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Some men with a deficit of sex hormones who take testosterone replacement therapy may experience a benefit that goes beyond improved sexual function.

When men have both hypogonadism and poorly controlled type 2 diabetes, testosterone replacement therapy may improve both sexual function and cognitive function, according to preliminary results of a small clinical trial presented at the Endocrine Societys annual meeting in Atlanta.

The findings are welcome news to men with diabetes and hypogonadism, since they often have a poor quality of life, said the lead study author, Preethi Mohan Rao, MD, of the University of Sheffield, England, in a statement.

Hypogonadism in men, often called low T, develops when the body doesnt produce enough testosterone. While men can be born with the condition, it can also develop later in life and cause symptoms like reduced sex drive, erectile dysfunction, depression, and difficulty concentrating, according to the Mayo Clinic. Not all men with hypogonadism have symptoms, and testosterone replacement therapy is recommended only when they do, according to the Endocrine Society.

Sexual dysfunction is a common symptom of both hypogonadism and type 2 diabetes. Men with type 2 diabetes have about twice the risk of low testosterone, according to the American Diabetes Association. Men with poorly controlled diabetes or obesity, or both, have an even greater risk of low testosterone.

For the new clinical trial, researchers randomly assigned 65 men with hypogonadism and poorly controlled type 2 diabetes to take either placebo shots or injections of testosterone replacement therapy every 12 weeks for six months. Then researchers extended the trial for an additional six months, continuing treatment for men on testosterone and starting testosterone for men in the placebo group.

Over the first six months of the trial, men who took testosterone experienced significantly bigger improvements in quality of life and a larger reduction in symptoms associated with low testosterone.

When these men continued testosterone for an additional six months, they experienced overall symptom improvements as well as increased sexual function and libido, the trial found. In addition, these men performed significantly better on delayed verbal recall tests, assessments done to detect early signs of dementia.

The trial was small, however, and more research is needed before health practitioners change treatment approaches for men with hypogonadism and type 2 diabetes.

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Testosterone May Aid Memory in Men With Uncontrolled Diabetes - Everyday Health

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Jun 27th, 2022 | Filed under Testosterone

Cheung argues the guidelines are grounded in opinion, rather than fact, and it is not clear that trans women retain a biological advantage over cisgender women once they reduce their testosterone levels. Kieren Perkins, now the Australian governments most senior sports bureaucrat, echoes this concern and demanded to see FINAs proof. The Age newspaper declared in an editorial that the science is not settled.

The science isnt settled and most likely never will be, due to ethical and practical constraints. As one prominent researcher in the field explained, to settle the question would require a randomised, placebo-controlled trial conducted on transgender athletes. Could any researcher, in good conscience, give a transgender woman a sugar pill instead of suppressing her testosterone?

Instead, the FINA guidelines are based on the cumulative research and wisdom of some of the worlds leading authorities on physiology, sports law and anti-discrimination.

To understand how FINA came to this position, a good place to start is the Court of Arbitration for Sport (CAS) judgment in the case of South African Olympic champion Caster Semenya.

Semenya is not a trans athlete; she has identified as female since birth. Due to a biological difference in sex development (DSD), she naturally produces testosterone in the range of an adult man. In world athletics, this made her unbeatable over 800 metres.

In 2018, Semenya initiated an unsuccessful challenge against the legality of the International Association of Athletics Federations DSD regulations, which require women athletes with naturally high testosterone levels to artificially reduce them to within an accepted range before they can compete in track and field events.

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The Court of Arbitration for Sport judgment was written by former Federal Court of Australia judge and current Anti-Discrimination Board of NSW president Annabelle Bennett, a member of the FINA legal and human rights panel who framed its eligibility guidelines. Bennett also presided over the related case of another DSD athlete, Indias Dutee Chand.

Both cases are highly complex and turn on one of the critical points that FINA considered; the scientifically established relationship between testosterone and sports performance and the implications this raises for womens sport. As Bennett noted in her judgment, this case involves a collision of scientific, ethical and legal conundrums. It also involves incompatible, competing rights.

It would be difficult to find a more qualified jurist to resolve these same conundrums for FINA.

To help understand deliberations in the Semenya case, Bennett heard expert testimony from Doriane Coleman, professor of law at Duke University. Coleman helped draft the FINA guidelines with Bennett, Australian-born barrister and London-based CAS arbitrator James Drake and Adrian Jjuuko, an LGBT rights advocate from Uganda, a country where homosexuality is criminalised and transgender people are regularly arrested and beaten by police.

In a 2017 research paper simply titled Sex in Sport, Coleman argues that replacing biological sex with the more subjective, social construct of gender something the Obama administration had already done in anti-discrimination law would have potentially dire, unintended consequences for womens sport.

The 800m medallists at the 2016 Rio Olympics (from left): Francine Niyonsaba of Burundi, Caster Semenya of South Africa and Margaret Nyairera Wambui of Kenya.Credit:Getty Images

In her evidence in the Semenya case, she expanded on this theme, noting that due to the proven performance gap between biological men and women, even a middling male competitor can beat the worlds fastest woman. She told the hearing the overwhelming dominance of male-bodied athletes over female-bodied athletes was not the product of culture, resources, training or gender identity, but simply the result of having male gonadal sex, specifically testosterone and bio-available testosterone in the male range rather than the female range.

It doesnt take a sea of them to obliterate the females competitive chances at every level of competition, she warned. If only a very small subset turn out to identify as women, we will be overwhelmed.

This may sound far-fetched in swimming, where college champion Lia Thomas is the first transgender woman to have significant success in elite competition. In track and field, we have already seen what this looks like. At the Rio Games where Semenya won her second 800m Olympic title, the other two medallists were DSD athletes.

The science and medical experts who informed the FINA guidelines include Dr Michael Joyner, a physiologist from the Mayo Clinic, Dr Sandra Hunter, the director of the Athletic and Human Performance Research Centre at Marquette University, and Dr Natalie Nokov, a professor in endocrinology who works with gender-diverse and DSD children in Colorado.

There is no longer any serious argument about the sporting advantage derived from testosterone, which biological males produce from the onset of puberty at about 15 times the rate of women. As Joyner explained to the FINA extraordinary congress in Budapest, it is the reason that the current US national records for 50m, 100m and 200m freestyle events for 13 and 14-year-old boys are faster than the womens open world records for the same events.

Hunter told the congress: As a result of testosterone and possessing the Y chromosome, males build larger, stronger and faster muscles, they have larger lungs and airways, they have bigger hearts to pump more blood, and they have more oxygen carrying capacity within that blood. Males are taller. They have longer limbs arms and legs they have bigger feet to kick water, they have bigger hands to pull that water.

FINAs panel concluded that these advantages cannot be entirely reversed once a swimmer has been through puberty. Even if testosterone is suppressed, its performance-enhancing effects will be retained, Joyner said.

One of the researchers who convinced FINA on this point is University of Manchester biologist Emma Hilton. In a 2020 peer-reviewed paper, she analysed previous studies in this area. She found that where the male sporting advantage ranges from 11-13 per cent in sports like rowing, swimming and running, it is closer to 20 per cent in some athletic events and up to 40 per cent in weightlifting the only discipline in which an openly transgender woman has competed at the Olympics.

Weightlifter Laurel Hubbard, a transgender woman who competed for Team New Zealand at the 2020 Olympic Games in Tokyo. She was eliminated after three lifts.Credit:Getty Images

Hilton goes on to find that transgender women lose up to 5 per cent of their biological power advantage after two years of testosterone suppression. The loss of cardiovascular advantage, although less studied, could be as great as 15 per cent.

These figures, if accurate, mean that transgender women only surrender a fraction of the biological advantage they gained through puberty. In swimming, it means that, in rough terms, transgender women retain an 8-10 per cent advantage over cisgender women. This doesnt create level a playing field; merely a slightly less uneven one.

Thomas provides a compelling case study; although her times have slowed by about 5 per cent since she transitioned, she has gone from being ranked outside the best 500 men to the No.1 ranked woman in the NCAA.

This is why swimmers who transition from male to female after puberty will now be invited to compete in a proposed open category, rather than against cisgender women. Researchers will continue to do their work. In the meantime, FINA has based its guidelines on what we know.

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How FINA decided testosterone cant be ignored in the pool - Sydney Morning Herald

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Jun 27th, 2022 | Filed under Testosterone

Although your 40s are still really young, noticable changes do start happening with your body. Hormones begin to decline, loss of muscle can occur, as well as lack of energy and more. While there's nothing we can do about aging, there are positive lifestyle choices we can make that help keep us healthy in our later years. Eat This, Not That! Health spoke with experts who reveal what bad health mistakes to stop now and why. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Michael May, Medical Director and Principal Surgeon at Wimpole Clinic says, "Every person, young and old, should continue to prioritize personal grooming. It not only makes a man look more youthful and neater, but it also helps avoid sickness and infection. For example, keeping nails short prevents dirt and bacteria from sticking to them. Moreover, hair thinning is also evident at this age. Men should continue to wash, comb, trim, and moisturize their hair and beard to avoid ingrown hairs, dandruff, and foul odor."

Dr. Hector Perez, Chief Surgeon with Bariatric Journal reminds us, "It's important to schedule regular check-ups with your doctor, especially as you get older. Many people tend to slack on check-ups as they get older, thinking they're healthy enough or don't see the need to go if they're feeling fine. But this isn't the case! Regular check-ups are essential for catching any potential health problems early on, before they become serious."

Dr. Perez emphasizes, "Stress can take a toll on your health, both mentally and physically. As you get older, it's important to find ways to manage your stress and keep it under control. This may involve things like meditation, yoga, or simply taking some time for yourself every day to relax."6254a4d1642c605c54bf1cab17d50f1e

Dr. Perez states, "Getting enough sleep is crucial for your health, no matter your age. This is something that's often overlooked, but it's essential to ensure you get at least 7-8 hours of sleep every night. Not getting enough rest can lead to fatigue, irritability, and a host of other problems.

Kent Probst, personal trainer, kinesiotherapist and bodybuilder with Long Healthy Life shares, "Annual blood testing can reveal if your free and total testosterone levels are low. Age-related declines in testosterone may not initially cause symptoms, so you may not know your testosterone levels are low.In men, low testosterone levels can be associated with:

Loss of bone mineral mass

Loss of strength and muscle mass

Erectile dysfunction

Reduced libido

Depression

Dementia

Obesity

Type II diabetes

Cardiovascular disease"

Probst states, "Regular stretching has been shown to provide the following benefits:

Postural Stability

Balance

Injury Rehabilitation

Improved Range of Motion

Injury Prevention"

According to Probst, "In addition to being at risk for type II diabetes, hypertension and cardiovascular disease, being overweight can lead to a host of other problems such as osteoarthritis, gout, sleep apnea, Alzheimer's and several forms of cancer. Decreasing the health risks of obesity is probably the best reason to lose weight. Body Mass Index and waist circumference can help you determine how overweight you are. Healthy body weight can be determined by Body Mass Index (BMI) and waist circumference. A normal BMI is 18.5 to 24.9 and a normal waist circumference is under 40 inches (102 cm) for men. BMI can be determined by using a BMI calculator."

Heather Newgen

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Health Mistakes No Man Over 40 Should Make Eat This Not That - Eat This, Not That

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Jun 27th, 2022 | Filed under Testosterone

SEX life? What sex life?

When men hit their forties, they often feel exhausted, irritable and are the butt of grumpy old man jokes.

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They are always tired, suffer broken sleep and even night sweats or a bulging waistline.

Most men simply put it down to ageing but The Sun on Sundays resident GP, Dr Jeff Foster, says it could well be the manopause a serious medical issue where testosterone levels drop.

Dr Jeff said: It is comparable to but more subtle than menopause, where oestrogen levels drop suddenly. Once men hit 30, they naturally lose around one per cent of their testosterone every year. Its very gradual.

It happens to everyone, though it may occur at different ages. You slowly grind down to become a grumpy, fat old man who doesnt want as much sex as when they were 20.

Society tells men what is happening to them is normal for their age, but its not normal. Its a medical problem and there is something you can do about it.

Here, Dr Jeff reveals all you need to know if you or your partner are going through the manopause...

Similar to menopause, where dropping oestrogen levels affect women, testosterone reduction affects men.

The most common symptoms are feeling run down and more tired, with less get-up-and-go.

Some men arent as motivated to get a job done, have a lack of interest and are less sharp. You will find they cant remember things, such as peoples names. We call it brain fog for women.

Partners often complain their man is more grumpy and irritable, with less sex drive.

A classic sign is the loss of the morning erection, which is caused by a surge in testosterone. If it goes, something is wrong and in the long term may lead to erectile dysfunction.

You might suffer hot flushes or be working really hard at the gym but getting fatter.

Low testosterone can cause changes to blood pressure and cholesterol, an increased risk of type 2 diabetes, heart disease, osteoporosis and depression.

Women typically hit menopause in their forties or early fifties and that is most common age for men too.

But there is no specific age. If you had high testosterone levels in puberty, exercised and ate well, your testosterone might not drop until you are 90.

If you were born with a lower level or had a medical problem, you might notice it in your 20s.

I have one patient in his 70s who was told he had dementia, but forgetfulness and memory problems were because he had low testosterone.

After treatment, his memory has returned. A lot of our patients have been referred by their partner and want to know if there is a medical issue or if he just no longer loves them. It can destroy relationships.

Not everyone needs drugs. There are ways to improve testosterone.

Start by keeping a healthy BMI. Being overweight drives oestrogen, which suppresses testosterone.

If you are too thin, your body suppresses sex hormone production to conserve energy.

Diets high in protein and lower in carbs (but not taken out completely) tend to produce better testosterone levels.

Regular exercise is vital. Aim for three or four intense sessions a week that get your heart racing and tire you out, for 40-45 minutes.

You need at least six to seven hours sleep a night. Deep sleep triggers the testosterone surge in the morning.

Having sex may also help. Some studies show that if a man is abstinent for four weeks, testosterone levels rise, but after 12 weeks will drop.

No. Nor will supplements. There are no studies on humans which show these products work.

If they are claiming evidence it was probably tested on rats for a few hours. Its a con.

If lifestyle changes dont help, a simple blood test from your GP will show if your levels are low.

If your GP cant help or you are just told everything is normal, find a mens health specialist.

Low testosterone could also be caused by thyroid disease, type 2 diabetes or anaemia, so you need to rule those out.

Then you need testosterone therapy. It can be hard to get an NHS diagnosis. In medical school we get little training on testosterone.

One that best suits you, fits your lifestyle and your blood test results.

Usually a gel, cream or injection. Tablets that can be toxic to the liver should no longer be offered in the UK.

Davina McCall made a brilliant menopause documentary that has helped millions of women and doctors, some of whom felt they didnt know enough and read up on it.

The same thing now has to happen for men.

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No, youre not just old and off sexits the manopause... - The US Sun

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Jun 27th, 2022 | Filed under Testosterone

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Trans women athletes were effectively barred from international swimming competitions in June, when the sports world governing body, FINA, introduced one of the strictest rules for eligibility to compete in womens events.

Its inclusion policy sparked debate after stating that people assigned male at birth may participate only if they have not experienced any part of male puberty beyond Tanner Stage 2, or have transitioned before the age of 12, whichever is later. A separate open gender category will be created instead.

The ruling follows the success of Texan transgender swimmer Lia Thomas, who in March became the first trans swimmer to win a division-one National Collegiate Athletic Association swimming title, the peak of US college sport. Thomas competed for the University of Pennsylvania mens swim team from 2018 until 2020 before going through hormone therapy and joining the womens college competition.

Her win sparked debate about eligibility and fairness, and a discussion around how going through male puberty may or may not affect the performance of transgender athletes taking female hormones.

So, what are the stages of puberty? And what does the science say?

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Puberty marks the start of the bodys physical developments towards adulthood, some of which are considered to enhance elite sporting performance.

The stages of puberty discussed since FINA released its policy relate to a five-stage scale defined by the pediatrician James Tanner in 1969 (after 20 years of research). Stage 1 is pre-pubertal but it is Stage 2, the beginning or earliest phase of puberty, that has come under the spotlight. In boys, their testes start to grow and produce the hormone testosterone.

Testosterone acts by binding to a specific protein, the androgen receptor in muscles, which triggers an increase in muscle growth, mass and strength. It also increases bone density, endurance and levels of the oxygen-carrying protein hemoglobin, allowing more oxygen to circulate, and largely account(s) for the sex differences in athletic performance, according to research published by the American National Library of Medicine in 2018.

The testosterone of those female at birth peaks between 20 and 25 years of age before declining gradually, but generally remains at less than 2 nanomoles per litre at all ages. Mens circulating testosterone levels are generally 7.7 to 29.4 nmol/L. The FINA policy requires athletes in womens events to maintain their circulating testosterone below 2.5 nanomoles per litre, though in the past a level of less than 5 has been deemed reasonable and, prior to that, a level of less than 10 nmol/L.

Swimming is not the only sport to be reassessing eligibility. Also in June, cyclings world body, Union Cycliste Internationale, announced it would tighten rules for transgender athletes. It doubled the amount of time before a rider transitioning from male to female can compete and lowered the testosterone limit from 10 nanomoles per litre for a year before competition to 2.5 nmol/L for a two-year period. And the International Rugby League has excluded transgender athletes from international competition, including this years Rugby League Womens World Cup.

Quoted in The New York Times, the Mayo Clinic doctor Michael Joyner, an expert in the physiology of male and female athletes, notes that before puberty, girls grow faster than boys and have a competitive advantage. But after puberty, you see the divergence immediately as the testosterone surges into the boys. There are dramatic differences in performances.

The records for elite adult male swimmers are on average between 10 per cent and 12 per cent faster than the records of elite female swimmers, the Times reports.

There are social aspects to sport, but physiology and biology underpin it, Joyner says. Testosterone is the 800-pound gorilla.

There is no sex-based advantage for boys before puberty, according to research by an international team including Australian endocrinology expert David Handelsman. After the completion of puberty the end of Tanner Stage 5 according to international research published in 2018 the sex difference in athletic performance emerges as testosterone concentrations rise and testes produce 30 times more testosterone than before puberty.

Increased testosterone provides a major, ongoing, cumulative and durable physical advantage in sporting contests by creating larger and stronger bones, greater muscle mass and strength, and higher circulating hemoglobin as well as possible psychological (behavioral) differences, the authors say.

These render women, on average, unable to compete effectively against men in power-based or endurance-based sports.

That male bodies produce 15- to 20-fold greater testosterone after Stage 5 puberty than children or women at any age appears to explain why FINA made testosterone levels and puberty status the basis of its policy. (FINA was advised by three expert committees: one scientific, one legal and human rights, and one of athletes.)

The FINA Extraordinary General Congress, held in Budapest at the 2022 World Championships, saw the new inclusion policy passed by 71 per cent of voters.

One of the most contentious aspects of the discussion is the question of just how much advantage testosterone and its impact on those who have been through male puberty allows transgender athletes, who are using hormones to dramatically reduce the bodys receptivity to it.

FINA referred to, but didnt source, scientific evidence reported to it by a group of independent experts, of ongoing male biological advantage as proof of the need to act decisively.

Olympic champion and chief executive of the Australian Sports Commission, Kieran Perkins, is among those who say there is no significant study into what advantage, or disadvantage, elite trans athletes may have against elite female athletes. I read FINA talking about the science has been proved. What proof? Everything that I have seen suggests that, actually, were not really sure yet. When you talk to medical professionals who are dealing directly in this environment, there isnt clarity without compromise with the science of it all, Perkins says.

The Institute for Health and Sport at Victoria University and Austin Health have just started a study that aims to address current research limitations and provide clear data for policies and guidelines. But for now, there is no good data giving insight into the competitive advantage, or otherwise, of transgender women, says Associate Professor Ada Cheung, an endocrinologist at Austin Health and lead at Melbourne Universitys Trans Health Research Group.

There is some data but its not definitive and its not good-quality research, she says. What we know is, theres a big difference between males and females and its largely driven by testosterone, and thats why we have segregated sport.

No ones arguing theres no difference between males and females ... what we dont know is, how do feminising hormones impact on sporting performance after someones been through gender transition.

When a person starts taking feminising hormones, research has shown that fat mass increases while muscle mass and strength drop and blood-count hemoglobin the oxygen-carrying red blood cells decrease to female levels, Cheung says. But theres only one research study that has followed trans women out to three years, that involved 19 trans women. They showed that, at three years [after starting female hormones], muscle mass and strength was still declining and had not yet plateaued, she says.

There was no comparison, and in research we always want to compare with a control group. They didnt recruit cisgender men and women to compare them [the transgender women] to. We need to, and also control for height. (A cisgender man or woman is someone whose gender corresponds to the sex they have at birth.)

Evidence indicates that transgender women using hormone therapies experience significant reductions in not only testosterone levels, but muscle mass, muscle strength and haemoglobin levels within the first 12 months of therapies, says Dr Patrice Jones of Victoria University.

Having a larger stature and smaller muscles as a result of feminising hormones may even be a disadvantage, says Cheung, who likens it to having a four-wheel-drive with a hatchback engine: They might have the stature but dont have the gas to power it.

I cant say definitely: trans women might have a biological advantage over cis women but, then again, science also suggests maybe trans women may be at a disadvantage, says Cheung.

Lia Thomass time of 4:33.24 seconds over 500 yards (457 metres) of freestyle was nearly two seconds faster than that of runner-up Emma Weyant, who won silver in the 400-metre individual medley at the Tokyo Olympics. Cheung notes that Thomass time was still slower than last years NCAA winner, the pool record and the college record, and about 15 to 20 seconds slower than the mens field. Shes definitely competing within the womens range, and has been through hormone therapy for at least three years, she says. The science isnt sure whether she should be there or not.

The New York Times notes that when Thomas entered womens races, she rose substantially in national rankings. For example, Thomas had ranked 65th in the mens 500-yard freestyle but won the title as a female.

Lia Thomas is the manifestation of the scientific evidence, Dr Ross Tucker, a sports physiologist who consults on world athletics, told the Times. The reduction in testosterone did not remove her biological advantage.

Dr Michele OConnell, paediatric endocrinologist at the Murdoch Childrens Research Institute, says the suppression of puberty from Tanner Stage 2 or before age 12 whichever is later ruling will be almost impossible to apply, in and of itself, and will bring no guarantee of added fairness because childrens bodies mature at different rates.

The ruling may also push children to make decisions that have long-term effects, including on their fertility, before they are ready, says OConnell.

In boys, puberty can start anywhere between ages 9 and 14, OConnell says (puberty in girls usually starts between the ages of 8 and 12). Athletes assigned male at birth who begin puberty early at 9 years old would have quite a different state of development from someone who progresses to Tanner Stage 2 at age 13, she says.

The biggest increase in testosterone is from around mid-puberty, so if you did have Tanner 2 at 9, and were progressing through the usual tempo of puberty, you may well have your growth spurt [by the age of 12].

OConnell says the cut-off point for timing of pubertal progression poses risks to children who, while they may know they are trans, may wish to preserve their fertility, which would require their body reaching a further stage of sexual maturity than it is at Tanner Stage 2.

This is talked about in clinical circles, she says. In all the recommended guidelines [for gender-affirming care], they talk about fertility and discussing that you might want to preserve some fertility and keep your options open before you go down gender-affirming pathways.

At Tanner 2, you wouldnt be able to do that. Youd have to make the decision, Im going to be an elite sportsperson and turn off my puberty now versus, Im going to wait a bit longer and collect some sperm.

A FINA spokesperson has said the idea that the ruling would create a rush to transition among aspiring swimmers was wrong. This is not saying that people are encouraged to transition by the age of 12. Its what the scientists are saying, that if you transition after the start of puberty, you have an advantage, which is unfair, FINAs James Pearce told the Press Association on behalf of the organisations president, Husain Al-Musallam.

Theyre not saying everyone should transition by age 11, thats ridiculous. You cant transition by that age in most countries and hopefully you wouldnt be encouraged to. Basically, what theyre saying is that it is not feasible for people who have transitioned to compete without having an advantage.

But the ruling does present a reason for possible urgency around intervention, says OConnell and that is not based in good science, and not in a persons best interest its for the potential benefit of others who would be competing against them, rather than for the individuals wellbeing.

While its framed as were trying to include them, the likelihood is the only people who are eligible to compete under this scenario are those who have a very firm, established female identity from an early age, or who have anxiety around sitting with any pubertal progression, she says.

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And even then, there may be a good argument to have some early pubertal progress for bone health or fertility.

Most young people who present to doctors seeking gender transition do so after the age of 12 anyway, and it would be extremely difficult to determine retrospectively when an athlete went through Tanner Stage 2 and entered Stage 3. I cant see whos going to fall in [within the FINA rules]. There is no good, one-size fits all as to when this progression happens.

FINA did not respond to a request for comment. Here is its full statement.

In the meantime, the debate about the necessity of defining who can compete in womens sport continues.

Addressing FINA before the vote on its new policy was passed, Australian Olympic Champion Cate Campbell spoke for it on the grounds that, Women, who have fought long and hard to be included and seen as equals in sport, can only do so because of the gender category distinction. To remove that distinction would be to the detriment of female athletes everywhere.

Meanwhile, Lia Thomas told Sports Illustrated in March, I just want to show trans kids and younger trans athletes that theyre not alone. They dont have to choose between who they are and the sport they love.

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What are the stages of puberty and are they a good measure of sporting power? - Sydney Morning Herald

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Jun 27th, 2022 | Filed under Testosterone

What are probiotics for men and why might you need to be taking them? If youre concerned about your gut heath, and want to know how you can help to boost your digestive function and potentially improve your immunity and mental health, probiotics have the potential to support you in these areas. On top of this, they may help with weight loss, which can be useful for men over 50, after testosterone drop off makes it harder to keep body fat down.

Dr Giuseppe Aragona, a GP and online doctor for OnlinePrescriptionDoctor (opens in new tab), explains the benefits of probiotics on mens health. One of the best ways to take care of your digestive and overall health is through probiotic supplements, he says. Probiotics are beneficial micro-organisms that live in your gut and help to support your physical and mental health. Every person's gut microbiome has different bacteria so your body's reaction to probiotics may be different to someone else. However, overall probiotics are beneficial for men's health, and support wellbeing.

Below, well delve into each benefit of probiotics for men, and give you an overall idea of why your probiotic needs might be different as a man.

A study in the Journal of Neurogastroenterology and Motility (opens in new tab) indicates that there is a direct link between sex hormones and the microbiome. This means that women and men may have differing needs when it comes to probiotic supplementation, as we have different concentrations of different sex hormones. Some strains of probiotics for men may actually be better for you than standard types, or probiotics for women, as theyre tailored to your needs as a man.

Aragona agrees that probiotics make a palpable difference to gut health. The main benefits of taking probiotics would be replenishment of good bacteria in your gut, reducing digestive disorder symptoms, supporting mental health, boosting the immune system and helping with weight loss.

You may have heard the term gut-brain axis and wondered what it means. A study in the Journal of Medicine and Food (opens in new tab) supports growing evidence that there is a direct link between the gut and the brain. The gut microbiome may even have the power to control your food choices, as it uses the nervous system and the vagus nerve to communicate with our brains. Theres a reason the gut is known as the second brain. With this in mind, a healthy gut microbiome can support good mental health, and an unhealthy gut microbiome can contribute to mental health issues.

Aragona says that probiotics have the power to improve your mood and support better overall mental health. Probiotics can also boost mood, cognitive function and can help to lower stress and anxiety. They may also prevent the development of mental health issues, such as depression in men, he says. However, of course, you cannot rely on probiotics, and if you are suffering with mental health issues you should consult a medical professional.

A study in Food Research International (opens in new tab) indicates that there is a close relationship between a healthy gut microbiome and good immunity. A diverse and healthy gut microbiome can reduce gut wall permeability, which in turn prevents bad microorganisms from traveling through the gut wall into the blood, which serves as a highway to the rest of the body.

Probiotics can help your body to fight off illness and disease as they enhance the immune system, and of course a healthy immune system is key for a healthy functioning body, says Aragona. You can't totally rid your body of bad bacteria from your system, but you can balance your good and bad bacteria out by taking probiotics. Men with busy lives may find that they don't have time to ensure they are eating all the right foods every day, and so probiotics can help with this and help to balance out your system and keep your digestive system healthy and functioning.

Another study in the Journal of Autoimmunity (opens in new tab) found that there are gender-specific differences in immunity, further suggesting that tailored probiotics for men might be a better choice. Additionally, the study indicates that our gut microbiome can produce so-called happy hormones serotonin and dopamine, illustrating the intrinsic relationship our gut health has with our mental health.

The journal Pharmacology & Therapeutics (opens in new tab) has published research that indicates that probiotics may be a new frontier in therapeutic aids to support mental health and cognitive conditions, such as anxiety, depression, autism spectrum disorders and Parkinson's disease. It also supports the gender split in probiotic requirements due to the interaction of the microbiome with our sex hormones.

As a man, its important to care for your prostate, with one in eight men diagnosed with prostate cancer in their lifetime. This goes up to six cases in 10 in men who are 65 or older, with the average age of diagnosis being 66. With this in mind, taking care of your prostate might be of particular concern for men over 50.

There is evidence that probiotics can help to reduce inflammation in the prostate, according to a trial in La Clinica Terapeutica (opens in new tab). The trial found that probiotics reduce the bacterial load of E. coli and E. faecalis in urine cultures, which promotes better prostate health and can help prevent swelling of the prostate (prostatitis) which can lead to further prostate issues.

Nutritionist Jenny Tschiesche, of sugar-free and vegan vitamin brand Nutriburst (opens in new tab), tells LiveScience about the effects that probiotics can have on testosterone levels. The stress hormone cortisol suppresses testosterone, and it has been proven in studies that probiotics can reduce cortisol levels therefore increasing testosterone levels, she says.

If you are trying to conceive and are looking for more ways to support your fertility, check out these 10 tips for men trying to conceive.

Aragona says that after the male menopause, where testosterone levels drop off, some men see an uptick in their weight. Probiotics can also help men to manage their weight. Aging and hormonal change can contribute to weight gain in men, especially when testosterone levels drop, he says. Probiotic strains such as bifidobacterium lactis can help with any unwanted weight gain and promote healthy weight loss.

A study in Current Obesity Reports (opens in new tab) supports this point, indicating the beneficial effects on weight reduction and other metabolic parameters via probiotic involvement in gut microbiota modulation. In short, a healthy gut microbiome can help you keep the pounds off, although the study states that more human trials need to be conducted in the area.

So, how individualized should your probiotics be?Aragona says that men and women often experience different digestive issues, which is another reason they tend to require different probiotics.

The type of probiotic strain being ingested is always dependent on the person, as not one person has the same gut bacteria or microbiome, he says. And the same goes for men's and womens probiotics. While they offer similar benefits, ultimately, they have been made specifically for their sex. For example, while women more commonly experience greater issues in the lower digestive tracts, such as constipation or IBS, men experience more in the upper gastrointestinal such as acid reflux, and so the needs differ and it is best to stick to the probiotic made for you.

This article is for informational purposes only and is not meant to offer medical advice.

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Jun 27th, 2022 | Filed under Testosterone

In this moderated poster presentation at the American Urological Association (AUA) 2022 meeting, Neal Shore, MD, detailed the safety analysis of the phase 3 HERO trial1 that ultimately led to the 2020 US Food and Drug Administration (FDA) approval of relugolix, the first and only oral gonadotropin-releasing hormone (GnRH) antagonist.

Patients in HERO were randomized in a 2 to 1 ratio to receive relugolix or leuprolide. Those who met the inclusion criteria were not considered appropriate for treatment with interventional therapy, such as surgery or radiation, but were appropriate candidates for starting androgen-deprivation therapy. Patients had to be treated for at least 1 year. Primary endpoints of the study focused on the efficacy of testosterone suppression. Other secondary endpoints included changes in prostate-specific antigen (PSA). The study also aimed to investigate the safety profile of relugolix.

Dr Shore noted that there has been a long-standing belief that luteinizing hormonereleasing hormone (LHRH) agonists are associated with cardiovascular events. In this vein, the study specifically evaluated the rate of major adverse cardiovascular events (MACE), which include nonfatal myocardial infarction, nonfatal cerebrovascular event, or death from any cause.

The investigators examined both the rate of events and the duration of use prior to experiencing an adverse event (AE).

Dr Shore illustrated that patients experienced a higher rate of AEs, such as hot flashes, fatigue, and diarrhea, with oral relugolix compared with leuprolide; however, all AEs were of grade 1 or 2 severity. There was also a slight increase in patients experiencing arthralgias in the oral relugolix arm. He presented a table comparing MACE that showed a significant odds ratio between patients who received an LHRH agonist every 3 months and those who took relugolix daily; the findings showed that MACE tended to occur earlier and at a higher rate in the LHRH group. Dr Shore commented that he believes this difference is likely related to the mechanism of action of an LHRH agonist, when compared to a GnRH antagonist, and that this accounts for the subsequent risk seen in the cardiovascular AE profile and, ultimately, the safety of the drug.

In this podium discussion at AUA 2022, Dr Shore began by outlining his desire to explain how relugolix (an oral agent that acts as a GnRH antagonist) compares with the standard of care (an LHRH agonist). This study was a pooled safety analysis investigation of 2 randomized controlled trials, the C27002 trial2 and the HERO study,1 that compared daily relugolix with leuprolide given every 3 months.

C27002 was a phase 2, randomized, open-label, parallel-group study of 125 men with advanced prostate cancer who were stratified 2 to 1 to either leuprolide or oral relugolix. Patients in the leuprolide arm received a 22.5-mg subcutaneous injection. The relugolix loading dose was 3 pills on the first day and 120 mg daily thereafter. Patients were given relugolix over 24 weeks. The study reported that these participants had reduced and sustained testosterone-to-castration levels, and that the drug was well-tolerated and had an acceptable safety.

In comparison, HERO was a phase 3, randomized, open-label, parallel-group study in which consistent results showed that use of relugolix led to sustained testosterone suppression over 48 weeks while maintaining an acceptable safety profile. Of particular interest, when compared to leuprolide standard of care, relugolix maintained a 54% decrease in the risk of MACE.

HERO was a pivotal trial that led to the registration and FDA approval of oral relugolix. Its design was similar to the C27002 clinical trial, except it included 934 patients. The primary endpoint for HERO were testosterone suppression; its many secondary endpoints included testosterone recovery, safety, tolerability, and PSA correlates.

Dr Shore focused on the pooled analyses and safety of these 2 landmark trials. Overall, AEs were comparable between the treatments. The rate of serious AEs (grade 3 and higher) was 9.5% in the relugolix arm versus 12% in the leuprolide arm. The rate of AEs leading to discontinuation was 3.6% in the relugolix arm versus 0.3% in the leuprolide arm. Dr Shore also emphasized the reports of MACE, which included nonfatal myocardial infarction, nonfatal cerebrovascular events, or death. For any grade, there was a 2.8% versus 6.3% risk of MACE for patients receiving relugolix compared to leuprolide; hot flashes (55.2% vs 52.4%) and fatigue (22.3% vs 19.3%) were similar between the 2 groups. Notably both low-grade constipation (11.7% vs 9%) and diarrhea (11.7% vs 6.3%) were worse in the relugolix arm when compared to the leuprolide arm. Dr Shore attributed this finding to relugolix being an oral drug that requires hepatic metabolism, which may contribute to an earlier onset of gastrointestinal symptoms.

Regarding duration and time of onset of AEs overall, patients given relugolix reported earlier experiences of AEs. When looking at MACE and pooling the analysis together in the C27002 phase 2 study, the findings corroborated what was seen in the HERO triala 54% reduction in the risk of a patient experiencing a MACE. During the question period, Dr Shore was asked if the patient cohorts were well-balanced in the pretreatment period prior to beginning the investigation of MACE. He answered affirmatively and said that one of the exclusion criteria for the trial was experience of MACE within 6 months of trial eligibility. A total of 15% of patients in each cohort had a history of experiencing a MACE more than 6 months before trial enrollment. He added that demographics were well-balanced between the cohorts, as were other cardiovascular risk factors that may contribute to MACE, such as glycated hemoglobin level and preenrollment electrocardiogram results.

Overall, Dr Shore expressed excitement that oral relugolix, a highly selective GnRH antagonist, is the first drug in its class to receive FDA approval. Its convenient once-daily administration and support from the pooled safety analyses trials help to highlight its potential for improving patient care.

David Ambinder, MD is a urologyresident at New York Medical College / Westchester Medical Center. His interests include surgical education, GUoncology and advancements in technology in urology. A significant portion of his research has been focused on litigation in urology.

References

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Safety of Relugolix in Advanced Prostate CancerAnalysis from the HERO Trial - DocWire News

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Jun 27th, 2022 | Filed under Testosterone

FOI 22/580

20th April 2022

Dear

Thank you for your enquiry dated the 24th March 2022 where you requested further detail on the Yellow Card data for seizures reported whilst on testosterone treatment.

When considering the provided spontaneous Adverse Drug Reaction (ADR) data, it is important to be aware of the following points:

A reported reaction does not necessarily mean it has been caused by the drug or vaccine, only that the reporter had a suspicion it may have. The fact that symptoms occur after use of a drug or vaccine, and are reported via the Yellow Card scheme, does not in itself mean that they are proven to have been caused by the drug or vaccine. Underlying or concurrent illnesses may be responsible and such events can also be coincidental.

It is also important to note that the number of reports received via the Yellow Card scheme does not directly equate to the number of people who suffer adverse reactions and therefore cannot be used to determine the incidence of a reaction. ADR reporting rates are influenced by the seriousness of ADRs, their ease of recognition, the extent of use of a particular drug or vaccine and may be stimulated by promotion and publicity about a drug or vaccine. Reporting tends to be highest for newly introduced medicines during the first one to two years on the market and then falls over time. For these reasons the above data should not be used as a basis for determining incidence of side effects. During assessment we take into account of the variable levels of reporting as part of our monitoring procedures.

To note, past medical history is not a mandatory field on a Yellow Card report and therefore is not always provided. Consequently, there may be patients in these reports that have a past medical history of epilepsy but due to the lack of information we cannot determine this.

Firstly, it may be helpful to provide some information on the dictionary that we use when classifying ADR reports. MedDRA (Medical Dictionary for Regulatory Activities) is a clinically validated international medical terminology dictionary. Its organised by System Organ Class (SOC), divided into High-Level Group Terms (HLGT), High-Level Terms (HLT), Preferred Terms (PT) and finally into Lowest Level Terms (LLT). We use this to code our ADR reports within our database.

Further to your request, I can confirm that up to the 30th March 2022 the MHRA has received a total of 7 UK, spontaneous suspected adverse drug reaction (ADR) reports of the HLGT Seizures (incl subtypes) in patients on testosterone therapy, which can also be seen on the interactive Drug Analysis Print (iDAP) for testosterone.

We have also enclosed Category 1b data on these cases which includes the following data fields relating to the above 7 ADR reports:

Please find the enclosed sheet containing the Category 1b data; Table 1: 1b line listing for these reports, Table 2: patient sex as aggregate values and Table 3: patient age as aggregate values.

I hope the information provided is helpful, but if you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within two months of the date of this response; and can be addressed to this email address.

Yours sincerely,

FOI Team,

Vigilance and Risk Management of Medicines Division

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Freedom of Information request on the yellow card reports following testosterone treatment (FOI 22/580) - GOV.UK

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Jun 17th, 2022 | Filed under Testosterone

Purpose of review: The purpose of this article is to examine the contemporary data linking testosterone therapy in overweight and obese men with testosterone deficiency to increased lean body mass, decreased fat mass, improvement in overall body composition and sustained weight loss. This is of paramount importance because testosterone therapy in obese men with testosterone deficiency represents a novel and a timely therapeutic strategy for managing obesity in men with testosterone deficiency.

Recent findings: Long-term testosterone therapy in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference and BMI and improvement in body composition. Further, testosterone therapy ameliorates components of the metabolic syndrome. The aforementioned improvements are attributed to improved mitochondrial function, increased energy utilization, increased motivation and vigor resulting in improved cardio-metabolic function and enhanced physical activity.

Summary: The implication of testosterone therapy in management of obesity in men with testosterone deficiency is of paramount clinical significance, as it produces sustained weight loss without recidivism. On the contrary, alternative therapeutic approaches other than bariatric surgery failed to produce significant and sustained outcome and exhibit a high rate of recidivism. These findings represent strong foundations for testosterone therapy in obese men with testosterone deficiency and should spur clinical research for better understanding of usefulness of testosterone therapy in treatment of underlying pathophysiological conditions of obesity.

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Testosterone and weight loss: the evidence - PubMed

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Jun 8th, 2022 | Filed under Testosterone

Resistance exercise has been shown to elicit a significant acute hormonal response. It appears that this acute response is more critical to tissue growth and remodelling than chronic changes in resting hormonal concentrations, as many studies have not shown a significant change during resistance training despite increases in muscle strength and hypertrophy. Anabolic hormones such as testosterone and the superfamily of growth hormones (GH) have been shown to be elevated during 15-30 minutes of post-resistance exercise providing an adequate stimulus is present. Protocols high in volume, moderate to high in intensity, using short rest intervals and stressing a large muscle mass, tend to produce the greatest acute hormonal elevations (e.g. testosterone, GH and the catabolic hormone cortisol) compared with low-volume, high-intensity protocols using long rest intervals. Other anabolic hormones such as insulin and insulin-like growth factor-1 (IGF-1) are critical to skeletal muscle growth. Insulin is regulated by blood glucose and amino acid levels. However, circulating IGF-1 elevations have been reported following resistance exercise presumably in response to GH-stimulated hepatic secretion. Recent evidence indicates that muscle isoforms of IGF-1 may play a substantial role in tissue remodelling via up-regulation by mechanical signalling (i.e. increased gene expression resulting from stretch and tension to the muscle cytoskeleton leading to greater protein synthesis rates). Acute elevations in catecholamines are critical to optimal force production and energy liberation during resistance exercise. More recent research has shown the importance of acute hormonal elevations and mechanical stimuli for subsequent up- and down-regulation of cytoplasmic steroid receptors needed to mediate the hormonal effects. Other factors such as nutrition, overtraining, detraining and circadian patterns of hormone secretion are critical to examining the hormonal responses and adaptations to resistance training.

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Hormonal responses and adaptations to resistance exercise and ... - PubMed

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Jun 8th, 2022 | Filed under Testosterone
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