Expert Diet and Weight Loss Solutions

Whenever you see someone looking great, happy and healthy, confident in their relationship and killing it at work, the first question that usually comes to mind is: What's your secret?

Of course, there has to be some unbeknownst-to-us reason for how they're holding it all together and living their best life. Being the creatures of curiosity we arewe want in on how they do it.

While it comes as no surprise that theanti-obesity medication Ozempic is responsible for the downsizing of America lately, what if we told you there is another secret to weight loss that no one is talking about?

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We asked a doctor who specializes in obesity and weight loss thoughts on the subject. Here's what he had to say.

"No one talks about it because it's boring," he explains. "It isn't flashy or social media worthy. Your favorite celeb isn't touting consistency. But consistency means eating a little less and moving a little more every single day."

He says it also means eating healthy meals every day, and not starving yourself one day and bingeing the next, or starving yourself all day long only to overeat at night because you're so hungry. "Consistency is creating an exercise plan that you can stick with daily, not crushing it in the gym one day and then not stepping foot in it for a week," he adds. "Consistency is the key to weight loss and a healthy lifestyle."

If you've tried eating healthy and working out consistently but find yourself facing an unmanageable number on the scale,Dr. Sekhar says weight loss surgery is proven to be the most effective treatment for the extremely obese. "Studies have shown that weight loss surgery produces greater weight loss in a year than diet alone," he explains, "And while weight regain is possible with surgery, the total amount of weight loss is still significant after five years.

"The best way to lose weight is to slightly decrease your calorie input and slightly increase your calorie output, sharesDr. Sekhar.This means keeping track of what you eat and how much you move daily. He also advises using a calorie-counting app like MyFitnessPal or BMR calculator to track your daily movement and food. "Better yet, consult with a registered dietitian to figure out exactly how many calories you need per day," he adds. Finally, try to incorporate weight lifting or another type of strength training into your fitness routine to increase your daily calorie burneven at rest.

WhileDr. Sekhar is a big proponent of apps tokeep track of your calorie intake and stay within that calorie level, he does acknowledge counting calories doesn't work for everyone. If that's the case for you, he also suggests dividing your plate in half at every meal. "One half of your plate you fill with vegetables and fruits, one-quarter of the plate is protein and the other quarter of the plate is high-fiber carbohydrates," he says.

By using this plate hack, increasing your activity level incorporating a strength training (muscle building) activity into your weekly fitness routine, you'll start to see progress. "Get off the diet roller coaster and don't starve yourself either," he warns. You're only setting yourself up for a binge later. "Eat healthy foods daily, manage your stress levels and get adequate amounts of high-quality sleep, which means waking up and going to bed around the same time each night."

If you've ever heard someone say they live by the 80/20 rule for weight loss but have no idea what this means, allow us to explain. "The idea is that you eat healthy 80% of the timeand 20% of the time, you can eat whatever you want, saysDr. Sekhar.

All foods can fit into a healthy diet, but some should be the primary focus and some should be eaten in lesser amounts. He also notes the theory of 80/20 is rooted in some truth, but it can lead to binge eating and other disordered eating patterns if not approached properly.

Sorry to be the bearer of bad news, butDr. Sekharsays fast weight loss is neither healthy nor permanent. "Aim to lose no more than 1 to 2 pounds per week by eating a little bit less and moving a little bit more every day," he advises. And one more time for the people in the back: Stay consistent!

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Who doesnt want to be lean and slim without putting in effort?

Physical activity or exercise has plenty of physical, emotional and mental benefits, but it doesnt necessarily mean you will shed the kilos easily by partaking in it.

Some people hate exercising and are not motivated to push or challenge themselves they simply dont get the same endorphin release as others.

Reluctant exercisers need external motivators to keep going, like the promise of boosting their overall health, to look good, or because their physician has said they must do so to stay alive.

Our ancestors remained active out of necessity, not choice: they had to move to hunt for food.

Once fed, they rested to conserve energy because there was nothing much to do.

When food supply diminished, theyd be on their feet, hunting again.

Resting is a natural human tendency, so dont beat yourself up if thats what you like to do.

With advances in technology and labour-saving devices, the world is now accessible with our fingers, and even minimal movement seems to have taken a backseat.

Thats why we are blossoming sideways.

Is that bad?

It depends on how much weight youre putting on.

One 2021 study published in the Annals of Epidemiology found that people who started adulthood with a body mass index (BMI) in the normal range, and became overweight but never obese in later life, tend to live the longest.

Adults in this category lived longer than even those whose BMI stayed in the normal range throughout their life.

However, those who started adulthood as obese and continued to add weight had the highest death rate.

So, a bit of extra weight is okay as long as you dont balloon out of control.

Any healthy person can lose weight without exercising you just need a lifestyle tweak and some discipline.

Prioritise what you enjoy doing instead of struggling to achieve unrealistic goals.

Try some of the following tips to help you trim down.

Chew your food thoroughly and savour every morsel before you swallow it to feel full faster. AFP

> Hydrate with water

Make it a point to drink two glasses of water after waking up to help activate your internal organs.

The water will help to remove any toxins before your first meal of the day.

Water helps regulate body temperature, lower blood pressure, carry nutrients and oxygen to various cells, and maintain optimal kidney function.

Replacing sugary drinks and alcoholic beverages with water can help reduce your daily caloric intake.

Whenever you feel hungry, you may actually be thirsty, or even slightly dehydrated.

So dont reach out for snacks, but drink a big glass of plain water first and ideally wait 30 minutes before eating.

Drinking water prior to meals can help you feel fuller and reduce your overall food intake, which can lead to weight loss over time.

If plain water isnt appealing, try adding fruit slices like oranges, or herbs like mint, lemon and rosemary, for extra flavour and nutrients.

> Eat slowly and mindfully

Instead of munching down solid food, especially poultry and meat, chew thoroughly.

Some time back, I attended a wellness retreat where we were told to chew every mouthful 27 times and savour all the flavours before swallowing.

The food almost turns to liquid by the time it goes down the throat.

Not only does this increase the amount of nutrients absorbed by the body, its also easier on the digestive process.

Additionally, longer chewing also helps develop a stronger jaw and chin, suppress hunger and gets you full faster, aiding in your weight loss journey.

> Load up on fibre and protein

You dont have to eliminate all carbohydrates, just minimise overly-processed ones, such as white breads and pre-packaged foods like cookies and crackers.

This is because such foods are rapidly digested and converted into blood sugar.

Instead, consume more protein and fibre.

Protein takes longer to digest and decreases the level of the hunger-regulating hormone ghrelin, making you feel fuller for a longer period.

Fibre expands in your gut like a sponge, so its a natural appetite suppressant.

It also moves faster in your intestines, which signals to the brain that you are full.

Along with lean meats and poultry, add on a good mix of fresh fruits, vegetables and whole grains to make up the rest of the meal.

Even a five-minute break to take deep breaths at work can do wonders to bring down stress levels. AFP

> Scale back on added sugar

Sugar itself doesnt make the weighing scale jump up, but it tends to be in foods that have too many calories.

Whether its soft drinks, teh tarik or desserts, it should be the first thing to go if youre trying to lose weight.

The sweet stuff is also hidden in all sorts of foods from salad dressing to sauces to canned fruits, so dont be deceived that youre eating a healthy salad when youve doused the greens with salad dressing.

ALSO READ: You wouldn't expect to find sugar in these foods

When it comes to caffeinated beverages, skip the sugar, honey and creamer if possible, as these can quickly add to the calories.

Having your tea or coffee black is best, but if like me, you need to add some milk, opt for skim or low fat over full cream.

By eliminating sugar, you can lower your risk of heart disease dramatically because too much sugar in your diet heightens your risk of high blood pressure, obesity, and diabetes the three main risk factors for heart disease and cardiovascular decline.

ALSO READ: What you can do to reduce heart attack and stroke risk

> Manage stress levels

This is hard for everyone, but weve got to try.

When the body is under pressure, it releases the hormone cortisol, which is linked to increased appetite and fat storage.

Excess cortisol levels can increase appetite and cravings for energy-dense, comfort foods.

High cortisol levels over time have also been linked to abdominal fat gain.

Take time daily to do something to lower the stress levels: laugh, read a good book, play with a pet or just take deep breaths.

Find a quiet corner at work, close your eyes and spend five minutes mid-morning and in the afternoon to do a few rounds of deep breathing by inhaling through the nose and exhaling through the mouth or nose.

Do this again in bed, just before you sleep.

> Get proper sleep

Your body relies on sleep to restore and repair itself, and getting enough rest can also benefit your weight-loss efforts.

There is mounting evidence that people who get too little sleep have a higher risk of weight gain and obesity than people who get seven to eight hours of sleep a night.

Sleep deprivation changes your endocrine function and metabolism by affecting your production of the hunger-regulating hormones ghrelin and leptin.

This can make you feel hungrier than usual, increasing the likelihood of craving for unhealthy snacks.

Its no surprise that when youre exhausted, its harder to control your impulses for comfort food like cookies, chocolates and ice cream.

Practise good sleep hygiene by sleeping at the same time every day, switching off all gadgets two hours before bedtime and ensuring the room temperature is comfortable.

Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. For more information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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A new study published in the British Journal of Sports Medicine finds that about 22 minutes a day of moderate to vigorous activity may combat the negative effects of prolonged sitting. Furthermore, they researchers found that as a person's activity level increases, the risk of dying prematurely from any cause goes down. NBC News reports: In the study, researchers looked at information from nearly 12,000 people ages 50 and older in four datasets from Norway, Sweden and the United States. In those datasets, the participants wore movement detection devices on their hips for 10 hours a day for at least four days. All of the individuals included in the new study were tracked for at least two years. In the new analysis, the researchers accounted for factors, including medical conditions, that could've affected risk of early death. About half of the participants spent 10 1/2 hours or more sedentary each day.

When the researchers linked the participants' information with death registries in the different countries, they found that over an average of five years, 805 people, or 17%, had died. Of those who died, 357, or 6%, had spent less than 10 1/2 hours a day seated, while 448 averaged 10 1/2 hours or more sedentary. Sitting for more than 12 hours a day, the researchers found, was associated with a 38% increased risk of death as compared to eight hours, but only among those who managed to get less than 22 minutes of moderate to vigorous activity a day.

The risk of death went down with increasing amounts of physical activity. An extra 10 minutes a day translated into a 15% lower risk of death among those spending fewer than 10 1/2 hours seated and a 35% lower risk among those who spent more than 10 1/2 hours sedentary each day. Lower intensity activity only made a difference among participants who spent 12 or more hours sitting every day. The study's lead author, Edvard Sagelv, a researcher at The Arctic University of Norway, broke the findings down into manageable terms. "Think of it: only 20 minutes of this a day is enough, meaning, a small stroll of 10 minutes twice a day -- like jumping off the bus one stop before your actual destination to work and then when taking the bus back home, jumping off one stop before."

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He offers testosterone optimization therapy, medical weight loss treatment and prevention and treatment for erectile dysfunction.

Jay Griffin, a nurse practitioner, thought that between his medical training and being a provider he had his health all figured out. When he started feeling zapped of energy all the time, feeling grumpy and continued to struggle with his weight, he was forced to rethink what he thought he knew. Not wanting other men to feel the same way, Griffin opened a mens health clinic in Longmont.

I feel like men are underserved. We are taught to grin and bear it and to not complain and its just aging. I think that is a flawed system and I dont like it and it has affected me, Griffin said.

Griffin, who turned 50 this year, started to feel constant fatigue, grumpiness and could not lose weight despite working out regularly. He tried several approaches to feel better including natural supplements and antidepressants, he said. None of them worked.

It was miserable, Griffin said.

A friend suggested Griffin test his testosterone levels and that is when things began to change.

Most men who have low testosterone are miserable. Theyre just unhappy, its just difficult, Griffin said.

Griffin discovered that his own testosterone levels were out of balance and began hormone replacement therapy and soon started seeing a big change.

It just changed. It was like a 180. I was happier, I was motivated, the brain fog was gone. All of these symptoms that I was experiencing disappeared, he said.

The difference the hormone replacement therapy made in his life inspired him to use his medical training to help other men in a similar way.

Griffin opened the Testosterone Optimization Clinic of Colorado in Longmont a year ago. At his clinic for men, located at 1515 Main St. #15, he offers testosterone optimization therapy, medical weight loss treatment and prevention and treatment for erectile dysfunction.

I dont want anybody to go through what I went through if I can make it where they dont have to, Griffin said.

In addition to helping men with their health, Griffin said wants to create an environment that allows men to discuss these issues without feeling shame. He uses an individualized approach to monitor the hormones and weight loss to reach a mans goals including nutrition advice.

I dont want guys to have a fear of Im a guy, Im good. I want them to feel like if something is going on, they have someone they can talk to and not try to do it on their own or suffer through it and not grin and bear it, Griffin said.

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While my body was returning to its natural state, the World Anti-Doping Agency discovered that some of my peers were purposely altering theirs. Russian athletes had been bribing I.A.A.F. officials to look the other way while they continued competing, even though they had taken illegal drugs. Doped athletes had been winning medals and prizes, yet despite the I.A.A.F.s talk of cleaning the sport of illegal drugs, it was people like Chand and me whose natural bodies were seen as abnormal and were being targeted and shamed out of the sport. We were the ones enduring public humiliation when people who had taken illegal drugs were often portrayed as just victims of their governments thirst for medals. (Years later, a former head of the I.A.A.F., Lamine Diack, along with his son, would be convicted of corruption after accepting bribes linked to Russias doping program.)

In 2018 the agency announced new regulations that would apply only to athletes with D.S.D. and only to those competing in distances ranging from the 400 meter to the mile. So a woman with a difference in sexual development could compete against other women without altering her body in five of the eight main distances in competitive track racing but not in the distances I ran. I knew these rules would affect several other runners, but I had become the face of this thing. To me, this was personal. I was the runner closest to the 800-meter world record, and I felt the I.A.A.F. wanted to shut me down. To me, its restrictions arent about leveling the playing field; they are about getting certain types of women off the field completely.

(The spokeswoman for World Athletics told The Times that the regulations for female athletes running those distances were established after scientific and medical research from athletes competing in our sport was clearly able to show that advantages existed. In March, World Athletics replaced these regulations with a stricter rule that applied across a broader range of events.)

The guidelines announced in 2018 set a maximum testosterone level that was 50 percent lower than even the low level I had taken so many drugs to achieve. And I would have had to achieve and maintain that level for six months before I was eligible to compete. I refused to again subject myself to the mental anguish and physical torture of the poison. I was no longer an 18-year-old girl desperate to run. I was a world champion, an Olympic champion. I had achieved my dreams.

When they announced the regulations in 2018, the I.A.A.F. offered women with D.S.D. who refused the medication but still wanted to compete what it surely felt was a generous and sympathetic offer: We could change our distances, run any distance we wanted in the male category or run in some future intersex category, should it ever become available.

Both of these suggestions are insulting. I am not a man. I have spent years in legal battles, fighting to be able to race without restrictions. But today I could compete only if I altered my hormone levels. For me, participating in a third category of human gender identity would be accepting being othered, accepting the discrimination that I had fought against. It would mean giving up the identity Id been born with and had never questioned to take on a new one I didnt believe. Even though I understand that those in the medical community call me an intersex person because of the way my internal organs are structured, I do not call myself intersex. That identity doesnt fit me; it doesnt fit my soul.

Ms. Semenya is a runner from South Africa, a two-time Olympic gold medalist and the author of The Race to Be Myself, from which this essay is adapted.

The Times is committed to publishing a diversity of letters to the editor. Wed like to hear what you think about this or any of our articles. Here are some tips. And heres our email: letters@nytimes.com.

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ORGOVYX is the First and Only Oral Gonadotropin-Releasing Hormone (GnRH) Receptor Antagonist Approved for Advanced Prostate Cancer in Canada

MISSISSAUGA, Ontario, Oct. 23, 2023 /PRNewswire/ -- Sumitomo Pharma Canada, Inc., announced today that Health Canada has approved ORGOVYX(relugolix), an oral gonadotropin-releasing hormone (GnRH) receptor antagonist, for the treatment of men with advanced prostate cancer. The approval is based on efficacy and safety data from the Phase 3 HERO study of ORGOVYX in men with advanced prostate cancer. ORGOVYX is expected to be available for prescription in Canada in Q1 2024.

"Roughly 1 in 8 Canadian men will develop prostate cancer in their lifetime, and the ability to suppress testosterone, primarily achieved through androgen deprivation therapy (ADT), is foundational in the treatment of the advanced stages of the disease," said Fred Saad, M.D., FRCS, Professor and Chairman of the Department of Surgery and Director of Genitourinary Oncology at the University of Montreal. "In the HERO study, ORGOVYX demonstrated rapid, sustained, and profound testosterone suppression when compared to leuprolide. ORGOVYX is the first approved ADT in Canada that can be administered orally, and once daily, offering a safe and effective option for advanced prostate cancer patients in the country."

"We're pleased that with Health Canada's approval of ORGOVYX, we are helping to expand upon treatment options for Canadian men living with advanced prostate cancer," said Lisa Mullett, General Manager of Sumitomo Pharma Canada, Inc. "We are committed to making ORGOVYX available to patients across Canada early in the new year."

The Health Canada approval was based on the results of the Phase 3 HERO study, a randomized, open-label, parallel-group, multinational clinical study evaluating the safety and efficacy of ORGOVYX in over 1,000 men with androgen-sensitive advanced prostate cancer who required at least one year of continuous ADT. In the Phase 3 study, ORGOVYX met the primary endpoint and demonstrated superiority in sustained testosterone suppression to castrate levels (< 50 ng/dL) through 48 weeks compared to those receiving leuprolide acetate injections, the current standard of care. The most frequent adverse events reported in at least 10% of men in the ORGOVYX group were hot flush, musculoskeletal pain, fatigue, constipation, and mild to moderate diarrhea.

ORGOVYX was previously approved by the U.S. Food and Drug Administration on December 18, 2020 and granted marketing authorization by the European Commission for advanced hormone-sensitive prostate cancer on April 29, 2022.

About Advanced Prostate Cancer Prostate cancer is the most common cancer in Canadian men, and, in 2023 an estimated 24,700 men will be diagnosed.1 Prostate cancer is considered advanced when it has spread or come back after initial treatment and may include biochemical recurrence (rising prostate-specific antigen in the absence of metastatic disease on imaging), locally advanced disease, or metastatic disease.

Front-line medical therapy for advanced prostate cancer typically involves androgen deprivation therapy, which reduces testosterone to very low levels, commonly referred to as castrate levels (< 50 ng/dL). Luteinizing hormone-releasing hormone (LHRH) receptor agonists, such as leuprolide acetate, are depot injections and the current standard of care for androgen deprivation therapy. However, LHRH receptor agonists may be associated with mechanism-of-action limitations, including the potentially detrimental initial surge in testosterone levels that can exacerbate clinical symptoms, which is known as clinical or hormonal flare, and delayed testosterone recovery after the drug is discontinued.

About ORGOVYX(relugolix) ORGOVYX (relugolix) is the first and only oral gonadotropin-releasing hormone (GnRH) receptor antagonist approved by the U.S. Food and Drug Administration, the European Commission and Health Canada for the treatment of adult patients with advanced prostate cancer. As a GnRH antagonist, ORGOVYX blocks the GnRH receptor and reduces production of testicular testosterone, a hormone known to stimulate the growth of prostate cancer.

About Sumitomo Pharma Sumitomo Pharma Co., Ltd. is a global pharmaceutical company based in Japanwith key operations in the U.S. (Sumitomo Pharma America, Inc.), Canada (Sumitomo Pharma Canada, Inc.) and Europe (Sumitomo Pharma Switzerland GmbH) focused onaddressing patient needs in psychiatry & neurology, oncology, urology, women's health, rare disease, and cell & gene therapies. With several marketed products in the U.S., Canada, and Europe, a diverse pipeline of early- to late-stage assets, and in-house advanced technology capabilities, we aim to acceleratediscovery, research, and development to bring novel therapies to patients sooner. For more information, please visithttps://www.us.sumitomo-pharma.comandLinkedIn to follow us.

The Sumitomo Pharma icon is a trademark of Sumitomo Pharma Co., Ltd., used under license. SUMITOMO PHARMA is a trademark of Sumitomo Pharma Co., Ltd., used under license.

Sumitomo Pharma America, Inc. is a U.S. subsidiary of Sumitomo Pharma Co., Ltd.

ORGOVYX is a trademark of Sumitomo Pharma Switzerland GmbH.

2023 Sumitomo Pharma America, Inc. All rights reserved.

References

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SOURCE Sumitomo Pharma America

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Transcript:

What is androgen deprivation therapy?

Alicia Morgans, M.D., MPH: Androgen deprivation therapy, sometimes called ADT or hormonal therapy, is a way of treating prostate cancer that is used pretty ubiquitously or used pretty uniformly for patients when the cancer is more advanced or has spread outside of the prostate, perhaps even throughout the body. This form of treatment is not giving androgens or giving hormones but actually decreasing hormone levels, particularly testosterone, that male hormone that goes up in patients or individuals when they go through puberty, and is also the hormone that drives prostate cancer cells to grow, divide, spread and cause the trouble that they cause.

When we use androgen deprivation therapy, we are lowering testosterone levels typically by turning off the testes from making testosterone. This starves cancer cells, causing them to shut down, causing some to essentially self-destruct or die, and causing others to go into a deep hibernation state where they are not going to be able to grow, divide, spread and cause trouble. They just sort of sit still and shrink. And that from a patient perspective and from a doctor perspective is really important and is what we want. We want to shut it all down. There are other things that we can add that are more hormonal therapies to further decrease that testosterone from driving cancer cells. But the ADT, or androgen deprivation therapy, is really just shutting off the testes.

It's important to know that there are several types of ADT. Of course, one is a surgical type, so you can remove the part of the testes on both sides that makes testosterone, and that's a surgical procedure. But more commonly, people use medications to have ADT or use treatment with ADT. Those medications can either be GnRH agonists, which is just a type of a hormonal therapy that causes a surge in testosterone before it causes low levels. That needs to be considered when you're starting the treatment. The other kind, which is a GnRH antagonist, causes the testosterone levels to go down right away. Both of these are really effective ways of lowering testosterone. They are both used really commonly, and they both can be given as injections. The GnRH antagonist form can also be given as a pill. There are lots of different ways and options for us to cause androgen deprivation and to treat prostate cancer with hormonal deprivation therapy. It's important with talk to your doctor about which one might be right for you.

Transcript is AI-generated and edited for clarity and readability.

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East Midlands Ambulance Service is reportedly giving men up to a year of paid leave for andropause related issues, which some are calling the male menopause.

This move has angered some commentators who question whether there really is such a thing as the male menopause or manopause.

The andropause is not a condition that was recently invented. The medical establishment has been talking about it since the 1940s when it was known as the male climacteric. Symptoms of this condition include a lack of energy, weight gain (including man boobs), sexual difficulties, sleep problems, anxiety, irritability, depression and even hot flushes.

While many private clinics recognise and treat andropause, it is not recognised as a syndrome by the NHS, nor is it usually caused by a radical drop in male hormones, such as testosterone. Testosterone levels do naturally decline in men, but the average decrease is around 1% per year after the age of 30.

Less common only seen in 6% of adult men under 80 are chronically low levels of testosterone, also known as androgen deficiency. This may result from accidents affecting their testes, experiencing severe illness, or treatment for prostate cancer.

The natural drop in testosterone can be worsened by obesity, extreme stress and some medications or diseases, including drinking too much alcohol. So the andropause is probably more of a lifestyle symptom and therefore should be tackled as such.

The recent media spotlight on female menopause has highlighted just how badly women can be affected by midlife reduction in hormone levels. So much so that the UK government had to appoint a dedicated menopause tsar to deal with the resulting shortage of oestrogel, a popular form of HRT, as more and more women seek menopause treatment.

Read more: Menopausal women often turn to doctors who know little about the symptoms here's what needs to change

The East Midlands Ambulance Service is commendable in wanting to support men in making mid-life lifestyle changes, but calling it the male menopause undermines the magnitude of the physiological changes women experience as part of female menopause.

For men, lifestyle changes can have huge benefits. Taking care of heart health, exercise and healthy diets in midlife are known to be good for brain function and can help prevent dementia and heart disease later on.

While many women report that taking sex hormones helps with brain problems, actual studies do not show overall long-term benefit of hormone treatment on memory or mood. There are also small risks linked with taking hormone therapy.

In contrast, for those who have had their ovaries or testes removed, or take hormone blockers because of cancers, a significant drop in memory and mood can occur and reduced testosterone has been associated with an increased risk for dementia, such as Alzheimers disease and heart disease the two main causes of death in the UK.

However, it is unclear whether testosterone treatment helps to reduce this risk in men, as some studies showed an increased risk of heart disease, while others found testosterone treatment to be protective or have no effect.

In men with low testosterone levels, overall studies suggest that taking testosterone reduced depression and improved erections and libido. There may also be benefits of oestrogen or testosterone gel on sexual function in women.

However, study results have been mixed and caution should always be taken with interpreting the results of research sponsored by the industries producing the treatments. Also, libido is not simply linked to hormones, and a dry vagina or limp penis can be influenced by factors such as relationship stress or work stress or both.

Could andropause be a manifestation of midlife stress? Most likely. And this is not a matter of hormone change. Rather, while dips in life satisfaction are only seen in 10-20% of adults in middle age (and often not shown over time), this is probably the result of an evaluation of life at this important new stage.

Importantly, suicide risk is highest in men between 40 and 49 and is the most common cause of death in men under 50. Many men may mask their depression with alcohol, drugs and overwork. This risk is highest in the poor.

We should applaud the East Midlands Ambulance Service for paying attention to mens mental health, but maybe not because of the andropause. Rather, interventions that tackle poor pay, working conditions, job stress, public harassment and work-life satisfaction may help improve mental health more than framing these concerns as male menopause.

In the full statement by the East Midlands Ambulance Services, it was made clear that there is no separate or special leave policy for andropause with 12 months off on full pay. Instead, decisions are made on a case-to-case basis, trying to keep staff in work where possible and supporting them with their mental health in a wide variety of ways.

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The combination of the investigational agent BXCL701 and pembrolizumab (Keytruda) elicited promising overall survival (OS) results in patients with small cell neuroendocrine prostate cancer (SCNC), according to findings from a phase 2 trial.1

SCNC represents a major unmet medical need, with the majority of patients unfortunately succumbing to their disease in less than one year following chemotherapy. The results of this trial suggest that BXCL701 has the potential to extend the lives of patients, and I look forward to its continued clinical development, stated Aggarwal.

In the single-arm, open-label trial, the median OS was 13.6 months (95% CI, 10.9NR) and the 12-month OS rate was 56.5% in this patient population.

OS is the most meaningful measure by which the effectiveness of an oncology treatment is evaluated. Though these results are based on a non-randomized cohort of patients, observing a median OS of this duration including patients with long-term survival at 12 months and beyond shows exceptional promise, bearing in mind historic data with checkpoint inhibitor monotherapy in this high-risk subset of prostate cancer, Principal Investigator Rahul Aggarwal, MD, associate director for clinical sciences, Helen Diller Family Comprehensive Cancer Center, and professor of medicine at the University of California San Francisco (UCSF), stated in a news release.1

BXCL701 is designed to modulate the tumor microenvironment by activating innate immunity, followed by adaptive immunity, ultimately resulting in cancer cell death.

The trial enrolled patients with histologically confirmed de novo or treatment-emergent SCNC. To be eligible for enrollment, patients needed to have received 1 or more prior lines of systemic therapy, experienced disease progression per Prostate Cancer Clinical Trials Working Group 3 criteria, and an ECOG performance status of 0 to 2. For those with treatment-emergent SCNC, a serum testosterone level of less than 50 ng/dL during screening was required.2

Patients were excluded if they had received more than 2 cytotoxic chemotherapy regimens for mCRPC or had prior treatment with an antiPD-1, antiPD-L1, or antiPD-L2 agent. Prior treatment with another agent directed to another co-inhibitory T-cell receptor was also prohibited.2

Overall, there were 34 patients (median age, 67.5 years) enrolled in the phase 2 study. Sixty-two percent of patients had a visceral metastasis at any site, and 32% had visceral metastases of the liver. The median number of prior lines of systemic therapy received was 3 (range, 1-8).3

At the data cutoff date of September 6, 2023, there were 28 efficacy evaluable patients able to be assessed for OS.

Previously reported data from the trial showed that the objective response rate was 20% among 25 patients who were evaluable for response. Patient responses included 4 confirmed partial responses (PRs) and 1 unconfirmed PR.3

SCNC represents a major unmet medical need, with the majority of patients unfortunately succumbing to their disease in less than one year following chemotherapy. The results of this trial suggest that BXCL701 has the potential to extend the lives of patients, and I look forward to its continued clinical development, stated Aggarwal.

Reference

1. BioXcel Therapeutics Reports Positive Overall Survival Results from Single-Arm, Open-Label Phase 2 Trial of BXCL701 in Patients with Small Cell Neuroendocrine Prostate Cancer. Published online and accessed October 10, 2023. https://ir.bioxceltherapeutics.com/news-releases/news-release-details/bioxcel-therapeutics-reports-positive-overall-survival-results

2. CT.gov. A Trial of BXCL701 and Pembrolizumab in Patients With mCRPC Either Small Cell Neuroendocrine Prostate Cancer or Adenocarcinoma Phenotype. Last updated May 23, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT03910660

3. Aggarwal RR, Zhang J, Monk P, et al. First-in-class oral innate immune activator BXCL701 combined with pembrolizumab in patients with metastatic, castration-resistant prostate cancer (mCRPC) of small cell neuroendocrine (SCNC) phenotype: Phase 2a final results. J Clin Oncol. 2023;41(suppl 6):176. doi:10.1200/JCO.2023.41.6_suppl.176

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Pembrolizumab plus novel agent shows promising OS in small cell ... - Urology Times

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It is the small things that make or break a long-standing relationship. That is what crossed my mind as I listened to Dan and Joyce. Dan was a 36-year-old biology teacher and his wife, Joyce, was 32. They had been married for seven years and had one child. They came to the Sexology Clinic after a week of serious disagreement: Joyce had bought Dan a perfume.

I feel demeaned. I am offended. If she wants me to shower more than once a day I can do that, but she does not have to buy a perfume to pass a message that I no longer smell good! Dan shouted as he explained the genesis of their conflict.

This is unfair, I just bought you a gift! Do you have to go to the extent of denying me sex because of this? Joyce shouted back, her eyes welling up with tears.

The story was that during their courtship, Joyce repeatedly told Dan that she loved his natural body odour. She would hold him for hours on end because of this. Dan enjoyed this whole experience which boosted his ego and confidence.

So would you say I am mistaken, doctor? Dan asked rhetorically, looking at me straight in the face, Tell me, have I gone out of my mind? How can it be that suddenly I no longer smell good?

Well, there is a relationship between smell and sexual attraction. If you keep animals, you may have observed that bulls actually put their noses on cows vaginas and in ecstasy lift their heads up, sniffing as they enjoy the sweet smell. Dogs and cats travel long distances to meet females on heat guided by pheromones, the attractive sex hormones produced by these animals during ovulation.

The issue of pheromones has however been contentious when you talk of human species. In one study, men were made to smell vaginal secretions from different women and their body reactions recorded. It was shown that secretions from ovulating women made men have a surge in testosterone, meaning that mens bodies may be able to detect and positively respond to ovulating women.

In another study, it was shown that women are attracted to men with high testosterone levels when they are ovulating, that they find body odour from such men more pleasing than from men with lower testosterone.

The studies on body odour and sexuality have however been non-conclusive. Further, the human brain has no ability to detect pheromones. This natural disadvantage implies that there is nothing sexually stimulating about the way a man or woman smells.

I dont believe that! Dan croaked throwing his hands in the air.

The only thing that has been proven is that body smell is closely tied to body immunity and women tend to be more pleased by the smell of men with immunity that significantly differs from theirs. This is important in reproduction since the offspring of such a union is likely to have much stronger immunity. Smell does not necessarily cause one to want to have sex with another.

That said, a good smell does have its place in making us feel good. This is the basis of aromatherapy. If your mate has worn a pleasantly smelling perfume this may elevate your mood and give you a sense of happiness.

And that is why I am saying that my body smell caused Joyce happiness and is an important factor and foundation of this relationship! Dan said.

But surely, you cannot say that the reason I married you is because of your body odour! Joyce replied.

Well, Dans body scent was pleasing to Joyce when they were courting just the same way a flower or air freshener would be pleasant to her. The good feeling elevated her mood. There is a possibility that Dan had a different immunity from Joyce, making her more attracted to the body scent as a prospective father of her children. In those early days of their relationship Dan must have had a higher level of testosterone, making the attraction greater when Joyce was ovulating.

But days do change and testosterone levels fall. We acquire new body smells as hormone levels change. A good smelling perfume is good for maintaining the pleasant smell and is not a bad gift from a loved one.

If you thought looking attractive was the prime factor to impress someone on a date, then you might be wrong. According to a recent study, it is how you smell that makes you sexually attractive, and interestingly, physical appearance, intellect and money take the back seat.

Astonished? Well, we were too! As per a report published in the Daily Star, extra-marital dating site Victoria Milan conducted a survey of 5,071 cheating adults from 12 countries to ascertain how big a role odour plays in such situations.

And the results were quite beguiling. 78 per cent of women preferred to go home alone rather than sleep with a man who smelled bad. However, men have other priorities too. Five in every 10 male participants said theyll bear any stench once they have a woman in the bedroom.

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Body odour and intimacy | Nation - Nation

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