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Many older adults make the mistake of exercising less than they did when they were younger. But we should know better. In fact, you could make a strong case for exercising being even more important the older you get.

"When we are in our teens and 20s, building and maintaining muscle mass is as straightforward as it's ever going to be, explains Jack McNamara, M.Sc., C.S.C.S., of TrainFitness. "With the right exercise selection, training intensity, and nutrition, our muscles are primed to effectively increase in efficiency, size, and strength. But most people, especially those who don't have a history of lifting, will begin to lose muscle mass from their 30s onwards."

The medical term for what Bailey is describing is sarcopenia, or the gradual loss of muscle with age. You may not care all that much about cultivating a bodybuilder's physique after 60, but sarcopenia can lead to a steep decline in life quality. Balance suffers, bones and joints become weaker, and, before long, everyday tasks like simply climbing a flight of stairs can feel like a challenge. Just like taxes, sarcopenia is unavoidableat least to a certain extent.

"Muscle loss is a natural part of the aging process, but that doesn't mean you can't do something about it," says Josh Schlottman, C.S.C.S. For example, one study published in PLOS One found that a six-month resistance exercise training program "markedly reversed" the aging process among participants' muscles.

When we spoke to fitness experts about the best way for older adults to start building more muscle, a few recommendations kept coming up time and time again. To start, don't push yourself too hard. It's important to begin with exercises, weights, and routines that are right for your body and health.

Rachelle Reed, Ph.D., Senior Director of Health Science & Research for Orangetheory Fitness, recommends that older adults set SMART goals for themselves. "SMART stands for specific, measurable, attainable, relevant, and timely," she says. "As you begin a new exercise routine, remember to be kind to yourself and set reasonable goals. Rather than jumping in head-first, start slowly and in a way that feels manageable with your schedule."

But what about specific exercises?

We all know that muscles are built with weightlifting and resistance exercises first and foremost, but many of the trainers and physicians we spoke with say it's a mistake for those over 60 to focus too heavily on one specific muscle group. "I recommend reducing the total volume per muscle group you do per day and combining several muscle groups in one training session," says Dimitar Marinov, M.D., Ph.D. "This way, there is no risk to overtrain a single muscle group and injure yourself. Instead, you will do 1-2 exercises per muscle and train either half or all of your muscles in one workout. You can do that 2-3 times per week which will compensate for the decreased volume per session."

For the record, he's referring to compound exercises, and this approach is advantageous for older individuals for a few reasons. By spreading out the strain you'll reduce risk of injury while simultaneously targeting and building more muscles. Moreover, compound resistance exercises are also great for increasing testosterone levels, which is essential when it comes to building and maintaining more muscle.

Research published in the European Journal of Applied Physiology found that just one month of weight training increased testosterone levels among male participants by an average of 36%. Of course, women can also benefit from an uptick in testosterone when it comes to muscle maintenance and growth. "Hormones that impact our ability to build and maintain muscle, such as testosterone, drop by around 1% per year after 40. Performing compound moves stimulates the body to spike production of these hormones and ameliorate the decline as we age," Jack McNamara continues.

If you're ready to get started, read on to learn more about some of the best compound exercises for more muscle after 60. And for more reasons to exercise, don't miss this Secret Side Effect of Exercising More After 60, Says New Study.

Pull ups are an exercise classicand for good reason. They target the lats, delts, triceps, back, and core all at once using nothing but a bar to hold on to and your body weight. Even better, you can target different muscle areas depending on your grip. A close grip will focus more on your biceps and outer lats, while a wider grip will work your traps and inner lats more. And for some great exercise advice, don't miss the Secret Side Effects of Lifting Weights for the First Time, Says Science.

A diligent squatting routine can improve balance, posture, strengthen your core, improve bone density, and even help prevent dementia! Squats don't always come easy, and proper form is notoriously hard for even some experienced exercisers, but the leg muscle building benefits of this exercise makes it an essential part of any workout.

"This exercise is key to building muscle in the legs and lower body. For those over 60 with balance or coordination issues hold onto the back of a chair for balance. Stand with your feet hip width apart with your toes pointed straight ahead. Begin to lower your hips towards the floor by pushing them back behind you like you're going to take a seat. Try to get your legs to go down low enough so they're parallel to the floor. Keep breathing throughout the movement as you return back up to the starting position," Josh Schlottman suggests.

The rowing machine can be pretty intimidating for fitness beginners, but it's ideal for older adults looking to build muscle for a few reasons.

"One of the best exercises for building and maintaining muscle over age 60 is rowing," explains Caley Crawford, NASM-CPT, Director of Education for Row House. "People often associate rowing with cardio, but it is also a great strength-building exercise as it engages over 85% of the body's muscles. Rowing is low-impact and works 85 percent of the body's muscles, which means more bones are loaded and in turn, strengthened. Because rowing is done from a seated position and individuals are strapped into the footholds, there is no risk of falling during the exercise either. This helps offset the effects of bone resorption and conditions like osteoporosis. And unlike a spin bike or elliptical, the erg allows for full range of motion, promoting flexibility and joint health."

One study published in Biomedical Materials and Engineering even reports that rowing can help improve elbow, shoulder, and knee movements.

A regular bench press really only works the pectoral muscles, which is why an incline bench press is the superior choice for those over 60. By lifting at an incline of anywhere from 30-45 degrees (this will vary somewhat depending on your height and body type), you'll be working your entire upper chest, front deltoids, and triceps.

But, remember: Don't push yourself too hard with the weight. Start light and gradually build up your max rep over time. Also, your eyes should be directly under the bar when you sit down to begin. And for some more ways to motivate yourself to get to the gym, don't miss The Secret Tricks for Convincing Yourself to Exercise, Say Experts.

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Over 60? Do These Exercises to Build Stronger Muscles, Say Experts | Eat This Not That - Eat This, Not That

Testosterone plays a vital role in a range of bodily functions, including muscle and bone health, cognition, red blood cell and sperm formation, and sexual and reproductive function in males.

However, testosterone levels can decline for various reasons, including stress, aging, and certain health conditions, such as hypogonadism.

This article discusses TRT in more detail, including who it is for, the types, how it works, how to get it, what to expect from it, and more.

TRT or androgen replacement therapy (ART) is a treatment that doctors give to males who have testosterone deficiency and are showing symptoms of hypogonadism.

Taking prescription testosterone helps restore the levels of this hormone in the blood, reversing the symptoms of low testosterone. People who take it may notice improvements in alertness, sexual function, energy, mood, and overall well-being.

Doctors prescribe TRT to males with hypogonadism. To receive a definitive diagnosis, blood tests must show that a person has low testosterone levels, which the American Urological Association notes as being below 300 nanograms per deciliter (ng/dl). The individual must also have other symptoms, such as fatigue, breast growth, and sexual dysfunction.

However, doctors do not usually recommend TRT as the first course of action for low testosterone levels, even for males who show such symptoms.

If other conditions or medications cause testosterone levels to drop, doctors usually treat the underlying condition before recommending TRT.

TRT is only available with a prescription. If a person presents with symptoms consistent with low testosterone levels, a doctor will only provide a prescription after taking a thorough medical history and performing physical and lab exams.

As hormone levels fluctuate depending on activity levels, diet, and the time of day, doctors usually take a blood test before noon on 2 consecutive days. They may sometimes also ask for imaging studies and additional tests, such as tests for luteinizing hormone and follicle stimulation hormone, to determine the cause of the low testosterone levels.

There are several ways to administer testosterone:

Injectable testosterone is an inexpensive and common form of TRT. A person can receive short-acting treatment, which involves a shot every 1 or 2 weeks, or long-acting treatment, in which the second shot is 4 weeks after the first, and all others are 10 weeks apart. The dosage and frequency of the treatment may vary depending on the person.

Doctors inject short-acting testosterone under the skin or muscle, while long-acting shots go in the gluteal muscles.

TRT can cause fluctuations in testosterone levels, which can affect energy levels, libido, mood, and the presence of symptoms such as breast tenderness.

People usually apply gels and creams on a daily basis. Gradual absorption causes more stable testosterone levels in the blood.

However, people using topical treatments must be careful to avoid skin-on-skin contact with other people for at least 6 hours after application. It is important to prevent the risk of transferring the medication onto other peoples skin because it may be dangerous for pregnant people and children.

Topical patches stick to the skin and stay in place for 24 hours until the next dose. The downsides to patches are that they are not cosmetically appealing and often cause skin irritations.

A person places a buccal patch above the upper teeth, and it releases testosterone over 12 hours. In comparison with oral medications, patches may be less toxic to the liver. However, these patches can cause headaches and gum and mouth irritation.

Testosterone pellets are small plastic pellets that doctors implant under the skin. The implant goes into a persons upper hip or buttock. The pellets dissolve slowly and can deliver TRT for 36 months.

Inserting implants is a minor inpatient surgical procedure. A doctor makes a small cut and then inserts the pellets in the fatty tissue below the skin. They perform the procedure under local anesthesia.

Learn more about testosterone pellets here.

Oral testosterone is a less common type of TRT that is more expensive and less practical. Its long-term use can potentially cause liver damage.

Most tablets also come with warnings about the drug causing hypertension and stroke. As a result, only individuals who cannot use other forms of TRT resort to taking testosterone by mouth.

A person applies nasal testosterone gel to the inside of the nose. They will need to do this three times a day at intervals of 68 hours, preferably at the same times every day. Some common reactions to this treatment include headaches, nosebleeds, a runny nose, and nasal discomfort.

TRT aims to restore a persons testosterone levels to normal. The individual can expect improvements in their blood testosterone levels within a week.

A person may also note other benefits, such as an increase in bone density and lean body mass, an improvement in well-being, and a boost to energy and libido. It may take from 4 weeks to several months to see positive changes.

TRT is typically a lifelong treatment. Once a person starts TRT, their doctor will continually monitor their response to treatment. People need to have routine checkups at least every 612 months to assess their blood testosterone levels.

A doctor will also monitor changes in symptoms and side effects at 3 and 6 months after the initial treatment and then annually.

TRT costs range from $150 to $1,500 per month and vary depending on various factors, including:

In addition to the possible short-term side effects, TRT may also cause health risks. The Endocrine Society recommends that people with the following conditions do not start using TRT:

It also states that the treatment is unsuitable for males who wish to conceive in the near future.

Males aged 40 years older, preadolescent people, and those with migraine or epilepsy may require special considerations.

The Food and Drug Administration (FDA) explains that the benefits and safety of TRT for treating low testosterone levels due to aging are not known. The organization requires that testosterone products carry warnings mentioning the possible risk of stroke and heart disease.

A 2017 review found that men undergoing TRT have a higher risk for cardiovascular events such as stroke.

Other side effects of taking testosterone include:

High cholesterol may also be a side effect. However, a 2021 study suggests that TRT may improve total cholesterol levels.

The current scientific literature suggests that TRT worsens breast and prostate cancer. However, TRT may offer benefits to people with early stage prostate cancer without stimulating the recurrence or progression of cancer.

The following are commonly asked questions:

TRT costs range from $150$1,500 per month depending on the type of TRT, the mode and frequency of administration, and the insurance coverage.

Yes. Most insurance companies cover all forms of TRT. However, there may be out-of-pocket costs.

Although TRT offers benefits to people with low testosterone levels, it can cause many short-term side effects. It may also put people who take TRT in the long term at increased risk of liver and heart problems.

TRT treatment length is indefinite unless the low levels are due to an underlying cause that is treatable.

TRT is a common treatment for low testosterone levels, but it is not suitable for everyone.

People who are considering TRT need a prescription and proper guidance from a doctor.

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TRT for low testosterone: Options, cost, and side effects - Medical News Today

This article was originally published here

Endocr Pract. 2021 Aug 11:S1530-891X(21)01158-7. doi: 10.1016/j.eprac.2021.08.002. Online ahead of print.

ABSTRACT

OBJECTIVE: This narrative review offers a guideline-based approach to optimizing the diagnostic evaluation and treatment decision-making in men being evaluated for testosterone deficiency.

METHODS: A narrative review RESULTS: Testosterone deficiency is a clinical syndrome that results from the inability of the testes to produce normal amounts of testosterone, and is characterized by a constellation of symptoms and signs associated with consistently low testosterone concentrations. The diagnosis of testosterone deficiency is made by ascertainment of symptoms and signs; measurement of total and, if indicated, free testosterone levels, in early morning fasting samples on 2 or more days; measurement of LH and FSH to distinguish primary from secondary hypogonadism; and additional evaluation to ascertain the cause of testosterone deficiency. Non-specificity of symptoms and signs; variations in testosterone levels over time; inaccuracy in the measurement of total and free testosterone levels; variations in binding protein concentrations; and the suboptimal reference ranges contribute to diagnostic inaccuracy. Testosterone treatment is indicated for men with symptomatic testosterone deficiency. Testosterone treatment should be avoided in men with prostate or breast cancer, erythrocytosis, thrombophilia, increased risk of prostate cancer or severe lower urinary tract symptoms without prior urological evaluation, recent major adverse cardiovascular event, uncontrolled heart failure or severe untreated sleep apnea. Testosterone replacement therapy should be accompanied by a standardized monitoring plan.

CONCLUSION: The shared decision to treat should be guided by consideration of the burden of symptoms, potential benefits and risks, patients values, and the cost and burden of long-term treatment and monitoring.

PMID:34390882 | DOI:10.1016/j.eprac.2021.08.002

Continued here:
Optimizing the Diagnostic Accuracy and Treatment Decisions in Men with Testosterone Deficiency - DocWire News

This article was originally published here

Can J Urol. 2021 Aug;28(4):10738-10742.

ABSTRACT

INTRODUCTION Androgen deprivation therapy (ADT) is often used in the treatment of prostate cancer. Specific factors affecting testosterone recovery after cessation of ADT have not been well-characterized in existing literature.

MATERIALS AND METHODS: We retrospectively reviewed patients at our institution who received ADT between 1999 and 2018. Patients with at least one course of ADT and subsequent testosterone level within 12 months of cessation of ADT were included. Patients received at least one of the following four agents: leuprolide, goserelin, triptorelin, and degarelix. Cox regression models were utilized to estimate the effect of patient and treatment characteristics on time to testosterone recovery( 240 ng/dL) after ADT cessation. Patients without testosterone recovery were censored at last testosterone evaluation. To account for the possible dependency between multiple ADT courses within a patient, we used a robust sandwich variance estimate.

RESULTS: Severty-six patients were included. Mean age was 64 +/- 8 years. Median duration of ADT was 15 months, with a median time to recovery of 19 months. On univariable analysis, age and duration of ADT were significant; a trend towards significance was noted for hypertension, diabetes, peripheral vascular disease, goserelin and bicalutamide. Patient age, duration of ADT, and treatment with the agent goserelin were significantly associated with prolonged hypogonadism on multivariable analysis (p < 0.01).

CONCLUSIONS: Increasing age and duration of ADT therapy are associated with decreased likelihood to recover normal testosterone levels after cessation of therapy. The use of the ADT agent goserelin was also associated with decreased testosterone recovery for unclear reasons.

PMID:34378507

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Decreased testosterone recovery after androgen deprivation therapy for prostate cancer - DocWire News

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Over the years, many physical traits have been touted as correlated with male success. Tall guys make more money. Attractive men have a better chance of getting hired. Obese fellows suffer in job interviews.

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That height/income correlation is pretty well documented. University of Florida researcher Timothy Judge and colleagues analyzed data from 8,500 American and British subjects and worked out that someone who is six feet tall earns, on average $166,000 more in a 30-year career than someone who is 5 feet 5 inches. This was true for both genders, though shorter men are slightly more likely to encounter height bias in the workplace than are shorter women.

Likewise, the attractiveness bias, sometimes called lookism, is well established. A 2019 article in the Harvard Business Review noted that it starts early. Attractive applicants score higher in college admissions interviews and earn higher grades when they get to class. The author, business psychology professor Tomas Chamorro-Premuzic, cites the very well-established halo effect whereby attractive people are generally perceived as being more sociable, healthy, successful, honest, and talented.

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He also makes an interesting suggestion for tackling this type of bias artificial intelligence. If programmed correctly, he writes, AI could become an objective way to measure what we dont always see ourselves. The key phrase there is if programmed correctly. So far, many artificial intelligence models simply automate the biases of their creators.

Testosterone certainly appears to predict some kinds of business success. Researchers led by Sean Harrison of the University of Bristol note that among male executives, circulating testosterone has been linked with a number of subordinates and among male financial traders, with daily profits.

It has been suggested that this happens because higher testosterone levels tend to increase a mans tolerance for risk. This, in turn, leads many guys with high testosterone to choose the path of entrepreneurship, with the attendant risks and rewards. Even for those in standard employment situations, a higher testosterone level may affect willingness to engage in assertive wage bargaining.

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Harrison and colleagues dove into a huge biomedical database, the U.K. Biobank, and studied the records of 306,248 men and women. They were seeking to establish a causal relationship between testosterone levels and what they called socioeconomic position (SEP).

One concern here is the direction of causation. Perhaps having a lower SEP causes lower testosterone levels in men. This would make sense because being poor is stressful and, as they note, psychosocial stress associated with socioeconomic adversity could influence testosterone alongside other aspects of health.

One unique contribution of this study is the fact that it used a technique called Mendelian Randomization. Made possible by advances in genetics, this method analyzes single nucleotide polymorphisms (SNPs) which are determined at conception and related to a single factor, in this case, testosterone production. This allows the researchers to rule out reverse causation and other confounding effects.

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At the end of the day, they concluded that We found little evidence that testosterone affected socioeconomic position, health, or risk-taking. Were previous studies wrong? Not necessarily, but they may have been clouded by reverse causation or other factors.

Another study, also from the U.K., compared men who grew up in the relatively healthy and wealthy environment of London with those raised in Sylhet, Bangladesh. As the authors note, Men in wealthier countries tend to have higher levels of testosterone than men in poorer countries or places with high rates of infectious disease.

What wasnt clear is when this effect took place. Was it in infancy? Childhood? After puberty? New research by Kesson Magid of Durham University studied men who moved to London at various life stages. The researchers looked at factors like height, age of puberty, and testosterone levels as adults.

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Migration before puberty predicted higher testosterone and an earlier recalled pubertal age compared with Bangladeshi sedentees or adult migrants, with more pronounced differences in men who arrived before the age of eight.

They have an interesting explanation for their results, which is based on the energy cost of various activities. Boys in Bangladesh, where sanitation is poor, spend a lot of their biological resources developing immunity. This comes at the expense of building a strong reproductive function.

As the authors write, We found that the longer a man lived in Bangladesh as a child, the shorter he was as an adult. This suggests that boys growing up in Bangladesh had to trade off growing taller for something else, such as immunity.

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Theres not much you can do about your height or attractiveness unless you are ready for serious plastic surgery. As for tweaking your testosterone levels, experts like urologist Dr. Puneet Masson of the University of Pennsylvania urge caution. He treats men with low testosterone levels who are trying to become fathers. Many times Im taking these guys off of supplements or medications and putting them on something to get their body to make its own testosterone, he notes. The Penn Medicine site also cautions that taking exogenous or external testosterone shuts off other hormones essential for sperm development.

Its worth a mention that these testosterone studies were published both in academic journals and, in a more approachable format, on a free website called theconversation.com/ca. Spending some time reading articles there might have an even stronger correlation with your career success than your height, looks, or testosterone levels.

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Keenan: Is your success tied to your testosterone? - Calgary Herald

Cyclocross fans were shocked by the news of Katie Comptons four-year USADA ban for anti-doping violations. Reports of different tests, isotopes, ratios, biological passports and terms like anabolic androgenic steroids had most of us turning to Google, or turning away in confusion.

Bruce Hildenbrand has covered professional cycling for four decades, and in that timeframe, he has developed more than a laymans knowledge of the unfortunate, darker side of the sport. He offers Cyclocross Magazine readers his insight and some background on the recent events that surround Comptons positive test and subsequent four-year USADA ban.

The stunning news that Katie Compton received a four-year doping ban for an anabolic androgenic steroid raised more questions than answers. Given that the Carbon Isotope Ratio (CIR) test was used to re-analyze her urine sample, it likely indicates that the anabolic androgenic steroid was testosterone.

Katie Comptons husband, Mark Legg-Compton, has since confirmed the substance was exogenous testosterone in a Facebook post.

It is well known that testosterone aids in recovery. Top professional road riders including Floyd Landis and Tom Danielson have been busted for testosterone by the CIR test, but it is not used very frequently by anti-doping laboratories.

This new finding brings the whole problem of the current form of testosterone testing to the forefront. For years, the testosterone-to-epitestosterone ratio test, known a the T/E Ratio test, has been used to determine if an athlete is taking an external source of testosterone.

Unfortunately, if an athlete is using a water-soluble version of testosterone and they take it during the late evening/early morning windows when athletes are not typically tested, it is very easy to beat the T/E Ratio test. This is the reason why the CIR test was developed. Using a gas chromatograph and mass spectrometer, the test can accurately detect the different carbon isotopes which occur between naturally occurring testosterone, which the human body produces in the gonads for men and ovaries for women, and the plant-based testosterone which is the form taken externally.

Why continue to use a flawed test? The reason why the T/E Ratio test is still being endorsed and used by the World Anti-Doping Agency (WADA) accredited anti-doping labs is that it costs about $30 per test whereas the CIR test costs about $300 per test.

In the sport of cycling, in-competition dope testing is typically paid for by the race, whereas the anti-doping agencies, such as USADA, pay for out-of-competition testing. Unfortunately, it just comes down to a matter of economics and not which test is the most accurate. However, as weve seen with samples from the last few Olympic Games, athletes samples, which are stored just for this purpose, are being re-tested. This can happen when new tests are developed, or in the case here with Katie Compton, when her biological passport indicated that her sample might need additional testing, USADA can use the more accurate CIR test.

So, what does this mean for Katie Compton? Recent changes to the WADA code require a four-year ban for the first doping offense. Clearly, the anti-doping authorities believe the results of their tests. The only avenue for Katie is to either challenge the handling of her sample or how her tests were performed, or perhaps prove it was unintentional and get a reduced sentence. Such a challenge is expensive and can cost hundreds of thousands of dollars. Some athletes in the early stages of their careers have chosen just to sit out the ban. Being near the end of her career, Katie chose to retire.

Bruce Hildenbrand has been covering the sport of professional cycling in the US and Europe for over 40 years. He has reported on numerous doping cases for major media outlets such as Outside Magazine.

What will fans focus on in remembering Comptons career given the recent news? photo: 2018 Superprestige Gavere Women. A. Yee / Cyclocross Magazine

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Katie Compton's Positive Steroid Test and Ban: Here's What We Know - Cyclocross Magazine

Testosterone Replacement Therapy Market Overview 2021 2026

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Testosterone Replacement Therapy Market Forecast to 2026 - Global Analysis and COVID-19 Impact by Type, Application and Geography - The Market Writeuo...

Ah, the Olympics. Normally, I am not a sports fan, but there is something about the Olympics that seems to appeal to everyone.

Besides the pure competition, there is the pride in our hometown heroes like Suni Lee, Grace McCallum, Regan Smith and Gable Stevenson; the joyous faces of their parents; the stories of sacrifice and success; the sportsmanship of the two men who helped each other finish after falling in the 800-meter race; the high jumpers who were willing to share a gold medal; the tiny underdog countries winning their first medals ever.

Sure, the spectacle is produced to tug at your heart strings. The nationalistic medal counts fly in the face of the purported Olympic goals of peace and goodwill. But, overall, it is wonderful.

Each Olympics gives us an exposure to sports few of us follow like individual epee (fencing), the 10-meter air rifle mixed team (shooting) or team dressage (equestrian). In addition, there are new events like BMX freestyle and canoe sprinting. Im just pleased they dropped live pigeon shooting after only one year.

Everything has rules. There are issues arising about uniforms being too revealing, or not revealing enough. The high-tech fabric used in swimwear in the 2008 games has now been banned after too many records were broken. BMX jerseys cant be made from Lycra, they cant have back pockets, and they must be tucked in. Even swim caps caused controversy when the Soul Cap, designed for voluminous hair and braids, was banned even though no competitors were wearing them. Earrings and nail colors are restricted in some sports, although this years fads of multi-colored hair and extreme eyelash extensions were allowed.

Drug testing has caused athletes to be prohibited from competition and lose medals. Russia, as a country, is banned from competition due to its history of doping, yet the Russian Olympic Committee sent 330 athletes to Tokyo. Go figure.

The 2020 games had been postponed for a year due to COVID. There were special protocols in place and no spectators allowed. A number of athletes had their Olympic dreams shattered when a positive COVID test forced them to withdraw from competition. Sadly, this sometimes affected entire groups of athletes who had been in contact with those who tested positive.

But the strangest story I heard was about Christine Mboma and Beatrice Masilingi of Namibia who were prohibited from running a 400-meter race because their natural testosterone levels were too high. However, they were allowed to compete in shorter races and Christine Mboma won the silver medal for the 200 meter race.

These women have some natural condition that gives them high testosterone levels. No one is alleging that they are men, nor that they have taken testosterone supplements or any other performance enhancing drugs. Their bodies just make extra testosterone. So, is that unfair? How are they considered women for short races, but not for longer ones?

What about the 7-foot-tall basketball players? They may have a natural condition that provided more human growth hormone? Dont they have an unfair advantage?

Or how about the tall, long-armed swimmers? The kids raised at high altitude whose lungs are better developed? The short female gymnasts who can easily clear the uneven bars? The athletes who have had elite coaches their entire lives? The baseball players who, as a group, have superb vision. Arent those unfair advantages?

Lets face it, most of us mere mortals could train for years and we might get pretty good at a sport, but few people have the physical capabilities that allow them to become world class athletes. So how do you determine which advantages are normal and which are unfair?

Sure, we ban drugs and equipment which enhance performance, but the variety of individual physical differences has been accepted and celebrated as part of sports.

The issue here relates to the real, and perceived, differences between men and women. It wasnt until 1972 that women were allowed to run the Boston Marathon. It was assumed that women couldnt run that far.

When I was in high school, women couldnt play full court basketball. The guards were on one side, the forwards on the other, and no one could cross the center line. Women were considered too delicate to run the full court. Tell that to the Lynx!

Women now compete in every sport imaginable. In many recreational contests there are some women who outperform the men, yet there remain differences in strength and endurance between men and women. Any woman who has performed too well athletically has probably been called too masculine. But does it really come down to measuring testosterone in a blood test? What else is considered?

There are now only three years before the Paris Olympics. Breaking (competitive breakdancing) will be added as an Olympic sport while baseball, softball and karate will be left out. There will be continuing disputes over uniforms, drug tests and womens testosterone levels. Well have more hometown heroes, proud parents, and sportsmanship stories with the Eiffel Tower and the Arc de Triomphe in the background. I cant wait!

Rochelle Eastman is a Savage resident who writes for Community Voices every month.

More:
Community Voices: Once again, the Olympics are filled with glory and controversy - SW News Media

Studies are beginning to suggest that COVID-19s impact on mens health might go beyond the lungs, heart, and kidneys. According to recently published studies, having COVID-19 could have lasting impacts on fertility and sexual function.

Ranjith Ramasamy, MD, associate professor and director of the University of Miami Miller School of Medicines Reproductive Urology Program, is uncovering what he says are clear links between COVID-19 infection and mens sexual health.

We know the COVID-19 virus can remain inside the testis long after the initial infection in asymptomatic men. We know the COVID-19 virus can decrease sperm count for up to 3 to 6 months. And we know the COVID-19 virus can affect the blood vessels and be present in the penis up to 7 to 9 months after the initial infection and can lead to erectile dysfunction, Ramasamy said.

Getting the mRNA COVID-19 vaccine does not appear to impact fertility and should be encouraged, according to Ramasamy, who has published several articles on COVID-19 and mens sexual health, including the research letter, Sperm parameters before and after COVID-19 mRNA vaccination published June 17 in JAMA.1

Findings from early studies looking at male infertility postCOVID-19 infection are concerning, reassuring, conflicting, and inconclusive.

COVID-19 does not appear to get into the semen, according to urologist James M. Hotaling, MD, MS, FECSM, medical director of the fertility integrated practice unit and director of the Mens Health program at the University of Utah, Salt Lake City.

Hotaling and coauthors in China conducted an observational study of 34 adult Chinese males who received a diagnosis of COVID-19 and found severe acute respiratory syndrome (SARS)-CoV-2 was not detected in the mens semen 1 month after COVID-19 diagnosis.2

Current evidence suggests a low likelihood of SARS-CoV-2 transmission through the seminal fluid. There are limited data characterizing SARS-CoV-2 infections impact on male reproductive hormones and semen parameters. And data suggesting SARS-CoV-2 gets into testes are inconclusive, according to Hotaling.

Data regarding the short- and long-term impacts of SARS-CoV-2 on male reproductive health remain largely inconclusive and need further long-term study, Hotaling and colleagues reported in a review of the literature published April 2021 in Fertility and Sterility.3

But Ramasamy and other investigators are finding causes for concern.

A study published earlier this year in the World Journal of Mens Health by Ramasamy et al looked at testis tissue collected from autopsies of 6 COVID-19 positive and 3 COVID-19 negative men. The investigators found 3 of the 6 COVID-19positive biopsies had normal spermatogenesis and 3 had impaired spermatogenesis. Electron microscopy showed the COVID-19 virus in testis tissue of 1 COVID-19positive autopsy case.

The novel COVID-19 virus has an affinity for angiotensin converting enzyme-2 (ACE-2) receptors. Since ACE-2 receptor expression is high in the testes, the study authors hypothesized that COVID-19 can be present in testes tissue of infected patients. This study suggests that the male reproductive tract, specifically the testes, may be the target of COVID-19 infection. They found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism of how COVID-19 can cause infertility, according to the study.4

Investigators in China also found evidence that SARS-CoV-2 can infect the testis and germ cells, suggesting a potential impact on spermatogenesis and male fertility.5

Nevertheless, further study is essential to reveal the underlying mechanism of SARS-CoV-2 infection of testicular cells and the correlation of testis infection with the clinical course of COVID-19, according to the correspondence published December 14, 2020, in Cellular and Molecular Immunology.

Although more quality research is needed to confirm these results, the findings make sense when one thinks about COVID-19 infection basics, according to Hossein Sadeghi-Nejad, MD, FACS, professor of Surgery/Urology at Rutgers New Jersey Medical School and Hackensack University Medical Center.

Infection from SARS-CoV-2 causes an exaggerated inflammatory response leading to immunosuppression. The body releases cytokines that mainly affect lung tissue but also lead to extrapulmonary effects, he said.

For example, some studies are showing overall testosterone levels can be lower in patients who get COVID-19. Investigators of a single-center cohort study of patients with COVID-19 found lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men.6 Still unclear is whether the decrease in testosterone is an adaptive or maladaptive COVID-19 response.7

The reason for the likelihood of lower testosterone levels in COVID-19 patients is that SARS CoV-2 gets into the system is through ACE-2, which has been expressed in Leydig cells and Sertoli cells, according to Sadeghi-Nejad.

Damage to Leydig cells may lead to testosterone deficiency, he said.

There are about 2 dozen peer-reviewed articles containing research or findings regarding COVID-19 and erectile dysfunction (ED), according to Martin Gross, MD, assistant professor at Dartmouth-Hitchcock Medical Center and codirector of the Dartmouth-Hitchcock Mens Health Center.

They predominantly include case reports, observational studies, survey data, expert opinions, and review articles. These types of articles tend to be on the lower end of scientific rigor, Gross said. We dont know much about the relationship between ED and COVID-19 at this point.

A study by Ramasamy et al, published in July in the World Journal of Mens Health analyzing penile tissue from COVID-19 patients who recovered and subsequently developed ED, was novel and interesting, according to Gross.8

It was the first study to demonstrate the presence of the COVID-19 virus in the penis up to 9 months after the initial infection and suggests that endothelial dysfunction from the virus could contribute to ED.

Omer Raheem, MD, MSc, assistant professor of urology and director of mens health at Tulane University School of Medicine, New Orleans, Louisiana, said he found it interesting that 1 of the 2 men Ramasamy and colleagues studied was hospitalized for COVID-19 infection, whereas the other had only mild COVID-19 symptoms, yet both men developed severe erectile dysfunction.

This study suggests that widespread endothelial cell dysfunction from COVID-19 infection can contribute to erectile dysfunction. Larger prospective studies are warranted to further validate this finding, Raheem said.

From patients perspective, albeit not conclusive, there is some evidence suggesting the potentially negative impact of COVID-19 infection on male reproductive function and overall mens health. Likewise, COVID-19infected or COVID-19recovered men should be aware of the possible risk of developing erectile dysfunction, male infertility, and hypogonadism, owing to the adverse effect of the SARS-CoV-2 virus on testicular Sertoli and Leydig cells via ACE-2 binding. And obviously those symptomatic men should seek urologic consultation to evaluate and treat these conditions, Raheem said.

Although the link between COVID-19 infection, endothelial damage, and ED is interesting, the finding should be further evaluated in larger studies and viewed cautiously, according Sadeghi-Nejad.

Endothelial damage is not restricted to COVID-19. Endothelial dysfunction is seen in many of our patients who have erectile dysfunction, which we know to be a neurovascular problem, Sadeghi-Nejad said.

There are conflicting data about whether sexual activity increased or decreased during the pandemic, according to Sadeghi-Nejad.

Many surveys on sexual activity during quarantining suggest decreased activity, possibly because the studies included younger patients with children living at home. Other studies on older patients showed increased activity.

Interestingly, investigators studying US sales of phosphodiesterase-5 (PDE5) inhibitors show sales of the medications spiked during lockdowns.9

Turkish authors of a paper published earlier this year in Sexual Medicine reported a significant increase in andrological diagnoses during the pandemic, compared with before it.10

There was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period, according to the authors. The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than [in] the preCOVID-19 pandemic period.

The papers authors suggest that although these problems are multifactorial, psychogenic factors might be a significant trigger.

In other research, the PDE5 inhibitors men use to treat erectile dysfunction could also treat COVID-19. These medications, the authors wrote, have anti-inflammatory, antioxidant, immune response regulation, and antiapoptotic properties.11

A lot of the paper was theoretical but solidly grounded in physiology and pharmacology, Gross said. These studies are all interesting to some degree, but they are snapshots in time that may lose relevance down the road.

Counseling patients about COVID-19s potential impact on sexual health and fertility might start with encouraging patients to get vaccinated.

I recommend that all couples trying to conceive get the vaccine. And that it is safe, Hotaling said.

Men who have acute COVID-19 infections and see a decline in spermatogenesis should consider waiting 3 to 6 months before planning fertility treatment so their sperm counts can recover, according to Ramasamy.

Sadeghi-Nejad cites American Society of Reproductive Medicine recommendations regarding shared decision-making and detailed discussions, including not withholding the vaccine from patients who are planning to conceive, those who are already undergoing fertility treatment, and pregnant patients. These groups should be encouraged to receive vaccination if there are no other contraindications.12

Gross, however, said he questions the value of further research on the link between ED and COVID-19, and a COVID-19 diagnosis does not change his approach to ED treatment.

It would be presumptuous to think that our little corner of medicine has any relevance to the bigger COVID-19 picture. And lots of conditions cause ED; lets try and tackle those first, Gross said. I have never found a good reason to wait to treat any patients erectile dysfunction. If a patient has a problem, hears his options, and is healthy enough and wants to proceed with some or all of these options, then Im happy to help. If patients arent healthy enough or otherwise prepared to move forward with treatment, then we can wait until theyre ready.

Questions remain about how the virus invades the immune system and can stay in organs for such a long time, as well as whether any impact from COVID-19 on male fertility or sexual function is permanent, according to Ramasamy.

More data should be coming out soon, according to Hotaling.

Some of the big IVF groups are tracking their outcomes where the men or women have had COVID-19. A lot of these big claims databases will release their data from 2020 sometime between now and the end of the year, Hotaling said. There are a lot of studies out of Europe that Ive seen tracking cohorts of patients who had COVID-19.

Ongoing and long-term studies to evaluate the potential impact of the COVID-19 infection on mens health are needed as we emerge from COVID-19 pandemic and monitor the novel COVID-19 Delta variant, Raheem said.

References

1. Gonzalez DC, Nassau DE, Khodamoradi K, et al. Sperm parameters before and after COVID-19 mRNA vaccination. JAMA. Published online June 17, 2021. doi:10.1001/jama.2021.9976

2. Pan F, Xiao X, Guo J, et al. No evidence of severe acute respiratory syndrome-coronavirus 2 in semen of males recovering from coronavirus disease 2019. Fertil Steril. 2020;113(6):1135-1139. doi:10.1016/j.fertnstert.2020.04.024

3. Patel DP, Punjani N, Guo J, Alukal JP, Li PS, Hotaling JM. The impact of SARS-CoV-2 and COVID-19 on male reproduction and mens health. Fertil Steril. 2021;115(4):813-823. doi:10.1016/j.fertnstert.2020.12.033

4. Achua JK, Chu KY, Ibrahim E, et al. Histopathology and ultrastructural findings of fatal COVID-19 infections on testis. World J Mens Health. 2021;39(1):65-74. doi:10.5534/wjmh.200170

5. Ma X, Guan C, Chen R, et al. Pathological and molecular examinations of postmortem testis biopsies reveal SARS-CoV-2 infection in the testis and spermatogenesis damage in COVID-19 patients. Cell Mol Immunol. 2021;18(2):487-489. doi:10.1038/s41423-020-00604-5

6. Dhindsa S, Zhang N, McPhaul MJ, et al. Association of circulating sex hormones with inflammation and disease severity in patients with COVID-19. JAMA Netw Open. 2021;4(5):e2111398. doi:10.1001/jamanetworkopen.2021.11398

7. Stolk RF, van Leeuwen HJ, Kox M, et al. The chicken or the egg: low testosterone predisposes for COVID-19 or COVID-19 induces a decrease in testosterone? Crit Care. 2021;25(1):237. doi:10.1186/s13054-021-03664-9

8. Kresch E, Achua J, Saltzman R, et al. COVID-19 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical, and ultrastructural study of the human penis. World J Mens Health. 2021;39(3):466-469. doi:10.5534/wjmh.210055

9. Hernandez I, Gul Z, Gellad WF, Davies BJ. Marked increase in sales of erectile dysfunction medication during COVID-19. J Gen Intern Med. 2021;1-3. doi:10.1007/s11606-021-06968-2

10. Duran MB, Yildirim O, Kizilkan Y, et al. Variations in the number of patients presenting with andrological problems during the coronavirus disease 2019 pandemic and the possible reasons for these variations: a multicenter study. Sex Med. 2021;9(1):100292. doi:10.1016/j.esxm.2020.100292

11. Mostafa T. Could oral phosphodiesterase 5 inhibitors have a potential adjuvant role in combating COVID-19 infection?. Sex Med Rev. 2021;9(1):15-22. doi:10.1016/j.sxmr.2020.08.006

12. ASRM issues statement on COVID-19 vaccines, joins other OB/GYN groups on community-wide statement. News release. American Society for Reproductive Medicine. Dec 16, 2020. Accessed July 13, 2021. https://bit.ly/3BbJ5Bq

More here:
COVID-19 and men's health: What we know so far - Urology Times

PROVIDENCE 'Twas a time when Buddy Cianci and the Mob ruled Rhode Island's Capital City.

Politicians and their minions frequented the clubs where the mobsters and their alcohol-infusedwannabeshung out, wagedturf battles and exchanged punches.

More than a few of these players ended up dead or in jail.

Providence MayorVincent A. "Buddy" Cianci Jr.was sentenced to five years in federal prison after a jury convicted him of running a criminal enterprise out of City Hall.

"It's a wild story,'' says former Providence club owner and sometime political candidate Pat Cortellessa, who survived clashes with thewiseguys, but gothishead proverbially handed to him by the mercurial mayor.

Former East Providence Police Capt. Joe Broadmeadow who also co-wrote a book with Brendan Doherty, the retired head of the Rhode Island State Police tells Cortellessa's story in a new book coming out Monday.

"Divine Providence: The Mayor, The Mob, and The Man in the Middle."

The book paints this vivid and Runyonesque picture of the 1970s-'80s Providence club scene:

"The payoffs and bribes for liquor licenses, the 'rent' paid to the mob for protection, and the always volatile mix of alcohol, pretty women, and testosterone-fueled muscle heads with too much brawn and ... under-used brains."

"Remember, this was in the cocaine-fueled insanity of the time when weapons, alcohol, testosterone, and dominance-seeking males often considered a night without a fight a failure."

At one point, the book tells us, "it got so bad Pat resorted to keeping an M-1 carbine in his car, just in case."

Cortellessa comes across as neither hero nor villain, but a survivor repelled by the blatantcorruption, he says, heencountered emanating out of City Hall.

Thebook tracks his attempts to make nice with the mayor by making $500 contributions and hosting fundraisers for him before their dealings turned into all-out war.

Coming five years after Cianci's death in 2016, the book gives Cortellessa a last word onwhat happened to his license to run the long-gone Caf Plaza in the oldcomfort station in Kennedy Plazawhen he refused to pay the tithe,he alleges, Cianci's front-manFrank Correntedemanded of him.

He recounts his version of how far Cianci and his allies on the city Board of Canvassers and in the city police department went to keep him from running against Republican-turned-Independent Cianci in 1998.

He reveals one or more conversations with the FBI.

He also spells out the hard lessonhe learned when he tried to open his firstrestaurant in Providence, at the site of the old East Side Diner, without "wiseguy insurance."

On Aug. 31, 1982, just weeks before finishing the renovations, the building went up in flames.

The city fire chief told The Journal-Bulletin: "the strong odor of a flammable liquid" remained the next day.

In 2018, Cortellessa ran for secretary of state against the incumbentDemocrat Nellie Gorbea. He lost:67.4% to 32.5%.

In 2020, running again as a Republican, he lost his bid for the state Senate seat held by Cranston Democrat Hanna Gallo.

Asked last week if he intended to run for anything next year, in 2022, Cortellessa said he has not yet definitely decided, buthis decision to tell his story, without holding back,would likely complicate his chances.

Take his relationship withMafia capo Frank L. "Bobo" Marrapese Jr.

Long known as one of the most vicious enforcers for New England crime boss Raymond L.S. Patriarca, Marrapese died in December 2017, while serving time for the murder of mob associate Richard Dickie Callei on March 15, 1975.

But when rivalries festered among the competitive club owners or tussles threatened to blow up Cortellessa, more than once,put his"faith in mob diplomacy and the word of Bobo Marrapese.'' He viewed him as his protector.

Cortellessa denies paying bribes for licenses or "rent" to the mob.

Here's the way it worked, according tothe book:

Bobo Marrapese owned the video games and pool tables. It served as a safety net from jealous nightclub owners. Using those machines was insurance against the business burning to the ground, as I knew from personal experience.

"Of course, Coin-O-Matic (the business front controlledby Raymond L.S. Patriarca) had the cigarette machines.

"Using the machines from these guys didnt cost the business anymore each side got 50% of the proceeds but using the wiseguys machines had other fringe benefits."

Buddy started coming in Slades for a drink once in a while,'' Cortellessa saidof hisbar and grillacross the street from City Hall."Sometimes, hed bring his daughter, Nicole, and while Buddy sat at the bar, shed play the Pac-Man video game."

The intersection between Cianci and the Mob?

In an exchange of emails last week, Broadmeadow provided tidbits from his research for an earlier book aboutJerry Tillinghast, "an at once intimidating and charming member of [mob associate Gerard] Ouimettes crew."

"The association with the mob started with the usual outreach for votes. When Buddy first ran against[incumbent Mayor Joseph] Doorley, he needed to gather votes. Patriarcas support (clandestine of course) was needed to get the Italian vote."

"Cianci reached out to Gerard Ouimette who had [Tillinghast] and others gather up 'absentee'ballotsfor Cianci, delivering over two thousand to the polling location from the Hill and South Providence with their connections to the black community.

"Jerry talks about it in my book 'Choices: You Make em You Own em.' Tillinghast would end up working for the city as a laborer. He was working for the city when he got arrested for the [George] Basmajian homicide."

But "Buddy wasnt the only candidate who came seeking votes from the wiseguys,'' Broadmeadow wrote in the book.

He said "Ouimette and crew'' also delivered votes for a certain [state] Senate candidate, but "soured" on him when he proposed re-instituting the death penalty for murder.

"Such legislation was anathema to groups where murder was a method of eliminating problems."

Broadmeadow identified the senator as the late Joseph Rodgers, future presiding justice of the R.I. Superior Court.

Cortellessa's fight with Cianci came to a head in the mid-'90s, after the mayor's returnto City Hall, following his time-out for assaulting a Bristol contractor.

Cortellessa had negotiateda $200,000 deal with Solon Mitrelis of S & J 351 Inc. to take over therest of a 15-year lease with the City of Providence for the cafe in Kennedy Plaza.

For the first five years, things went well. The Caf Plaza had an outside area for seating permitted by the Providence Parks Department.

When the lease came up for renewal in 1995, "Pat asked the mayor how to proceed."

Go see Frank, Cianci said, giving Pat a wink of the eye.

He did, according to court testimony recounted in the book.

We sat in his office,'' said Cortellessa ofCianci's director of administration Frank Corrente who would later be indicted and convicted with Cianci during Operation Plunder Dome. "And Corrente said, 'you can help us if we can help you.'

I said what do you mean by that? Cortellessa testified.

He says, do you own property on Eddy Street?

"I said, yes, I do. I had a piece of property on Eddy Street which was a restaurant at the time ... called Caf Anzio."

"He said, 'we want the business and the building too.'

I said that I couldn't help [him] because there was already 'a sales agreement' on the property," Cortellessa testified.

"He said, you better break the agreement.'

"I never went back."

"Within a few days, Cortellessa ... was told by the city Board of Licenses that the license allowing him to operate an outdoor patio at Caf Plaza was revoked."

"He operated under a Superior Court injunction for two years while the suit made its way through ... court."

Ultimately, "the Rhode Island Supreme Court ruled 3-1 against Pat."

Thelma Correntetold The Journal last week that husband Frank was not up to answering questions about an alleged incident that long ago.

"What most didnt know was the FBI ... approached Pat about working undercover."

According to the book, Cortellessa told them he believed he could do moreby running for mayor himself.

"He wanted to take the public role of targeting the mayors corruption,'' Broadmeadow wrote.

But that did not go well.

A candidate for mayor needsat least 500 signatures from registered voters. Cortellessa's campaignsubmitted 802. Election officials certified 534, just enough to qualify him for the ballot.

But the Providence Democratic City Committee filed a challenge.

"Cianci sent city workers, accompanied by Providence Police officers, to interview anyone who signed the papers. Fifteen of those interviewed signed affidavits that they did not sign the nomination papers.

"Cortellessa still qualified for the ballot with 519 signatures."

But then, "a lawyer representing the local Democratic Party urged the board to disqualify Cortellessa as a candidate and ask Police Chief Urbano Prignano to open a criminal investigation ... [into] fraud and forgery."

As recounted in The Journal at the time: "Jack Potter, himself a Democratic candidate for Governor in 1998 ... accused the party and board of executing a setup."

"Standing near the table and raising his voice, Potter testified that he had signed Cortellessas papers himself, only to have [Democratic party] staff members call him and try to coerce him to say otherwise under a threat of a perjury charge."

"Now you can see why no one runs against the son-of-a-bitch," Potter said of Cianci.

"Despite testimony to the contrary, the signs of intimidation and threats, and that some signatures were unchallenged, the board removed two full pages of signatures from Pats nomination papers."

He was out. Cianci ran unopposed.

In 2018, the state Board of Electionsruled in an unrelated case that only the invalid signature needed to be removed.

According to Broadmeadow, thebook will be available from Amazon, Barnes & Noble, local book stores and directly from his ownJEBWizard Publishing.

See the original post here:
Political Scene: Former club owner, candidate recalls era when Buddy and the Mob ruled Providence - The Providence Journal

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