NO and NOS in the tissue of the prostate and bladder, lending to worsening lower urinary tract symptoms.
Low Testosterone and Erectile Dysfunction / ED
- Surprisingly, low testosterone by itself rarely causes ED.
- Studies show that low testosterone alone, with no other health problems accounts for a small minority of men with ED
- Erection problems are usually caused by atherosclerosis, the hardening of the arteries – see the article Factors that drive atherosclerosis in the is blog
- If damaged, the tiny blood vessels supplying the penis can no longer dilate to bring in the strong flow needed for a firm erection.
- 3 main causes of atherosclerosis and ED are:
– High blood pressure
- BUT – low testosterone is a frequent accomplice in creating atherosclerosis.
- 1 in 3 men mentioning ED to their doctor have low testosterone
- AND – Low testosterone is linked in with many of the conditions that lead to ED
– Metabolic syndrome
– Endothelial dysfunction / atherosclerosis
- It’s the chicken and egg syndrome – what comes first?
Low Testosterone and Libido
- 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 ED are sexual problems that can result from low testosterone.
- If low testosterone is the cause, treating it can help
- 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, others that should be addressed:
– Sleep problems
– Opportunities for sex
- BUT – if testosterone is lowered far enough, virtually all men will experience some decline in sex drive.
Low Testosterone and Mental Health
- Depression, anxiety, irritability, and other mood changes are common in men with low T
- However, researchers aren’t sure what causes the correlation.
- Many researchers believe that because testosterone is a neuroactive steroid it will impact the central nervous system and thereby mood.
- Low testosterone levels are also linked with depressive symptoms and disorders in men.
- Certain research has found that men with depression tend to have lower levels of total testosterone.
- TRT can boost the mood
- Low levels of testosterone are also associated with a risk for dementia in elderly men.
- The association between low testosterone and dementia may be more relevant to men 80 years or older and men with a high level of education – READ MORE
- Men with low testosterone commonly experience cognitive issues, often described as “brain fog,” such as
– trouble forming sentences or finding the right words while they speak
– bump into objects more often than normal
– might forget important things or difficulty focusing on certain tasks
– may have issues with organizing and setting schedules
– controlling emotions.
- Studies show that TRT can help increase memory and concentration.
- Low testosterone may also increase the risk for neurodegenerative disorders like Alzheimer’s.
- Several studies link low testosterone with an increased risk for Alzheimer’s disease – READ MORE
- Recent studies show that TRT replacement may help reduce this risk – READ MORE
Low Testosterone and Bone Health – Osteoporosis
- Osteoporosis is a loss of bone strength that makes you vulnerable to broken bones.
- Unlike women, men do not generally go through periods or rapid hormonal change.
- However, men can develop osteoporosis as a result of low hormone levels in the body, especially low testosterone levels.
- BUT – scientific literature clearly indicates that physicians tend to underestimate osteoporosis in men, and is thought only affect men from around age 70. READ MORE
- Men usually suffer fractures from osteoporosis later in life than women do
- Men are more likely to die from complications following an osteoporosis-related hip fracture than women are.
- About 25,000 men break a hip each year in UK
- After a fracture, 60% of surviving men have a higher chance of suffering a second fracture.
- Men are also more susceptible to rib fractures
- Men benefit from being aware of their bone health, especially if they have an increased risk for osteoporosis.
- Men who have experienced a loss in height greater than 2 inches / 5 cm or who are known to have low levels of testosterone are often advised to undergo diagnostic testing for osteoporosis.
- Unfortunately testing for osteoporosis with a bone mineral density test is usually not recommended for men unless there is a fracture.
- Male osteoporosis must should not be underestimated, and therefore screened as for women.
- At the very least to start the correct treatment for osteoporosis in male patients after a fragility fracture.
- Unfortunately it is still common for doctors not to start appropriate treatment
- Estrogen is important for creating and protecting bone density in both men and women.
- Research suggests that estrogen deficiency may play a role in men developing osteoporosis as it does for women.
- Levels of Estrogen less than 16 pg/ml is an added risk factor – READ MORE
- Men have greater bone mass and osteoporosis is more often due to secondary causes than in women.
- In women, 20 to 40% of osteoporosis is secondary
- In men 65% of osteoporosis is secondary.
- Several risk factors and diseases have been shown to cause secondary osteoporosis in men (and women):
– Alcoholism – defined as either daily intake, or greater than 10 servings per week
– Low BMI
– Glucocorticoid / steroid medication excess
– Hypogonadism – age related and or hormonal suppressive therapy for prostate cancer
– GI disorders – malabsorption syndromes, inflammatory bowel diseases, gluten intolerances
– Rheumatoid arthritis
– Sedentary lifestyle
- Replace testosterone
- Bisphosphonates the most common treatment today are associated with
– gut discomfort and problems
– increased risk for atypical femoral breaks
– development of kidney disease
– osteonecrosis of the jaw bone
- Lifestyle and diet is a key strategy for preserving bone mass after menopause.
- Diet rich in proteins, especially collagen – 25 – 30 g per meal
- Diet rich in nutrients like Vitamin C, D, K2, magnesium and calcium
- Daily sunlight for Vitamin D
- Daily weight-bearing exercise, such as walking, stomping, jumping strengthens bones
- Smoking and excessive alcohol use are toxic to bones and should be avoided.
- Reduce Cortisol production, ie. reduce stress and inflammation as Cortisol ‘loves’ breaking down collagen and thereby bone tissue
NB! – Check these blogs for more information:
Low Testosterone and Weight
- Many men gain weight as Testosterone levels decline, especially central fat storage
- Low Testosterone increases weight gain, body fat and makes it harder to lose weight
- Male obesity has been linked to low testosterone levels
- Testosterone supports Insulin and thereby blood sugar control
- Age related drop in Testosterone leads to changes in body composition, such as decreased muscle and increased fat and in particular where fat is stored
- These changes are detrimental to metabolic health, increasing the risk for metabolic syndrome
- TRT in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference, BMI and body composition and improves components of the metabolic syndrome. READ MORE
- Remove excess carbohydrates from the diet – under 30g per meal as often as possible
- Eat more protein, especially animal protein – minimum 30g per meal
- Eat more fat, especially short and medium chain fatty acids which are not stored and are not affected by Insulin
- Intermittent fasting and or Time Restricted Eating
- H.I strength training, max 50 minutes to build muscle which increases metabolic health and stabilises blood sugar
- Reduce stress and inflammation – these increase Cortisol and Cortisol increases blood sugar levels and thereby Insulins.
Symptoms Related to Low Testosterone
- Low libido / sex drive
- Erectile dysfunction
– difficulties getting and or keeping erections
– lack of spontaneous erections
– erections not as strong as usual
- Increased fat accumulation especially around the middle and / or hips and butt
- Man boobs
- Higher fat% in general
- Poor muscle definition and strength
- Increasing muscle mass doesn’t come easy
- Low bone density – osteoporosis
- Height loss
- Loss of body hair
- Low energy
- Hot flushes / sweats
- Mood swings
- Lower self-esteem (than usual)
- Low motivation
- Poor decision-making and procrastination
- More cautious than before
- More ’grumpy’ than before
- More irritable than before
- Poor sleep
BTW – many of the symptoms can be caused by chronic stress/increased Cortisol production.
Serum Testosterone levels are measured in various ways
- TT – Total Testosterone – the total amount of Testosterone found in the blood
- SHBG – Sex Hormone Binding Globulin – a protein that binds free testosterone
- Free Testosterone – usually a calculation of Total Testosterone minus SHBG = free testosterone
- Free Testosterone is the bioavailable hormone and the only Testosterone that can be used by the cells.
TT levels are measured in ng/dl and vary depending on age:
- Age 17-20
- Age 21-29
- Age 30-39
- Age 40-49
- Age 50-59
215-878 – a good range when using TRT for optimal CV health
- Age 60-69
- Age 70-79
TRT – Testosterone Replacement Therapy
- Patches – every day
- Gels – every day
- Injections – 2 – 4 weeks
- Capsules – 2 x daily
NB! – Always test testosterone and estrogen before and after starting TRT. Aim for:
– am. serum levels of TT (total testosterone) of 500 – 800 ng/dl
– am. serum Estradiol 20 – 40 pmol/L
- Aromatase is the enzyme that converts T to Estrogen
- Aromatase inhibitors block this conversion
- Can be used in combination with and or instead of TRT
- DIM – increases the excretion of all Estrogens and is a mild aromatase blocker – BUY HERE
- Grape Seed Extract – blocks aromatase – BUY HERE
- Prescription aromatase inhibitors – such as letrozole are very effective in increasing testosterone. Careful with the amount – <2.5mg once a week is more than enough for most men. Work with a professional
- TRT is a lifetime commitment.
- TRT is not a silver bullet, lifestyle is equally important.
- TRT can be harmful if taken by men with normal levels – think misuse of anabolic steroids
- TRT can reduce the hormone FHS necessary for sperm production and health, thereby reducing fertility
- TRT is still ‘officially’ contraindicated for any man with prostate cancer
- Decrease in Testosterone has been associated with an increase in all-cause mortality and cardiovascular (CV) risk.
- Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes.
- There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk.
- However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not.
- In fact, existing data suggests that T therapy may offer CV benefits to
- See the studies in the article ‘studies supporting TRT in this blog.
Best Post-Andropause Health Checks
- Regular check-ups
- Daily / Weekly home monitoring
– Waist circumference
– Blood sugar
– Blood pressure
- Prostate scanning – PSA – annually
- Well-man blood check-ups – annually – check the list here
- Blood testing for Total Testosterone and Estradiol is important – annually
- Cardiovascular check-ups, such as cardiac stress tests and CAC scores, especially if a family member has or had cardiovascular problems – annually
- Abdominal Aortic Aneurysm / AAA check-ups – annually after 60
- Colon check-ups, such as colonoscopy, especially if a family member has or have had colon cancer – every 2 years
- Neurological check-ups, such as MRI or CT scans, especially if a family member has or had dementia – annually
- Bone scans, such as DEXA or Ultrasound, especially if a family member has or had osteoporosis and as close to 50 as possible – every 2 years.
Lifestyle Choices to Increase Testosterone
- Blood sugar control and fat burning with TRE – Time Restricted Eating and low carb regimes – read more in this blog
- H.I. strength exercise to increase muscle mass – 50 minutes sessions daily can be enough
- Reduce stress
– Cortisol increases blood sugar and breaks down muscle tissue, not a good cocktail if you want to burn fat
– Chronic stress and Cortisol overrides Testosterone production
- Block the conversion to Estrogen with natural aromatase inhibitors, such as DIM and or Grape Seed Extract DIM – BUY HERE
- Grape Seed Extract – BUY HERE
- Stop smoking
- Reduce alcohol
- Get some sun – vitamin D increases testosterone – BTW – that’s why we get horny when sunbathing
– Soy and soy-based products due to plant estrogens
– Licorice root
– Vegetable oils and margarines
– Trans fats which means most processed foods
– Excess nut consumptions especially walnuts and almonds which increase SHBG.
Post-Andropause and Diet Changes
Your body changes as you age, so your diet needs to change, too.
Low carbs for health blood sugar
- Insulin resistance and Type 2 Diabetes are prevalent in aging males, which are disease states related to excess and or poor glucose regulation
- Restrict carbohydrates aka glucose to max 30g per meal
- Glucose is in ALL carbohydrates, ie. starches and sugars
- Don’t be conned by whole grains – if there is flour, there are processed grains and thereby lots of glucose
Protein for healthy muscle mass
- Sarcopenia is age related loss of muscle mass
- Men near 80 years have lost as much as 50% of their skeletal muscle mass.
- Eating enough protein reduces the impact of that muscle wasting – animal protein is superior
- 1.2 -1.5 grams of protein per kilogram of weight – if you weigh 80 kilos you need 90 – 120 g per day / 30 – 40 g per meal – check your foods here
Healthy Fats for a healthy brain
- MCT, ALA and EPA fatty acids are important as the brain will readily produce ketones from these fatty acids, hopefully instead of breaking down its own fats
- As glucose becomes less stable, ketones are needed to make energy
- BTW – Animal fats increase satiety and they taste great
B’ vitamins for health in general
- Better brain function
- Better energy production
- Essential for methylation, especially methylcobalamin aka B12 and folates aka B9
- More mature red blood cells to carry oxygen
Magnesium for a healthy in general
- Better energy production – glycolysis aka the breakdown of glucose in the cell fluid
- Relaxation – by controlling the excitatory effects of calcium
- Better bone health – by assisting the activation of vitamin D, which helps regulate calcium and phosphate influencing the growth and maintenance of bones.
- More Vitamin D – all of the enzymes that metabolize vitamin D to its active forms Calcifediol / D3 and Calcitriol require magnesium
- Make unprocessed foods the foundation of your diet.
- Focus on healthy meats and organs, bone broth, fruits, healthy animal fats and if you want to eat veggies make sure they are cooked to remove anti-nutrients – read more here
- Drink plenty of water, even if you don’t feel thirsty, start the day with a big glass of warm/hot fresh lemon water
- Plan your food intake for the day – put it in your schedule, eg. 1pm lunch which contains 100 – 150g of animal meat or organs with an avocado, balsamic vinegar and a piece of fruit, etc.
Studies supporting TRT
- Ronny et. al. Testosterone and the Prostate. Journal of Sexual Medicine. Vol. 2, Issues 3-4, P112-120. Pub. October 2014
- Khera et al. Testosterone Replacement in Men Treated and Untreated Prostate Cancer. Journal of Sexual Medicine. Vol. 1. Pages 143-149. Pub. 2013
- Yano M, Imamoto T, Suzuki H et al. The clinical potential of pretreatment serum testosterone level to improve the efficiency of prostate cancer screening. Eur Urol 2007; 51: 375–80
- Pichon A, Neuzillet Y, Botto H, Raynaud JP, Radulescu C, Molinie V, Herve JM and Lebret T. Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading. Prostate Cancer Prostatic Dis. 2015; 18:382-387.
- Travis Goodale, M.D., Archana Sadhu, M.D., Steven Petak, M.D., J.D., and Richard Robbins, M.D. Testosterone and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun; 13(2): 68–72. doi: 10.14797/mdcj-13-2-68
- B Son,1 S Ogawa,2 and M Akishita. Testosterone inhibits Aortic Aneurysm Formation Through Suppression of Inflammation. Innov Aging. 2018 Nov; 2(Suppl 1): 104. Published online 2018 Nov 11. doi: 10.1093/geroni/igy023.388 PMCID: PMC6229892
- Christina Villard MD, PhD Joy Roy MD, PhD, Marko Bogdanovic Per Eriksson PhD, Rebecka Hultgren MD, PhD. Sex hormones in men with abdominal aortic aneurysm. Journal of Vascular Surgery, Volume 74, Issue 6, December 2021, Pages 2023-2029
- Wenshan Lv, Na Du, Ying Liu, Xinyi Fan, Yunyang Wang, Xiujuan Jia, Xu Hou, Bin Wang. Low Testosterone Level and Risk of Alzheimer’s Disease in the Elderly Men: a Systemtic Review and Meta-Analysis. PMID: 26154489 DOI: 10.1007/s12035-015-9315-y
- Eka J. Wahjoepramono, Prita R. Asih, Vilia Aniwiyanti, Kevin Taddei, Satvinder S. Dhaliwal, Stephanie J. Fuller, Jonathan Foster, Malcolm Carruthers, Giuseppe Verdile, Hamid R. Sohrabi, and Ralph N. Martins. The Effects of Testosterone Supplementation on Cognitive Functioning in Older Men, CNS Neurol Disord Drug Targets. 2016 Apr; 15: 337–343. Published online 2016 Apr. doi: 2174/1871527315666151110125704
- Abdulmaged M. Traish. Testosterone and weight loss: the evidence. Curr Opin Endocrinol Diabetes Obes. 2014 Oct; 21(5): 313–322. Published online 2014 Aug 28. doi: 10.1097/MED.0000000000000086.