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Testosterone is the key hormone responsible for developing male sex characteristics, such as facial hair and a deeper voice, and it plays a pivotal role in muscle mass and sexual function in both men and women.

Over the past few decades, research has shown a subtle yet steady decline in testosterone levels among men, a trend documented since the 1980s and highlighted by a 2021 study in the peer-reviewed journal European Urology Focus. This study, which analyzed testosterone levels in adolescent and young adult men from a U.S. national database, revealed a consistent drop in average total testosterone over the past 20 yearsa decline that correlates with rising body mass index. Despite this trend, testosterone levels have not yet dipped to clinically low ranges across the population, but they are inching closer to that point each year.

So, whats driving this downward trend? While some factors are beyond individual control, lifestyle choices significantly contribute. Conditions like diabetes and obesity are closely linked to lower testosterone levels. Data show that another increasingly common concern seems to be whether sexual activities like masturbation and ejaculation decrease testosterone levels and lead to hormonal imbalances in males. In short, research in this area does not support the idea that these activities impact testosterone levels over the longterm.

Keep reading for more, as researchers and experts Lawrence Hawkim, MD, a board-certified urologist at the Cleveland Clinic, Kevin Pantalone, DO, a board-certified endocrinologist at the Cleveland Clinic, and Jessica Shepherd, MD, MBA, FACOG, board-certified OB/GYN and thought leader on menopause, speak to the science between masturbation and testosterone levels.

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While masturbation does influence testosterone, it does not decrease these levels, according to Cleveland Clinic urologist Dr. Hawkim. He says masturbation neither triggers hypogonadism (low testosterone or low T) nor impacts long-term testosterone levels. However, Dr. Hawkim says, its short-term effects are still under investigation.

Researchers in Germany, focusing on molecular and cellular sports medicine and cardiovascular research, also investigated this subject. Their 2021 study, published in the peer-reviewed journal Basic and Clinical Andrology, suggests that masturbating before strength training could actually lead to a temporary boost in testosterone levels, aiding in muscle growth. Further studies are necessary to solidify these findings.

Testosterone is also essential for females, particularly postmenopausal women. Dr. Shepherd explains that reductions in testosterone, along with decreases in estrogen and progesterone during menopause, impact the physical response as well as the psychological response surrounding sexual activity. Maintaining a healthy lifestyle and considering hormone supplementation can be important for women during this transition.

An article published in The Journal of Sexual Medicine in 2021 found that higher testosterone levels in women are associated with increased libido and more frequent masturbation or sexual activity, and, like in men, the long-term effects of masturbation on testosterone levels appear negligible.

Although further research is necessary to fully understand the specific effects of various sexual activities like masturbation on testosterone levels, current scientific evidence and expert consensus indicate that masturbation does not cause a long-term decrease in testosterone levels.

According to the American Urology Association (AUA), low blood testosterone is defined as levels below 300 nanograms per deciliter (ng/dL). Dr. Hakim notes that anything that negatively affects overall health can diminish testosterone levels.

Here are several factors that commonly lead to decreased testosterone:

Low T can present through various symptoms. Here are some typical signs to be aware of:

Boosting your testosterone is largely about embracing a healthier lifestyle.

Dr. Pantalone explains, Its normal for a person to experience a drop in testosterone as they age, but were seeing that process accelerated in more recent times because of poor overall health.

Here are some effective strategies to enhance your hormonal health:

Exercise more: Regular physical activity, especially strength training and high-intensity interval training, can boost testosterone levels.

Eat healthy: Focus on a balanced diet rich in proteins, healthy fats, and whole grains. Foods like eggs, leafy greens, and fatty fish are particularly beneficial. Avoid excess alcohol, smoking, and substance use.

Get quality sleep and manage stress: Aim for 7-9 hours of sleep per night and explore stress reduction techniques such as meditation, yoga, or deep breathing exercises.

If youre concerned about your testosterone levels or are experiencing symptoms such as fatigue or low libido, consult your healthcare provider. They can perform tests to determine the cause, which may be linked to low testosterone or another health issue. They can also discuss if you need testosterone replacement therapy if levels are significantly low due to medical conditions.

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Does Masturbation Decrease Testosterone? Here's What Sexual Health Experts Say - The Healthy

(WXYZ) Scientists report promising results for an innovative form of birth control for men.

This hormonal gel has been shown to effectively reduce sperm production in clinical trials.

This potential birth control for men contains testosterone and Nestorone. Nestorone is a synthetic progestin, a type of hormone used in contraceptive methods. The results from the phase-two trial showed that the gel successfully decreased sperm production in men.

Now, a total of 222 men took part in this study all between the ages of 18 and 50. Every day, they applied about a teaspoon of the gel to each shoulder blade.

Researchers monitored their sperm production every four weeks. By the 12th week, 86% of the men experienced a decrease in sperm count, making pregnancy unlikely.

On average, effective contraception was achieved within eight weeks, which was faster than previous methods tested.

Also, participants maintained testosterone levels that did not affect their sex drive, and no adverse side effects were reported. The second phase of the study is still in progress, with researchers monitoring the effectiveness of the gel in preventing pregnancy.

A phase-3 trial for this potential male contraception gel is still needed. On average, it costs $1 billion to $2 billion to get a drug to market. For this product, funding from a partner like a major pharmaceutical company is essential. But so far, none have stepped up.

As for non-hormonal options, a San Francisco-based biopharmaceutical company called YourChoice Therapeutics found its non-hormonal pill safe in a small UK trial with 16 men. The pill works by blocking a vitamin A receptor thats needed for male fertility. The company is now planning a much larger study.

Also, a Virginia medical device company called Contraline is testing its non-hormonal male birth control method. It involves a 15-minute procedure where a gel is injected into the tubes that carry sperm from the testicles. An early trial in Australia showed a 99.8% to 100% reduction in motile sperm within 30 days for 25 participants. Contraline aims to start trials in the U.S. in 2025.

I support male contraception because it would give men greater control over their reproductive health and help them share the responsibility of preventing pregnancies. It would also provide more birth control options, especially for women who arent able to use hormonal methods due to side effects or medical reasons.

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Trial finds male birth control gel safe and effective - WXYZ 7 Action News Detroit

It was a breakthrough performance and the announcer used his correct pronouns.

I just thought, It took some time to get there. But we did it,'" he said.

On July 20, 2021, Riccomini, then 17, announced on social media that he was a gay transgender man who would from then on use the pronouns he and him. I want the world to know who I am and who Im meant to be so I can pursue it openly, he wrote.

Now 20, he is on top of the world: In January, he placed third at a World Cup slopestyle competition, an event that features skiers spinning and flipping down a mountain slope filled with rails, bumps and jumps. He also finished third in two other events last season, giving him a third-place finish in the overall slopestyle standings. He was recently promoted to the U.S. Freeski pro team. And he's being mentioned as an Olympic hopeful for the 2026 Milan-Cortina Winter Games.

As part of his transition, Riccomini underwent top surgery more than a year ago to create a masculine appearance. But he has decided to put off taking testosterone until his career is over, to stay in compliance with the regulations. He still competes in womens events, and will continue to do so if he makes the Team USA roster for the Olympics.

Riccomini says he has received nothing but support from the freestyle skiing world since he announced he was trans.

I thought I was going to have to give up my hopes and dreams, he said. People rose above my expectations, for sure.

But he also acknowledges that the road to becoming Jay Riccomini was neither smooth nor straightforward.

Its not a linear line. Its a freaking roller coaster through it all, he told The Associated Press recently, in one of his first interviews with a national news outlet.

From a young age, even before he realized what it was, Riccomini began experiencing gender dysphoria, when a persons gender identity doesnt match their sex assigned at birth. But he kept it secret.

The mountains provided both a refuge and an escape. Growing up in Port Matilda, Pennsylvania, he spent many winter weekends with his brother at Tussey Mountain, which featured a terrain park loaded with jumps and rails.

On numerous occasions, his family also traveled to Copper Mountain, Colorado, where coaches at Woodward, a training ground for kids interested in action sports, recognized his talent.

But not being able to share his secret weighed heavily on him, and ultimately led to such a severe depression that even the mountains couldnt save him. His parents didnt know the depths of his struggles, either.

I just wanted Jay to be happy, and Jay was unhappy for so many years, said his mother, Andrea. Thats been the hardest part for me, that he was unhappy for so long."

Rock bottom came at 17, while Riccomini attended a winter sports school in Park City, Utah. He missed classes. His grades suffered. And in perhaps the most worrisome sign that something was wrong, he was often absent from the terrain park, one of his favorite spots.

When people saw that I wasnt there, theyre like, Where are you? Riccomini recounted. I was depressed. I wasnt eating. It wasnt good.

Even when he had a memorable moment finishing 18th in his World Cup debut in Aspen in March 2021 he wasn't able to truly celebrate. It was under his old name. Every time someone referred to him as her, it gave him anxiety.

I just felt like I was going to throw up, he said.

He decided to take action.

First, he told a close friend he was trans. Then, he changed his pronouns on his Instagram bio to they/them and told more teammates and friends. Not long afterward, while out skiing, he came up with a new name.

I was like, Should I call myself Jake or Jack or Ace? he said. I thought, Jay Jay is perfect. Its just easy" and it happened to echo his father's middle initial, J.

Teammate Colby Stevenson began calling him Jay-Bird.

I like that, Riccomini said. I really like that.

With his name in place, Riccomini went public on Instagram, writing that he was "over constantly feeling trapped in my own body."

The announcement set him free, transforming his anxiety into hope and happiness.

Seeing him happy, his mom said, "is priceless.

At a World Cup event in February 2023, the International Ski Federation used Jay Riccomini's new name in its results for the first time.

It is our duty to do everything within our reach to ensure he feels included and respected in our competitions, the federation's integrity director, Sarah Fussek, said in a written statement to AP. "As the institution that represents snow sports around the whole world, for all, we have a moral obligation to do so.

U.S. Ski & Snowboard has also expressed its support.

"His dedication to the sport has resulted in a number of podiums at a young age, Sophie Goldschmidt, president and CEO of USSS, said in a statement. We know that he will continue his success on the world stage throughout the upcoming years.

Riccominis mission now is to open doors for other transgender athletes and to inspire them the way he has been motivated by others.

This young athlete has fought for and has earned with his results the right to be seen, said Rook Campbell, a trans athlete and professor in areas of advertising, sports, globalization and media at the University of Southern California. Visibility is powerful.

As difficult as his own journey has been, Riccomini knows it is even harder for transgender women. After swimmer Lia Thomas became the first openly transgender athlete to win an NCAA Division I national championship, World Aquatics effectively banned transgender women from competing in womens events. World Athletics, the governing body for track and field, has done the same.

Transgender girls are also banned from competing in girls sports at the high school level in numerous Republican-led U.S. states, where some lawmakers argue that they have an unfair strength advantage over cisgender girls. People on both sides point to limited research to back their opinions.

Thomas is someone Riccomini looks up to he even wrote a paper about her experience for a civics class.

I cant imagine the toll taken on her mental health, Riccomini said. Shes just amazing.

Campbell said it is sometimes easier for transgender men to speak out and gain acceptance than it is for transgender women. He said he thinks it's great to use that privilege.

I just wish it was broader, he said.

As happy as he is, Riccomini realizes his transition won't be fully complete until he can take testosterone, something he knows will help ease his gender dysphoria. But for now, just being recognized publicly as Jay is good enough.

When people call me he, I get this warm feeling in my stomach, he said. This overwhelming wave of happiness that flows through my body, knowing everyone sees me now for who I am.

AP Winter Olympics: https://apnews.com/hub/winter-olympicsAP

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With his transgender identity public, skier Jay Riccomini finds success on and off the slopes - The Daily Gazette

BUFFALO GROVE, Ill., June 2, 2024 /PRNewswire/ -- Tolmar Inc., a fully integrated pharmaceutical company, today announced results from a landmark survey of more than 300 US physicians, revealing barriers to treatment with testosterone-replacement therapy (TRT) among patients and physicians that, if addressed, may improve patient care.Detailed results of the survey will be presented at ENDO 2024, the signature annual meeting in endocrinology, in Boston on Sunday, June 2.The survey was conducted in partnership with the leading online physician community, Sermo.

"Men living with a testosterone deficiency have more treatment options than ever, but this expanded range of choices can be confusing. A key finding in the survey is that 66% of men on TRT switched therapy in the last year in order to find a form of therapy that works best for them. Not surprisingly, much of this is driven by insurance, but there is also a lack of awareness of newer and safe treatment options, like oral therapy, that may improve patient care," saidSandeep Dhindsa, M.B.B.S., Director of Division of Endocrinology, Diabetes and Metabolism, St. Louis University School of Medicine.

Uncovering Insights Into the Current TRT LandscapeResults from the survey showed challenges and potential solutions to effectively treat men with low or no testosterone. More than one-quarter of patients do not take their TRT as prescribed, according to physicians surveyed. For 71% of patients, oral medication is the preferred choice, but only 22% percent are aware of them. Lastly, half of physicians (50%) are unaware of current oral TRT and its proven safety profile.

"This reinforces the need for continued education on TRT and the importance of working closely with patients on a treatment plan. With a better understanding of safe and effective TRT options, we can improve adherence, minimize the need to switch treatments and help patients get the care they deserve," said AdrianDobs, M.D., Professor of Medicine and Oncology, The Johns Hopkins School of Medicine.

To explore the data driving these insights, visit http://www.JatenzoHCP.com to download the presentation of results and findings.

About the Survey In February 2024, Sermo conducted a survey of 303 physicians, including endocrinologists, urologists, primary care physicians and others experienced in prescribing testosterone-replacement therapy (TRT). The objectives of the survey were to: 1) understand the TRT patient experience and unmet needs; 2) outline prescribing behaviors and barriers across multiple specialties; and 3) uncover barriers to treatment and opportunities for patient and peer education.

About Tolmar Inc. Tolmar is a fully integrated pharmaceutical company focused on the development, manufacturing, and commercialization of specialty pharmaceuticals across multiple therapeutic areas, including Endocrinology. Tolmar's product development and manufacturing facilities are based in Northern Colorado and its executive offices and commercial headquarters are based in Buffalo Grove, Illinois. For more information about the company, please visit http://www.tolmar.com.

About Sermo Sermo is the largest global healthcare research company and the most trusted physician and provider engagement platform. Sermo engages with more than 1.5 million HCPs across 150 countries and has reach into the U.S. Payer market that now exceeds 230M commercial lives covered.For over 20 years, Sermo has been turning physician experience, expertise, and observations into actionable business insights that benefit pharmaceutical companies, healthcare partners, and the medical community at large. Sermo offers on-demand access to HCPs via a proprietary health-tech ecosystem to gain targeted HCP insights that inform strategic decisioning in real-time. To learn more, visit http://www.sermo.com.

About JATENZO

Indication

JATENZO (testosterone undecanoate) capsules, CIII, is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone:

Primary hypogonadism (congenital or acquired): testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serum testosterone concentrations and gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) above the normal range.

Hypogonadotropic hypogonadism (congenital or acquired): gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range.

Limitation of use Safety and efficacy of JATENZO in males less than 18 years old have not been established.

IMPORTANT SAFETY INFORMATION

WARNING: INCREASES IN BLOOD PRESSURE

JATENZO can cause blood pressure (BP) increases that can increase the risk of major adverse cardiovascular events (MACE), including non-fatal myocardial infarction, non-fatal stroke and cardiovascular death.

Before initiating JATENZO, consider the patient's baseline cardiovascular risk and ensure blood pressure is adequately controlled.

Periodically monitor for and treat new-onset hypertension or exacerbations of pre-existing hypertension and re-evaluate whether the benefits of JATENZO outweigh its risks in patients who develop cardiovascular risk factors or cardiovascular disease on treatment.

Due to this risk, use JATENZO only for the treatment of men with hypogonadal conditions associated with structural or genetic etiologies.

CONTRAINDICATIONS

JATENZO is contraindicated in men with breast cancer or known or suspected prostate cancer. JATENZO is contraindicated in women who are pregnant as testosterone may cause fetal harm.

WARNINGS AND PRECAUTIONS

Check hematocrit prior to initiation and every 3 months while a patient is on JATENZO and if hematocrit becomes elevated, stop JATENZO until hematocrit decreases to an acceptable level.

If hematocrit increases after JATENZO is restarted, stop permanently.

Monitor patients with benign prostatic hyperplasia (BPH) treated with androgens due to an increased risk for worsening signs and symptoms of BPH.

Venous thromboembolic events (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), have been reported in patients using testosterone replacement products like JATENZO. Evaluate patients with signs or symptoms consistent with DVT or PE and, if a VTE is suspected, discontinue JATENZO and initiate appropriate workup and management.

Testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids.

Large doses of androgens can suppress spermatogenesis by feedback inhibition of pituitary FSH. Inform patients of this risk before prescribing JATENZO. Prolonged use of high doses of methyltestosterone has been associated with serious hepatic adverse events. JATENZO is not known to cause these adverse events; however, patients should be instructed to report any signs of hepatic dysfunction and JATENZO should be discontinued while the cause is evaluated. Edema, with or without congestive heart failure, may be a serious complication in patients with pre-existing cardiac, renal, or hepatic disease. In addition to discontinuation of the drug, diuretic therapy may be required.

Gynecomastia may develop and persist in patients being treated for hypogonadism.

Sleep apnea may occur in some patients, especially those with risk factors such as obesity or chronic lung disease.

Changes in the serum lipid profile may require dose adjustment of lipid-lowering drugs or discontinuation of testosterone therapy. Monitor the lipid profile periodically, particularly after starting testosterone therapy.

Use JATENZO with caution in cancer patients at risk of hypercalcemia. Monitor serum calcium concentration regularly during treatment with JATENZO in these patients.

Androgens, including JATENZO, may decrease concentrations of thyroxine-binding globulin, resulting in decreased total T4 serum concentrations and increased resin uptake of T3 and T4. Free thyroid hormone concentrations remain unchanged, however, and there is no clinical evidence of thyroid dysfunction. Depression and suicidal ideation have been reported in patients treated with JATENZO in clinical trials.

ADVERSE EVENTS

The most common adverse events of JATENZO (incidence 2%) are headache (5%), increased hematocrit (5%), hypertension (4%), decreased HDL (3%), and nausea (2%).

These are not all of the risks associated with JATENZO. For more information, clickherefor full Prescribing Information, including BOXED WARNING on increases in blood pressure.

Company Contact: Steve Yuan [emailprotected] 224.880.1616

SOURCE Tolmar Inc.

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Tolmar Announces Results From Inaugural Landmark Survey of US Physicians To Assess Current State of ... - PR Newswire

In a recent episode of The Mike OHearn Show, fitness legend Mike OHearn hosts Dr. Rand McClain to discuss the health implications of bodybuilding and fitness trends among the younger generation. The conversation spans a wide array of topics, from the benefits of early athleticism to the risks of extreme bodybuilding practices and the nuanced understanding of testosterone therapy.

Dr. Rand McClain is a renowned physician specializing in regenerative medicine and sports medicine. He holds a medical degree from Western University of Health Sciences and has dedicated his career to pioneering advancements in hormone therapy, anti-aging treatments, and regenerative health practices. Dr. McClains expertise extends beyond traditional medicine, incorporating cutting-edge techniques to enhance patients quality of life and athletic performance.

Dr. McClain returns to the podcast to discuss TRT, testosterone levels, and fitness as we age in more detail. More specifically, he details the delicate balance in preventing long term health issues before its too late while also preventing over use of certain treatments due to blanket rules in the medical community that may isolate certain individuals. Lets dive in!

Mike OHearn begins the conversation by addressing the promising future that young athletes and bodybuilders can secure for themselves through early and sustained physical fitness. He refers to this as a free ticket to health in middle age, emphasizing that a robust foundation in youth translates to a healthier and more resilient body in later years. Mike underscores the long-term benefits of staying fit, such as reduced health declines and enhanced quality of life during ones twilight years.

However, Mike expresses concern over a growing trend among the younger generation to push their fitness to dangerous extremes. Many young bodybuilders today aim to emulate the mass monster physiques of legends like Ronnie Coleman, often resorting to excessive drug and steroid use to achieve these goals. Mike warns that this approach is detrimental to long-term health, leading to severe consequences such as reduced natural testosterone levels, weakened joints and connective tissues, and an increased risk of cardiovascular diseases by the time they reach their 40s.

Dr. McClain concurs with Mikes observations, noting that social media has significantly influenced young aspiring athletes and bodybuilders. The widespread availability of information on drug and steroid protocols, coupled with the ease of obtaining these substances online, has exacerbated the problem. Moreover, the visibility of extreme and often unhealthy physiques on platforms like Instagram has set unrealistic and dangerous standards for young people.

Dr. McClain explains that the constant exposure to these images leads young individuals to believe that achieving such physiques is not only desirable but also easily attainable through steroids alone. This misconception overlooks the numerous other factors that contribute to such body compositions, including genetics, years of rigorous training, and meticulous dietary practices. He cautions that indiscriminate steroid use at a young age can drastically shorten lifespan and degrade the quality of life in later years.

RELATED: Bodybuilders Are Dying An Investigation Into Modern Bodybuilding, Health, & PED Use

Both Mike and Dr. McClain emphasize that becoming a successful bodybuilder or athlete is a marathon, not a sprint. It requires decades of dedicated training, yet many young athletes seek shortcuts through steroids to fast-track their progress. This impatience often results in severe health issues down the line, undermining the very goals they set out to achieve.

Dr. McClain also sheds light on the broader benefits of testosterone beyond muscle building. While testosterone replacement therapy (TRT) is commonly associated with enhanced body composition, it also plays a critical role in cognitive functions. Individuals with low testosterone levels frequently experience brain fog and diminished focus, which can be significantly improved with TRT. Although patients rarely seek TRT for cognitive benefits initially, many report feeling more alert and mentally sharp after undergoing therapy.

Dr. McClain advocates for a more individualized approach to assessing testosterone levels, challenging the medical communitys reliance on rigid norms. He argues that what is considered normal testosterone levels can vary significantly between individuals. For instance, a 25-year-old with historically high testosterone might feel the adverse effects of a decline in their levels, even if those levels are within the average range for the general population.

This nuanced perspective is crucial for providing optimal care. Dr. McClain illustrates this with the example of Mike OHearns partner, Mona Muresan, a former Ms. Universe winner with exceptionally low natural testosterone levels. Despite this, Mona maintains high energy levels and impressive physical strength. Dr. McClain suggests that in such cases, TRT might not be necessary unless other symptoms or preventative concerns arise.

Conversely, Dr. McClain points out that individuals with seemingly normal testosterone levels but poor physical health might have underlying conditions like polycystic ovary syndrome (PCOS). Therefore, a comprehensive evaluation of each patients unique medical history and current health status is essential for determining the appropriate treatment.

The discussion between Mike OHearn and Dr. Rand McClain highlights the complexities of modern bodybuilding and fitness. While early athleticism can lay the groundwork for a healthier future, the pursuit of extreme physiques through steroid abuse poses significant risks. Dr. McClains insights into the broader benefits of testosterone and the need for personalized medical evaluations underscore the importance of a balanced and informed approach to health and fitness. As the conversation reveals, understanding the individuals unique needs and history is paramount in promoting long-term well-being.

You can watch the full episode of the The Mike OHearn Show above. And dont forget to check back every week for new episodes on the Generation Iron Fitness Network or wherever podcasts are downloaded!

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Testosterone Levels Are More Than Just A Number | The Mike O'Hearn Show - Generation Iron Fitness Network

The cast of The Outsiders (photo: Matthew Murphy)

Amid an intoxicating blend of testosterone and tenderness, the gripping new Broadway musical The Outsiders shares a coming-of-age story of family bonds (both chosen and blood-born) and the eternal clash of haves and have-nots.

Adapted from S.E. Hintons 1967 novel and Francis Ford Coppolas iconic 1983 film adaptation, The Outsiders (book by Adam Rapp and Justin Levine) follows the Curtis brothers, who live on the wrong side of the tracks in Tulsa, Oklahoma, circa 1967. Our narrator, Ponyboy (Brody Grant in a stunning Broadway debut), is a sensitive teen with aspirations of a better life.

He lives with his two brothers older brawny bro Sodapop (Jason Schmidt, who garners whoops from the audience by doffing his shirt within seconds) and eldest brother Darrel (Brent Comer), whos become the stand-in father figure since their parents died in a train crash.

When not hanging with his bestie quiet, introspective Johnny Cade (Sky Lakota-Lynch) Ponyboy spends his time writing in his notebook and reading the classics like Dickens Great Expectations.

Along with several others in their neighborhood, they are part of the lower-class Greasers, who often clash with the more privileged Socs (short for socials) who live on the west side of town, led by Bob (Kevin William Paul) and his sweetheart girlfriend Cherry (Emma Pittman).

Among the Greasers is ex-con Dallas (Joshua Boone), who takes Ponyboy and Johnny under his wing. When an innocent drive-in conversation between Ponyboy and Cherry leads to a tragic encounter with Johnny killing one of the Socs in self-defense, Dallas gives the two boys money and directs them to hide from the police in an abandoned church.

During their time in hiding, the duo reflect on the journey that brought them to here, and Ponyboy shares his love for the Robert Frost poem Nothing Gold Can Stay with Johnny which sets the stage for one of the musical highlights of the evening.

What follows is a tragic chain of events including a church fire, a suicide, and a final clash between the Greasers and the Socs before were left with a hint of hope on the horizon. While its a universal story, queer theatergoers will definitely connect with the plight of marginalized young people who have felt other (aka outsiders).

Danya Taymors direction artfully handles the storytelling, keeping the pace on point and constantly repurposing surrounding junkyard items (set by design collective AMP) to create each setting from the drive-in movie, to the abandoned church, the Curtis home, Ponyboys bed, and more.

Major props to Rick and Jeff Kuperman for their oh-so-muscular choreography, especially in the much-talked-about, spectacular, rain-soaked rumble. Paired with brilliant lighting by Brian MacDevitt and cinematic sound design by Cody Spencer, its a theatrical must-see moment.

The winning score by Jamestown Revival (Jonathan Clay & Zach Chance) and Justin Levine has just the right touches of guitar-based folk/Americana to remind us were in late-60s Oklahoma. Just a few standout songs include: Dallass first-act closer, Run Run Brother, as well as his second-act heartbreaker, Little Brother; the emotionally shattering Stay Gold, delivered by the pitch-perfect Ponyboy and Johnny; and the soul-baring Throwing in the Towel, wherein Darrel tells Sodapop he fears hes failed Ponyboy.

The outstanding cast (which includes ten actors making their Broadway debut) is impressive across the board. With 12 Tony Award nominations, its not surprising that Brody Grant scored a nod for Best Performance By An Actor In A Leading Role In A Musical, and Sky Lokota-Lynch and Joshua Boone were honored in the Best Performance By An Actor In A Featured Role In A Musical category. Additional nominations include Best Musical, Best Book, Best Score, Best Direction, and Best Choreography.

The Outsiders is running now at the Bernard B. Jacobs Theatre. (Rated 5 out of 5 stars)

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The Outsiders - A Moving Tale Of Muscular Misfits And Chosen Family Instinct Magazine - Instinct Magazine

While there is a lot of hype around testosterone therapy for postmenopausal women, there is no denying that testosterone is an important hormone for women.

By the time a woman reaches their mid-fifties testosterone blood levels are about one quarter of what they were at their peak in their twenties. Surprisingly there is increasing evidence that testosterone is protective of the heart. So, researchers are asking the question, could this decrease in testosterone be putting women at risk when it comes to their heart?

Researchers from the Baker Heart and Diabetes Institute and Monash University's Women's Health Research Program are leading a world first study to see if testosterone therapy can prevent the development of heart failure in postmenopausal women.

Heart failure is a condition where the heart cannot pump enough blood to match what the body needs. This condition develops silently and impacts half a million Australians.

Heart failure is most common in women with high blood pressure, who are overweight or have obesity, or diabetes. The changes that lead to heart failure occur well before there are any symptoms the very early changes can be detected by an echocardiogram.

Our researchers will investigate whether supplementing testosterone in postmenopausal women can prevent the development of heart failure and improve exercise capacity.

We are seeking postmenopausal women in Melbourne, aged 55 years and over, who are at high risk of future heart failure (such as have high blood pressure or are overweight) to be in the study.

The study involves use of a testosterone cream (approved for use in women) for 4 months and an identical placebo cream for 4 months in random order. Heart function will be measured by exercise testing and echocardiography (heart ultrasound).

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Testosterone Therapy May Combat Heart Disease in Older Women - Mirage News

Mark C. Markowski, MD, PhD

In this interview, Mark C. Markowski, MD, PhD, discusses bipolar androgen therapy (BAT), including its advantages and disadvantages, trials that have evaluated the treatment, and what some next steps may include. Markowski is an associate professor of oncology at Johns Hopkins University in Baltimore, Maryland.

We've been doing a lot of work at Johns Hopkins using high-dose testosterone therapies to treat patients with metastatic prostate cancer. It's probably been going on for more than a decade, at least with preclinical studies, and eventually moving into clinical trials. When you treat a patient with metastatic prostate cancer, the backbone of therapy is hormone suppression. We're lowering testosterone levels, trying to get them as low as possible, because testosterone fuels the cancer to grow. When we remove it from the equation, PSA levels go down and that tumor starts to shrink. As a result, patients can live a long time and do very well. But there are also can be a lot of toxicities associated with hormone-based therapies, and so trying to develop non-castrating therapies has been a goal of ours. As I said, when we lower testosterone levels in a patient with metastatic prostate cancer, the cancer will initially respond, but inevitably will become resistantthis is called castration resistance. At the end of the day, even during castration resistance, we think the cancer still wants to signal through the androgen receptor; it still wants to use that testosterone receptor to drive its growth. And it will do so in a number of different ways to get around the testosterone suppression. It can mutate the receptor, it can make more of the receptor, it could splice the receptor so that it doesn't even need testosterone to bind to it anymore, and that cancer will grow. What we've discovered is when you use high-dose testosterone therapy, for lack of a better term, there's just too much electricity flowing through that circuit, and we think we're overwhelming the cancer. By signaling through that testosterone pathway again after potentially years of experiencing a low testosterone environment, this will lead to apoptosis, cell death, and tumor regression. And so, we're trying to take advantage of how it becomes resistant to castration and then really whacking that cancer down by giving it high-dose testosterone therapy that is just too much for the cancer to handle.

We've conducted a number of clinical trials over the years. Initially, we did pilot studies, so very small numbers of patients to test for safety. Weve been treating metastatic prostate cancer with testosterone suppression for the past 80 years. So, when you propose using high-dose testosterone therapies, it can be a bit alarming to move it forward in patients. We did an initial study with etoposide and bipolar androgen therapy. In this trial, it looked like the testosterone therapy by itself worked such that chemotherapy was not necessary. We subsequently moved on to doing different groups of patients, such as patients at different stages of their cancer care. By testing bipolar androgen therapy before and after different novel androgen receptor targeting therapies, we have begun to tease out where bipolar androgen therapy may fit in the treatment paradigm for patients with metastatic prostate cancer? Is it after abiraterone [Zytiga]? Is it after enzalutamide [Xtandi]? After chemo? Where should we employ this kind of testosterone therapy? These questions remain unanswered, but we are getting closer. The largest clinical trial to date was the TRANSFORMER study [NCT02286921], which was a randomized phase 3 study for patients with metastatic castration-resistant prostate cancer after having cancer progression on abiraterone. Patients were randomized to the bipolar androgen vs enzalutamide. The primary end point was radiographic progression-free survival. What we learned from that study was that bipolar androgen therapy certainly works on its own. We can induce clinical responses, PSA decreases, and tumor regression. But when you compare them head-to-head, the results look similar with the enzalutamide. Enzalutamide had similar response rates and a similar radiographic progression-free survival compared to bipolar androgen. It was somewhat disappointing that the primary end point was not met, but when we started to look at secondary end points, we began to better understand that bipolar androgen may prime the tumor to respond to the next line androgen receptor inhibitor. It's not only that the bipolar androgen may work on its own. But it's also that the testosterone therapies may sensitize the patients to other novel androgen receptor targeted therapies. I think when we were designing the TRANSFORMER study, we were looking at testosterone by itself vs enzalutamide by itself. But when we looked at the data, those patients that got testosterone then crossed over to enzalutamide did very well. And there was actually an overall survival benefit when we looked at patients receiving bipolar androgen followed by enzalutamide vs those who just received enzalutamide by itself. That was a secondary end point, so it wouldn't change the standard of care, but at least it was cluing us in to the mechanism here, that it may not just be the bipolar androgen therapy that works, even though it does in certain patients; they do very well. But when they have cancer progression on the testosterone, we really can take advantage of that sensitization effect with next line treatment And so, we may want to prime patients between oral AR-targeted therapies with the testosterone therapy, and I think that was the lesson that we learned from TRANSFORMER.

I think we're still working on that and trying to identify where bipolar androgen therapy would be best suited. We've done a number of trials; like I said, the TRANSFORMER study. We also just completed the COMBAT study [NCT03554317], which was a combination of bipolar androgen with the immune checkpoint inhibitor nivolumab [Opdivo]. The eligibility for the COMBAT study was that patients had to have cancer progression on at least 1 AR-targeted therapy, but there was no limit in number of therapies. And so, we actually got a very heterogeneous population of patients in terms of treatment; some were early phase, early in their clinical disease course, and some were heavily pretreated with a number of oral AR-targeted therapies and even chemotherapies. And so, we got to look at some of the response rates to testosterone therapy in a bunch of different clinical states of prostate cancer. There did not appear to be an advantage of treating early vs later; it seemed like if the testosterone was going to work, it was going to work for however long it was going to work for, irrespective of the number of therapies. So, it's not exactly clear where we should implement it. It seems to work reasonably well wherever we choose to use it. But I think, in a little bit more general terms, mixing in the bipolar androgen after an AR-targeted therapy will sensitize patients to that next line of AR-targeted therapy. We've learned over the years that trying to move from an oral AR-targeted therapy like abiraterone straight to enzalutamide is not the best treatment approach. There should be something in the middle there, whether it's chemotherapy or something else. But that may be a spot where testosterone therapies would become useful to see if we can get you to sensitize to that second AR-targeted therapy.

We're trying to understand that. Conventional wisdom would suggest that the harder you've been targeting that AR-targeted pathway, the more likely you may be to benefit from the testosterone. So, the more pressure you put on the androgen receptor over time, perhaps we can take advantage of giving the bipolar androgen therapy, and that's been our hypothesis. We have not found clear, convincing evidence that the line of AR-targeted therapies will either improve or worsen outcomes. We're looking into that. What we're trying to do now is pool all the patients that we've treated over a number of clinical trials and even off clinical trials to answer this question. If we have 500 to 700 patients with various degrees of prior treatment, we may be able to at least retrospectively get a signal to say, which patients responded best to bipolar androgen. We're trying to figure that out. But I think right now, that's unclear, and we don't have that answer.

That's the million-dollar question right now. We're going over the data from the COMBAT study. The best part about that study is that we took serial biopsies from patients, so we have actual tissue that we can study from before testosterone and during testosterone. We have serial blood draws; we have a lot of time points where we're collecting specimens for patients to try to answer that question. Dr. Laura Sena, Dr. David Sanin, and others have begun to analyze some of that data. I think it's no surprise that when we study the androgen receptor and androgen receptor signaling, we're starting to see a pattern of who's going to respond to bipolar androgen. Its not just in patients who have the highest level of androgen receptor -That doesn't appear to be the case. But the data suggest that those patients that have high signaling through the androgen receptor - so if you can give them a score for androgen signaling, those that had the highest androgen receptor scorehad the best response to testosterone. From a practical perspective, that makes sense; those patients who are heavily dependent on the androgen receptor pathway may see the most benefit using a drug that's clearly hitting the androgen receptor pathway. I think that's what we found so farthat high AR signaling will predict response. We're also finding that bipolar androgen therapy can reduce MYC expression. MYC is a common oncogene in many cancers, not just prostate cancer. We found that those patients who respond deeply to bipolar androgen had very significant declines in MYC protein expression. There are still some pieces to put together there. So I think if I'm going to answer this a little bit more succinctly, patients with tumors that had high AR signaling did better on bipolar androgen, and those that we found had the most robust MYC decrease in protein expression also did very well. The relationship between AR and MYC is there, and we're trying to explore that further.

I think it's received attention. I think people are interested in the topic. The beauty of bipolar androgen is that it's relatively cheap. Injections of testosterone are somewhere in the range of $20 to $30 a month. For cancer treatments, that's remarkably inexpensive. I think there's a cost effectiveness to it. I think it's very safe. And then, in terms of the side effects of bipolar androgen, many of the "side effects are actually positive changes. Hot flashes go away, they have more energy, they get more libido, they can have erections, and this is all during the course of received treatment for metastatic prostate cancer. I think people are interested in it based on the quality-of-life perspective, the cost efficiency of it. But I also think providers need to see concrete data showing that bipolar androgen is superior to whatever cancer treatment that we're comparing it to. I think each trial that we do, we're clearly seeing signal and the treatment seems safe. What we're still trying to identify is what's the right sequence so that we can inform treatment. That kind of parlays into ongoing clinical trials with bipolar androgen. And I think the one trial that I will highlight is the STEP-UP trial [NCT04363164]. This trial involvespatients with metastatic castration-resistant prostate cancer who received prior treatment with abiraterone. They get randomized to 1 of 3 groups. They can go into the enzalutamide-only group, so they go straight from abiraterone to enzalutamide. That was 1 of the control groups in the TRANSFORMER study. And then there are 2 experimental arms. In 1 of these arms, patients get bipolar androgen therapy until progression, and then enzalutamide until progression. The third arm is a kind of flip-flop; patients receive bipolar androgen therapy for a period of time, then enzalutamide, then bipolar androgen and back to enzalutamide. The hope here is that this trial is going to be a more definitive study to really show the benefit of bipolar androgen therapy because TRANSFORMER didn't build that second piece, the enzalutamide treatment, into the primary end point. So if STEP-UP is positive and shows a clear difference vs enzalutamide alone, then I think the way patients with metastatic prostate cancer are treated is going to change. Bipolar androgen will get more attention, and more people are going to do it. I think the other part of this conversation is that there is some concern about providers and patients doing testosterone therapy off label and on their own without clear clinical guidance. It's great to get attention for your work, but we're also a bit concern that providers are just going to do it in patients because testosterone is FDA approved affordable. But we worry about safety and monitoring. How do you follow those patients? It can be a little tricky because we're using testosterone. Testosterone can signal through AR, and those cancers can make more PSA. Well, that rise in PSA may not reflect tumor growth, so do you manage that in patients? It becomes a little bit tricky. We've gotten good experience with managing these patients, like I said, over the past 10 years, sowe kind of know what patterns we're looking for. Whereas if you don't have experience, we just worry about safety. It's a double-edged sword. It's nice to get attention; I think it is getting attention. But we also worry about people going out and doing it without the proper guardrails in place.

As we learn more about mechanism, which we're understanding from the COMBAT study, we're trying to find logical partners to put with bipolar androgen therapy. I think there are 2 directions that we're going in. One is bipolar androgen by itself and the sensitization to other AR therapies story, and I think STEP-UP is going to tell that story. And then there's another direction that is somewhat open endedwhat are logical partners to pair with bipolar androgen? How do we make bipolar androgen therapy work better? Can we figure out a way to keep MYC levels down for longer? Can we pair testosterone with some MYC inhibitor or some suppressor of MYC expression to make it work better? It's possible. Are there other logical pairs of treatments that go with bipolar androgen? Yes, absolutely, and we're trying to figure those out as we go. I think it's a 2-pronged approach. One is the conventional approach, which is STEP-UP. And then as we dig through the data from our prior studies to say what makes sense to pair with bipolar androgen? We are working those out right now.

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Bipolar androgen therapy in prostate cancer: Current evidence and next steps - Urology Times

A recent study published in the journal Psychopharmacology shows that men currently using anabolic-androgenic steroids face challenges in accurately recognizing facial expressions of emotion, especially those of anger and disgust. This effect appears to be more pronounced among individuals with steroid dependence.

Anabolic-androgenic steroids, synthetic variations of the male hormone testosterone, are widely known for their use among athletes and bodybuilders to enhance physical performance and muscle mass. Despite their popularity, anabolic-androgenic steroids come with a host of potential side effects, including significant impacts on mental health and cognitive functions.

Prior studies have associated anabolic-androgenic steroids use with increased aggression, anxiety, depression, and personality disorders. Intriguingly, these behavioral changes may stem from impaired social cognitive functions, such as recognizing and interpreting others emotionsa crucial skill for effective non-verbal communication and empathy.

Motivated by the gap in understanding the specific impact of anabolic-androgenic steroids on emotional recognition, researchers conducted this study to better understand the effects of steroid use and dependence on the ability to recognize facial expressions of emotion accurately. They hypothesized that anabolic-androgenic steroid use would correlate with diminished accuracy in emotional recognition, potentially mediated by altered hormone levels.

Our team has previously investigated the role of anabolic steroids in recognizing emotions from biological movement and theory of mind video tasks, so we were interested in how people who use(d) steroids recognize emotions from facial expressions, said study author Morgan Scarth, a postdoctoral researcher at Oslo University Hospital.

We were also interested if fluctuations in hormone levels could explain any differences in emotional recognition abilities. The ability to recognize and respond to other peoples emotions may have implications for social behaviors.

The study cohort comprised 171 adult men engaged in heavy resistance training, divided into two main groups: those who had used anabolic-androgenic steroids (94 participants) and a control group with no history of steroid use (77 participants). The steroid group was further categorized based on current usage status into those currently using steroids (On) and those who had ceased use (Off).

Participants underwent a comprehensive evaluation including emotional recognition tasks, hormone level measurements, and assessments for anabolic-androgenic steroid dependence. Emotional recognition was tested using a computerized task where participants identified emotions from facial expressions. Hormone levels were analyzed from blood samples, focusing on the serum free testosterone index (FTI) among others.

Men who were currently using steroids demonstrated a significantly lower ability to accurately recognize facial expressions of anger and disgust. This indicates that steroid use may impair individuals capacity to interpret these particular negative emotions, which could have implications for social interactions and communication.

The researchers further identified that individuals with a dependence on steroids showed a worse recognition of fear compared to those without such dependence. This suggests that beyond the general effects of steroid use, developing a dependence on these substances might be associated with additional deficits in social cognition.

The researchers did not find evidence that FTI levels significantly mediated the impact of steroid use on the ability to recognize facial expressions of emotion. This indicates that while testosterone levels are altered by steroid use and correlated with changes in emotion recognition, they do not fully explain the observed deficits in recognizing certain emotions.

Men who are currently using anabolic steroids may have a reduced ability to recognize negative facial emotional expressions, specifically anger and disgust, Scarth told PsyPost. This effect does not seem to be explained by fluctuations in the hormone levels measured in the study. Men who had previously used anabolic steroids but have quit did not seem to have the same deficits, suggesting that this effect may be temporary.

However, the study is not without its limitations. The specificity of the sample all male, heavily involved in resistance training, and primarily Norwegian limits the generalizability of the findings to broader populations, including females and those from other cultural backgrounds. Additionally, the cross-sectional design precludes conclusions about causality, and the presence of unmeasured confounding variables could influence the observed relationships.

The study is cross-sectional, so we cannot make any claims that steroid use causes impaired emotion recognition, Scarth explained. Also, we do not account for the specific types of anabolic steroids used, nor the duration of use or how recently steroids were used prior to completing the emotion recognition task, which may have some impact on social cognitive abilities.

Looking ahead, the research team aims to delve deeper into the neurological impacts of anabolic-androgenic steroids, with a particular focus on how these substances affect brain aging and cognitive functions over time. By unraveling the nuanced ways in which synthetic hormones influence our minds and social lives, this line of inquiry holds the promise of informing more effective interventions for those affected by steroid use and dependence.

The research group is continuing to investigate how anabolic steroids impact the brain and cognition, and is particularly interested in the effects of anabolic steroids on brain aging, Scarth said.

The study, Supraphysiological testosterone levels from anabolic steroid use and reduced sensitivity to negative facial expressions in men, was authored by Morgan Scarth, Lisa Evju Hauger, Per Medbe Thorsby, Siri Leknes, Ingunn R Hullstein, Lars T. Westlye, and Astrid Bjrnebekk.

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Steroid use linked to diminished emotional recognition skills in men - PsyPost

A study published online Dec. 27, 2023, by JAMA Network Open confirms prior research showing that testosterone replacement therapy (TRT) in men with documented low testosterone levels does not increase their risk of prostate cancer compared to men not using TRT.

Researchers recruited 5,246 men with hypogonadism (a condition in which the testes don't produce enough testosterone), no family history of prostate cancer, and prostate-specific antigen (PSA) levels of less than 3 nanograms per milliliter (ng/ml), a number associated with a low risk of prostate cancer. The researchers randomly divided the men into two groups.

For 14 months, the men used either a topical testosterone gel at a dose designed to maintain normal testosterone levels, or an inactive (placebo) gel. Researchers measured PSA levels and conducted digital rectal exams of the prostate at regular intervals over the next three years. By the end of that period, the number of men diagnosed with prostate cancer was equally low in both the testosterone and placebo groups. Those in the TRT group did see their PSA levels rise during the first year of using the gel. However, the increase was small, and PSA levels did not rise again after that, according to the researchers. The testosterone users also reported few symptoms of an enlarged prostate, such as frequent urination, difficulty urinating, and dripping.

The study was limited to men with hypogonadism who had a low risk of prostate cancer, so it's not clear how TRT may affect higher-risk men or those who use testosterone in higher amounts, for longer periods of time, or for treating other conditions.

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Appropriate use of testosterone therapy does not appear to raise prostate cancer risk - Harvard Health

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