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Men, Do You Need Testosterone Supplementation?

Steve Parker MD, Advanced Mediterranean Diet, Ketogenic Mediterranean Diet

Testosterone is one reason men are better than women at push-ups

I’m running across more middle-aged and older men who are taking testosterone supplements. I don’t know if it’s a national trend or simply a Scottsdale, AZ, phenomenon.

The Endocrine Society in 2010 published guidelines regarding testosterone therapy for men who are androgen-deficient. Here are their recommendations on who should be tested for deficiency, and how:

1.1 Diagnosis and evaluation of patients with suspected androgen deficiency

“We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.

We suggest that clinicians measure serum testosterone level in patients with clinical manifestations shown in Table 1A. We suggest that clinicians also consider measuring serum testosterone level when patients report the less specific symptoms and signs listed in Table 1B.

TABLE 1.
Symptoms and signs suggestive of androgen deficiency in men

A. More specific symptoms and signs
Incomplete or delayed sexual development, eunuchoidism
Reduced sexual desire (libido) and activity
Decreased spontaneous erections
Breast discomfort, gynecomastia
Loss of body (axillary and pubic) hair, reduced shaving
Very small (especially < 5ml) or shrinking testes

Inability to father children, low or zero sperm count
Height loss, low trauma fracture, low bone mineral density
Hot flushes, sweats

B. Other less specific symptoms and signs
Decreased energy, motivation, initiative, and self-confidence
Feeling sad or blue, depressed mood, dysthymia
Poor concentration and memory
Sleep disturbance, increased sleepiness
Mild anemia (normochromic, normocytic, in the female range)
Reduced muscle bulk and strength
Increased body fat, body mass index
Diminished physical or work performance

We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test.

We recommend confirmation of the diagnosis by repeating measurement of total testosterone.

We suggest measurement of free or bioavailable testosterone level, using an accurate and reliable assay, in some men in whom total testosterone concentrations are near the lower limit of the normal range and in whom alterations of SHBG are suspected.

We suggest that an evaluation of androgen deficiency should not be made during an acute or subacute illness.”

Harriet Hall thinks testosterone is being over-prescribed.

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Are You About to Pull the Trigger on a Sous Vide Device? Watch Us Unbox Our New Anova Precision Cooker

My wife got interested in the sous vide cooking method in 2016. She gave her original Anova cooker away to someone and replaced it with another brand that broke and shocked her, literally. We just got our new Anova and made this unboxing video. (I’m told that unboxing videos are “a thing.”)

We’ve noticed in our corner of the universe that steaks are getting more expensive. Sous vide cooking allows us to use cheaper and tougher cuts of meat and it comes out very tender. The method often yields foods that are also more flavorful and juicier compared to other cooking styles.

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Mediterranean children stopped eating the Mediterranean diet, and it shows 

“A senior official at the World Health Organization pronounced the Mediterranean diet dead last week — a casualty of changing lifestyles in countries such as Greece, Spain and Italy.

New data from the organization shows that children in southern Europe have obesity rates higher than 40 percent. In a presentation Thursday to health officials at the European Congress on Obesity, João Breda, the program manager for nutrition, physical activity and obesity at the WHO Regional Office for Europe, blamed the incursion of sodas and snacks into the region’s traditionally low-sugar, produce-heavy diet.

“The Mediterranean diet for the children in these countries is gone,” Breda told the assembled officials. “There is no Mediterranean diet anymore. … The Mediterranean diet is gone, and we need to recover it.”

Source: Mediterranean children stopped eating the Mediterranean diet, and they now have the highest obesity rates in Europe – The Washington Post

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Arden’s Father Attended the Novo Nordisk Insulin-Pricing Summit 

I’m infuriated about the price some folks have to pay for their life-saving insulin. Big Pharma knows it’s a major PR problem for them. Scott Benner is the father of a T1 diabetic girl, Arden. He attended Novo Nordisk’s recent PR conference in Indianapolis.

“If you think that you have a commonsense idea that fixes the problem – I promise that you don’t. The issue of insulin pricing, in my estimation, is a microcosmos of every political stalemate that I’ve ever considered. On the surface it feels like someone just needs to do the “right thing”. Problem is, there are too many ‘someones’ and they all hold a different version of what doing the ‘right thing’ means. – no magic wand.”

Source: Novo Nordisk Summit — Arden’s Day and The Juicebox Podcast

I tried to leave a comment at Scott’s blog but couldn’t get it to work. So here it is:

I suspect Sarah P (an earlier commenter) is on the right track.

How much does Novo Nordisk sell their insulin for in socialized systems like Britain’s National Health Service? I bet it’s a lot lower than the retail price in the U.S. And yet they are quite likely making a decent profit on sales in the U.K.

On the other hand, if the U.S. market is subsidizing markedly lower drug prices in other countries, that needs to change.

Many drugs are dramatically cheaper outside the U.S. Look up hepatitis C treatment and rattlesnake anti-venom, for example. But I can’t cross the border into Mexico, buy those drugs, then return to the States and sell them here at a lower price. That’s illegal. Big Pharma would never allow that law to be changed.

-Steve

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Diabetes Exposure in Womb Tied to Later-Life T2 Diabetes

How much of this is socioeconomic vs genetic vs physiologic?

“Diabetes during pregnancy may put offspring at a higher risk for incident type 2 diabetes later in life, an analysis of indigenous and non-indigenous Canadians found.

Overall, those who had been exposed to type 2 diabetes and gestational diabetes in utero had a higher risk for developing type 2 diabetes before the age of 30 compared with those who had no exposure to diabetes (3.19 versus 0.80 versus 0.26 cases per 1,000 person-years, respectively, P<0.001), according to Brandy Wicklow, MD, MSc, of the University of Manitoba in Winnipeg, and colleagues.”

Source: Diabetes Exposure in Womb Tied to Later-Life T2D | Medpage Today

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You Can Get Cheap Insulin at Walmart Without an Rx in Many U.S. States

Good news from Sysy Morales at Diabetes Daily:

“Did you know that Walmart sells Novolin Regular human insulin and Novolin N insulin (commonly known as NPH) for approximately $20 a vial? In most states, you don’t even need a prescription.

These older insulins were what people with diabetes relied on during the 1980s and 1990s before new insulin came along like Humalog, Novolog, Levemir, and Lantus. The activity profiles of R and NPH were combined in patients with type 1 diabetes so that there would be peaks and valleys throughout the day. A peak of insulin action would cover breakfast, lunch, and dinner. Snacks may also be needed at various times to avoid hypoglycemia. Patients were generally injecting both R and NPH in the morning before breakfast and then again before dinner, but of course, there were various schedules provided to patients. Meals on these two insulin types were kept somewhat consistent regarding the quantity of food and carbohydrate intake as well as mealtimes.”

Source: You Can Get Cheap Insulin at Walmart Without an RX in Some States

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The New Accuracy Standard for Home Glucose Monitoring Devices: +/- 15%

Finger-pricking four times a day gets old real quick!

The U.S. Food and Drug Administration has issued new guidelines for manufacturers of home glucose monitoring devices. The old standard was that the glucose reading of the device had to be within 20% of the actual or true value compared to a medical lab-grade machine.

For example, if the device read 165 mg/dl, the true value could be anywhere from 132 to 198 mg/dl.

Under the new +/- 15% rule, the true number should be between 140 and 190 mg/dl.

I bet you thought your device was more accurate than that.

From the FDA to device manufacturers:

“Blood glucose test results are used by people with diabetes to make critical decisions about their treatment; therefore, it is important that the results are accurate so that nutritional and drug dosing errors are better avoided. Your studies should demonstrate that your SMBG [self-monitoring of blood glucose] is sufficient for this purpose by showing that 95% of all SMBG results in this study are within +/- 15% of the comparator results across the entire claimed measuring range of the device and that 99% of all SMBG results are within +/- 20% of the comparator results across the entire claimed measuring range of the device.”

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