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Second- or third-order test for evaluating testosterone status (eg, when abnormalities of sex hormone-binding globulin are present)

Testosterone is the major androgenic hormone. It is responsible for the development of the male external genitalia and secondary sexual characteristics. In females, its main role is as an estrogen precursor. In both genders, it also exerts anabolic effects and influences behavior.

In men, testosterone is secreted by the testicular Leydig cells and, to a minor extent, by the adrenal cortex. In premenopausal women, the ovaries are the main source of testosterone with minor contributions by the adrenals and peripheral tissues. After menopause, ovarian testosterone production is significantly diminished. Testosterone production in testes and ovaries is regulated via pituitary-gonadal feedback involving luteinizing hormone (LH) and, to a lesser degree, inhibins and activins.

Most circulating testosterone is bound to sex hormone-binding globulin (SHBG), which in men also is called testosterone-binding globulin. A lesser fraction is albumin bound and a small proportion exists as free hormone. Historically, only the free testosterone was thought to be the biologically active component. However, testosterone is weakly bound to serum albumin and dissociates freely in the capillary bed, thereby becoming readily available for tissue uptake. All non-SHBG-bound testosterone is therefore considered bioavailable.

During childhood, excessive production of testosterone induces premature puberty in boys and masculinization in girls. In adult women, excess testosterone production results in varying degrees of virilization, including hirsutism, acne, oligo-amenorrhea, or infertility. Mild-to-moderate testosterone elevations are usually asymptomatic in males, but can cause distressing symptoms in females. The exact causes for mild-to-moderate elevations in testosterone often remain obscure. Common causes of pronounced elevations of testosterone include genetic conditions (eg, congenital adrenal hyperplasia); adrenal, testicular, and ovarian tumors; and abuse of testosterone or gonadotrophins by athletes.

Decreased testosterone in females causes subtle symptoms. These may include some decline in libido and nonspecific mood changes. In males, it results in partial or complete degrees of hypogonadism. This is characterized by changes in male secondary sexual characteristics and reproductive function. The cause is either primary or secondary/tertiary (pituitary/hypothalamic) testicular failure. In adult men, there also is a gradual modest, but progressive, decline in testosterone production starting between the fourth and sixth decades of life. Since this is associated with a simultaneous increase of SHBG levels, bioavailable testosterone may decline more significantly than apparent total testosterone, causing nonspecific symptoms similar to those observed in testosterone deficient females. However, severe hypogonadism, consequent to aging alone, is rare.

Measurement of total testosterone (TTST / Testosterone, Total, Serum) is often sufficient for diagnosis, particularly if it is combined with measurements of LH and follicle-stimulation hormone (FSH) (LH / Luteinizing Hormone [LH], Serum and FSH / Follicle-Stimulating Hormone [FSH], Serum). However, these tests may be insufficient for diagnosis of mild abnormalities of testosterone homeostasis, particularly if abnormalities in SHBG (SHBG / Sex Hormone Binding Globulin [SHBG], Serum) function or levels are present. Additional measurements of free testosterone or bioavailable testosterone are recommended in this situation; bioavailable testosterone (see TTBS / Testosterone, Total and Bioavailable, Serum) is the preferred assay.

TESTOSTERONE, TOTAL

Males

0-5 months: 75-400 ng/dL

6 months-9 years: <7-20 ng/dL

10-11 years: <7-130 ng/dL

12-13 years: <7-800 ng/dL

14 years: <7-1,200 ng/dL

15-16 years: 100-1,200 ng/dL

17-18 years: 300-1,200 ng/dL

> or =19 years: 240-950 ng/dL

Tanner Stages*

I (prepubertal): <7-20

II: 8-66

III: 26-800

IV: 85-1,200

V (young adult): 300-950

Females

0-5 months: 20-80 ng/dL

6 months-9 years: <7-20 ng/dL

10-11 years: <7-44 ng/dL

12-16 years: <7-75 ng/dL

17-18 years: 20-75 ng/dL

> or =19 years: 8-60 ng/dL

Tanner Stages*

I (prepubertal): <7-20

II: <7-47

III: 17-75

IV: 20-75

V (young adult): 12-60

*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (+/-2) years and for girls at a median age of 10.5 (+/-2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. For boys, there is no definite proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (young adult) should be reached by age 18.

TESTOSTERONE, FREE

Males (adult):

20 - <25 years: 5.25-20.7 ng/dL

25 - <30 years: 5.05-19.8 ng/dL

30 - <35 years: 4.85-19.0 ng/dL

35 - <40 years: 4.65-18.1 ng/dL

40 - <45 years: 4.46-17.1 ng/dL

45 - <50 years: 4.26-16.4 ng/dL

50 - <55 years: 4.06-15.6 ng/dL

55 - <60 years: 3.87-14.7 ng/dL

60 - <65 years: 3.67-13.9 ng/dL

65 - <70 years: 3.47-13.0 ng/dL

70 - <75 years: 3.28-12.2 ng/dL

75 - <80 years: 3.08-11.3 ng/dL

80 - <85 years: 2.88-10.5 ng/dL

85 - <90 years: 2.69-9.61 ng/dL

90 - <95 years: 2.49-8.76 ng/dL

95-100+ years: 2.29-7.91 ng/dL

Males (children):

<1 year: Term infants

1 to 15 days: 0.20-3.10 ng/dL*

16 days to 1 year: Values decrease gradually from newborn (0.20-3.10 ng/dL) to prepubertal levels

*Citation: J Clin Endocrinol Metab 1973;36(6):1132-1142

1-8 years: <0.04-0.11 ng/dL

9 years: <0.04-0.45 ng/dL

10 years: <0.04-1.26 ng/dL

11 years: <0.04-5.52 ng/dL

12 years: <0.04-9.28 ng/dL

13 years: <0.04-12.6 ng/dL

14 years: 0.48-15.3 ng/dL

15 years: 1.62-17.7 ng/dL

16 years: 2.93-19.5 ng/dL

17 years: 4.28-20.9 ng/dL

18 years: 5.40-21.8 ng/dL

19 years: 5.36-21.2 ng/dL

Females (adult):

20 - <25 years: 0.06-1.08 ng/dL

25 - <30 years: 0.06-1.06 ng/dL

30 - <35 years: 0.06-1.03 ng/dL

35 - <40 years: 0.06-1.00 ng/dL

40 - <45 years: 0.06-0.98 ng/dL

45 - <50 years: 0.06-0.95 ng/dL

50 - <55 years: 0.06-0.92 ng/dL

55 - <60 years: 0.06-0.90 ng/dL

60 - <65 years: 0.06-0.87 ng/dL

65 - <70 years: 0.06-0.84 ng/dL

70 - <75 years: 0.06-0.82 ng/dL

75 - <80 years: 0.06-0.79 ng/dL

80 - <85 years: 0.06-0.76 ng/dL

85 - <90 years: 0.06-0.73 ng/dL

90 - <95 years: 0.06-0.71 ng/dL

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What are androgens?

Hormones are chemical messengers madeby glands in the body that are carried inthe blood to act on other organs in thebody. Hormones are needed for growth,reproduction and well-being.

Androgens are male sex hormones thatincrease at puberty and are needed for aboy to develop into a sexually mature adultwho can reproduce. The most importantandrogen is testosterone.

Testosterone is the most important androgen(male sex hormone) in men and it is neededfor normal reproductive and sexual function.Testosterone is important for the physicalchanges that happen during male puberty,such as development of the penis and testes,and for the features typical of adult mensuch as facial and body hair. Testosterone alsoacts on cells in the testes to make sperm.

Testosterone is also important for overallgood health. It helps the growth of bonesand muscles, and affects mood and libido(sex drive). Some testosterone is changed intooestrogen, the female sex hormone, and thisis important for bone health in men.Testosterone is mainly made in the testes. Asmall amount of testosterone is also made bythe adrenal glands, which are walnut-sizedglands that sit on top of the kidneys.

The pituitary gland and the hypothalamus,located at the base of the brain, controlthe production of male hormones andsperm. Luteinizing hormone (LH) andfollicle stimulating hormone (FSH) arethe two important messenger hormonesmade by the pituitary gland that act onthe testes.

LH is needed for the Leydig cells in thetestes to make testosterone, the male sexhormone. Testosterone and FSH from thepituitary gland then act together on theseminiferous tubules (sperm-producingtubes) in the testes to make sperm.

Androgen, or testosterone, deficiency iswhen the body is not able to make enoughtestosterone for the body to functionnormally. Although not a life-threateningproblem, androgen deficiency can affectyour quality of life.

Androgen deficiency due to diseases of thetestes or hypothalamus-pituitary affectsabout one in 200 men under 60 years ofage. It is likely that androgen deficiency isunder-diagnosed and that many men aremissing out on the benefits of treatment.About one in 10 older men may have testosterone levels lower than those inyoung men, but this is usually linked withchronic illness and obesity. The benefits oftestosterone treatment for such men arenot yet known.

Testosterone levels in men are highestbetween the ages of 20 and 30 years. Asmen age there is a small, gradual drop intestosterone levels; they may drop by up toone third between 30 and 80 years of age.

Some men will have a greater drop intestosterone levels as they age, especiallywhen they are obese or have other chronic(long-term) medical problems. On the otherhand, healthy older men with normal bodyweight may not experience any drop inserum testosterone levels.

There is no such thing as male menopauseor andropause that can be compared tomenopause in women.

Low energy levels, mood swings, irritability,poor concentration, reduced muscle strengthand low sex drive can be symptoms ofandrogen deficiency (low testosterone).Symptoms often overlap with those of otherillnesses. The symptoms of androgen deficiencyare different for men of different ages.

Androgen deficiency can be caused bygenetic disorders, medical problems, ordamage to the testes or pituitary gland.Androgen deficiency happens when thereare problems within the testes or withhormone production in the brain. A commonchromosomal disorder that causes androgendeficiency is Klinefelters syndrome.

A diagnosis of androgen deficiency involveshaving a thorough medical evaluation andat least two blood samples (taken in themorning on different days) to measurehormone levels. Diagnosis should not be simply based on symptoms as these could becaused by other health problems that needdifferent treatment. A diagnosis of androgendeficiency is only confirmed when blood testsshow a lower than normal testosterone level.

A reference range is used as a guide bytesting laboratories and doctors to decide whether a persons hormone levels arenormal or low, and whether treatment is needed. Testosterone is measured in units called nanomalor. The normal testosterone reference range for healthy, young adult men is about 8 to 27 nanomolar but these numbers vary between measurement systems.

Androgen deficiency is treated with testosterone therapy; this means giving testosterone in doses that return the testosterone levels in the blood to normal. Testosterone is prescribed for men with androgen deficiency confirmed by blood tests. Once started, testosterone therapy is usually continued for life and the man needs to be checked regularly by a doctor.

In Australia testosterone therapy is available in the form of injections, gels, lotions, creams, patches and tablets, and works very well for men with confirmed androgen (testosterone) deficiency. The type of treatment prescribed can depend on patient convenience, familiarity and cost.

Commercial testosterone products contain only the natural testosterone molecule that is chemically produced from plant materials.

Side-effects are not expected because testosterone therapy aims to bring a mans testosterone levels back to normal. However, testosterone therapy can increase the growth of the prostate gland which can make the symptoms of benign prostate enlargement (such as needing to urinate more often) worse. In the case of prostate cancer, testosterone therapy is not used because of concerns that it can make the tumour grow.

Too high a dose of testosterone can lead to acne, weight gain, gynaecomastia (breast development), male-pattern hair loss and changes in mood. Any side-effects should be managed by a doctor and the testosterone dose lowered.

There are many herbal products marketed, particularly on the Internet, as treatmentsthat can act like testosterone and improve muscle strength and libido (sex drive). However, there are no known herbal products that can replace testosterone in the body and be used to treat androgen deficiency.

Testosterone therapy generally stops the production of the pituitary hormones FSH and LH, which reduces the size of the testes and can lower or stop sperm being made.

Testosterone treatment should not be given to a man wanting to become a father in the foreseeable future. If sperm production was normal before testosterone therapy, it usually recovers after treatment stops but it can take many months to go back to normal.

Testosterone therapy in men with androgen deficiency aims to bring testosterone levels back to normal and to return muscle strength and energy levels back to normal. However, the use of androgens (anabolic steroids) by normal men to improve athletic performance is illegal and has important short-term and long-term health risks.

Men who use anabolic steroids will lower or even turn off their own testosterone and sperm production. It may take many months for testosterone levels and sperm counts to return to normal after stopping anabolic steroids.

There are no known ways to prevent androgen deficiency caused by damage to the testes or pituitary gland. However, if you live a healthier lifestyle and manage other health problems your testosterone levels may improve, if your low testosterone levels are caused by other illness.

Not all men have a drop in testosterone levels with age. A healthy lifestyle may help you to keep testosterone levels normal.

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Androgen (testosterone) deficiency | Andrology Australia

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O

n February 19th, 2014 GNC the nation's largest specialty vitamin retailer announced its annual product award winners. GNC singled out less than ten companies and products for special awards.

One award winner in particular received strong praise. Nugenix a free testosterone booster and the top selling product in the Men's Vitality category.

As we grow older it can be tougher and tougher to keep up. Maybe you're struggling to workout? Perhaps you feel sluggish and slow. Are you seeing progress in the mirror or is your body going downhill?

Your libido and performance may not be as intense as it once was and youand your partnerwant the 'youthful you' to return to the bedroom.

But, how can you improve even as you grow older?

For men, the solution is found in free testosterone.

Your bloodstream contains two types of testosterone: bonded testosterone and free testosterone.

Bonded testosterone attaches to molecules in the body and is mostly ineffective. However, the 'free' testosterone can enter your cells easily and plays a vital role in helping you feel stronger, with more energy and vitality.

In short, free testosterone helps a manwellbe a man!

Boosting free testosterone levels can lead to increased sex drive, a higher libido, and heightened desire. Maintaining an optimal free testosterone level is absolutely vital for men who want to get the most out of their bodies.

But how do men raise their free testosterone levels?

This is where it gets a little complicated. Over the years, any number of pills, potions, and gels have claimed to work wonders for men's free testosterone. In reality, few of these options do any good.

It's only been more recently that free testosterone has slipped from being a "dirty word" into something that many men are discussing. As our knowledge of free testosterone has grown, so has the selection of ingredients, products, and compounds available.

Nugenix helped break the stereotype that free testosterone boosters are only for hardcore bodybuilders. GNC stores secured the exclusive rights to Nugenix's US launch and within three months it was one of the top selling vitality supplements in the entire GNC chain.

The key ingredient is Testofen which is made from the rare Fenugreek plant. Testofen has been shown in clinical trials to boost free testosterone levels, increase sex drive, and improve libido.

The proprietary Nugenix Free Testosterone Complex includes additional ingredients to complement and work closely with Testofen. Nugenix is safe, effective, and has a number of youth-boosting benefits like helping you feel stronger, leaner, with a lot more drive and energy. Although most users report seeing the best results after at least four to six weeks of usage.

Studies from India and Queensland, Australia have shown strong and even spectacular results with the key ingredient in Nugenix, Testofen. Benefits include increased sex drive and improved libido. These benefits primarily come from safely boosting free testosterone levels.

Nugenix is encapsulated in the United States under FDA Good Manufacturing Practices (GMP). GNC stores secured the exclusive retail rights to Nugenix's US launch but it's now available in Vitamin Shoppe, Vitamin World, and GNC. Right now, the company that has developed Nugenix is providing samples to customers who qualify for them online.

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Many of us might not consider testosterone, a hormone in the androgen (or male) category, as vital for women. However, a womans sexual health can be extremely affected by decreased testosterone levels (or low T).

Testosterone hormone in women is emitted from the ovaries and adrenal glands, with levels of the hormone naturally increasing during puberty and pregnancy and decreasing with age and the onset of menopause. However, a sudden drop in testosterone can affect a womans libido, energy levels, and mood.

Here are ten common signs of low testosterone in women

Women with decreased testosterone levels often notice a sudden drop in their energy levels. This can manifest in several ways; you may have a hard time finding the energy to get out of bed in the morning, or you just may feel drained of energy throughout the day. Physical activities which dont normally cause fatigue may leave you feeling spent or exhausted, and you may struggle to get through what would otherwise be a normal day or work or leisure.

One of the telltale signs that your chronic fatigue may have an underlying cause (and could therefore be related to low testosterone levels) is that is is unrelieved by sleep. In other words, if youre finding yourself chronically tired even though youre getting lots of sleep at night or supplementing with naps throughout the day, a hormone deficiency could be the underlying problem. However, lots of medical conditions can cause fatigue, so youll have to see a doctor for a diagnosis.

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Testosterone is a major sex hormone produced in the testes of men. The pituitary gland is responsible for controlling the production of testosterone hormone. In the testes, luteinizing hormone binds to receptors on Leydig cells; this stimulates production and secretion of testosterone. Testosterone helps to develop the primary and secondary sexual characteristics in males. Development of sex organs, deeper voice, muscle mass, and facial hair all result from the sufficient production of this hormone. Testosterone deficiency as happens with age needs effective testosterone treatment.

Along with the development of sexual features, testosterone hormone also controls the following actions in a body:

With age, testosterone production declines, thus disturbing overall body functioning. Low levels of testosterone hormone lead to a condition termed as hypogonadism that can be treated with testosterone replacement therapy. Hypogonadism can be divided into two categories depending on the occurrence of pathology.

Primary Hypogonadism: It occurs at testicular level with high release of follicle stimulating hormone (FSH), luteinizing hormone (LH), and low release of testosterone.

Secondary Hypogonadism: It occurs at pituitary hypothalamic level with low or in some cases normal release of luteinizing hormone and follicle stimulating hormone along with low levels of testosterone hormone.

Testosterone replacement therapy effectively works to improve upon the conditions of primary and secondary hypogonadism.

Along with aging, there are some other factors that contribute toward low testosterone production and make a man go for testosterone treatment.

Deficient testosterone hormone levels can lead to many undesirable symptoms, like poor libido, lack of vitality, erectile dysfunction, declining muscle mass, osteoporosis, loss of body hair, depression, lower blood hemoglobin, memory loss, poor concentration, mood swings, mild anemia, disturbed cholesterol profile and a decrease in cognitive function that effects all of your activities. Testosterone therapy is the only possible way to cope with testosterone deficiency.

Before start of the testosterone treatment, there should be the right detection of the hormone deficiency. If you consult an expert doctor for testosterone therapy, he may prescribe you the blood test in the morning because testosterone levels are at peak during that time.

We, at Nationwide Synergy Inc, provide patients with best available options to treat their hormone deficiency.

Choosing one best option for testosterone therapy requires consultation with your physician. We have qualified physicians and doctors at our panel who provide expert guidance to the patients.

Stay Young and Healthy with Balanced Hormones Testosterone Replacement Therapy Is Your best Choice!

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Dr. Matthias Heck, Dr. Silvia Thne und Dr. Christof Winter(from left to right). Image: Andreas Heddergott / TUM

When bacteria develop antibiotic resistance, treatment with these medications becomes ineffective. Similarly, tumor cells can also change in such a way that renders them resistant to particular medications. This makes it vitally important for cancer patients and their doctors to determine as early as possible whether a specific therapy is working or not. A new blood test developed by researchers at the Technical University of Munich (TUM) can predict drug resistance in patients with advanced prostate cancer.

Prostate cancer tumor cells require the androgen hormone, testosterone, to grow. They possess a receptor to which testosterone binds and then signals the cancer cells to divide and grow. If a prostate tumor has already grown to a large size and started spreading throughout the body, therapeutic drugs are used to block the growth at its molecular origin either by targeting tumor cell receptors to prevent testosterone from binding, or by entirely blocking the bodys overall production of testosterone. Two of the drugs most frequently used in this type of therapy are abiraterone and enzalutamide.

THE HUNT FOR RESISTANT TUMOR CELLS

During the course of treatment, however, some tumor cells develop resistance to these drugs, and continue to grow and metastasize. The culprit: the tumors testosterone receptors have changed their structure, and the new variant can signal the cancer cells to continue dividing and spreading even without testosterone. The most common receptor variant seen in patients is called AR-V7. If we know in advance whether or not a tumor has developed cells with this receptor, we can provide advice on an individual basis at an early stage this can spare seriously-ill patients from undergoing an ineffective therapy, explains Assistant Professor Dr. Matthias Heck, co-leader of the study and a specialist for Urology at the University Hospital TUM Klinikum rechts der Isar in Munich.

Heck and his team collaborated with colleagues led by Dr. Christof Winter, a physician and bioinformatician and the head of the Liquid Profiling and Bioinformatics lab at the TUM Institute of Clinical Chemistry and Pathobiochemistry, to develop a new blood test. Until now, blood tests used to detect prostate tumor cells have looked for specific surface structures on the cells. Its not only a time-consuming and expensive process because of the special equipment required for the tests, but its also not always efficacious. If the cells being tested lack the specific structure being searched for, these tests fail to detect their presence. The new test developed by TUM researchers utilizes a completely different method in order to reliably, quickly and inexpensively measure the presence of the modified receptor AR-V7 at an early stage. Moreover, it can also determine whether or not the tumor is resistant to treatment with abiraterone and enzalutamide.

HIGH TESTING SENSITIVITY AND ACCURACY

The new blood test provides an alternative to existing models and potential to improve them: It analyzes the amount of AR-V7 RNA molecules in the blood. In each and every one of the cells in our body, RNA is responsible for the translation of genetic information into protein molecules, including receptor molecules. If the test detects high levels of AR-V7 RNA in the blood, it is likely that the patient already has tumor cells resistant to therapy with abiraterone and enzalutamide. Dr. Silvia Thne, co-lead author of the study, emphasizes the high sensitivity and accuracy of the new testing method: Only minute amounts of RNA are needed in a sample for the test to work. Additionally, since AR-V7 RNA is present in every tumor cell that possesses the resistant receptors, it means that no tumor cells are slipping by undetected.

For the study, TUM researchers analyzed blood samples from 85 patients with advanced stages of prostate cancer. They were able to successfully demonstrate that approximately one fifth of the patients had large amounts of AR-V7 RNA in their blood an indication of large quantities of resistant tumor cells. It was exactly these patients who failed to respond to therapy with abiraterone and enzalutamide. They also had poorer prognoses during the subsequent course of their illness: Their tumors returned more quickly and they had shorter survival times than other patients.

MORE WORK AHEAD

We were able to demonstrate that we can accurately predict whether or not resistance against abiraterone or enzalutamide is present in a patient, explains Winter. The next step for researchers will be to further improve upon the testing method and also compare its efficacy to that of existing testing methods using a larger sample of patients. The goal? TUM researchers want to determine if their new blood test can be incorporated into the routine battery of clinical examinations for prostate cancer patients in the future.

Reference

Seitz, A. K., Thoene, S., Bietenbeck, A., Nawroth, R., Tauber, R., Thalgott, M., ... & Ruland, J. (2017). AR-V7 in Peripheral Whole Blood of Patients with Castration-resistant Prostate Cancer: Association with Treatment-specific Outcome Under Abiraterone and Enzalutamide. European Urology.

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ZMD Center for Face & Body is excited to be the first in Tampa to offer the FIRST and ONLY swallowable, FDA-approved 3-balloon system for weight loss.

Brian K. Zebrowski, MD FACS is committed to the health and well-being of his patients through a team approach that includes weight loss surgery, diet, exercise, and educational support. Dr. Zebrowski is a firm believer that the goal of weight loss surgery is long-term success, not just surgery. He firmly believes that individualized patient care is of paramount importance.

How It Works:Three balloons are placed for a six-month non-surgical treatment, combined with a professionally supervised nutrition and exercise program for optimal weight loss. Patients in the clinical study lost twice as much weight as with diet and exercise alone.

Simple Concept:The Obalon Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less.

Meaningful Results:When used with a diet and exercise program, people in the clinical trial lost twice as much weight as those with diet and exercise alone.

Helps Supporting Long Lasting Resuts:Average of 89% of weight loss was kept off at 1 year (6 months post-removal), when combined with a moderate intensity diet and exercise program.

Quick Placement:The placement of each Obalon balloon typically takes less than 10 minutes and doesnt require sedation. In our medical office, you swallow a capsule containing a small balloon, and then Brian K. Zebrowski, MD FACS inflates the balloon. After six months, all three balloons are removed in one procedure with light sedation. The removal procedure is typically no longer than 15 minutes.

Lightweight:A fully inflated single balloon has a volume of 250cc, weighing approximately 3 grams (less than a penny) and about the size of a small orange. Therefore, all three balloons have a combined volume of 750cc.

http://www.zmdcenter.com/

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While nutrition and exercise are the keys to our fittest selves, it can be a real struggle to lose weight and keep it off when you are significantly overweight. Very few people can accomplish that kind of substantial weight loss on their own. The IU Health Bariatric Program offers many options that can help reverse obesity and restore health. Read on for answers to some common questions about medical weight loss treatment options.

When should someone seek medical help for weight loss?

Obesity is a chronic life-threatening disease that causes many serious health conditions, including coronary artery disease, high blood pressure, stroke, Type 2 diabetes, high cholesterol, metabolic syndrome and sleep apnea.

When you realize that your weight starts interfering with your quality of life and negatively impacting your health, you may want to seek medical help.

How do I know if I am a candidate for bariatric surgery?

First, it boils down to insurance. Each insurance company sets specific criteria needed to approve a patient for bariatric surgery. Generally, if you have a body mass index (BMI) of 40 or more, or of 35 with a serious health condition, you may be a candidate for the IU Health Bariatric Surgery Program.

If an individual qualifies, there are other aspects that doctors consider, including that persons willingness to:

1

Agree to program expectations you need to comply with taking vitamins, showing up for doctor visits, be willing to engage in exercise and more.

2

Cut back on food consumption after the surgery, your diet will be substantially modified, and you will feel full more quickly; in anticipation of these changes, decreased food intake is also practiced prior to surgery.

3

Stay focused on your goals you need to be willing to continue working after surgery to lose and maintain your weight.

4

Be fit for surgery you should take care of yourself and be healthy enough for surgery.

5

Have support seek support from family, friends and professionals to keep you on track and help you achieve your goals.

What are the surgical treatment options?

There are different surgeries to accomplish different goals, which are tailored to each patient. All procedures are very safe and performed using minimally invasive techniques, which leads to less pain, faster recovery and fewer complications. Here are the most commonly performed surgeries:

1

Roux-en-y Gastric Bypass: This operation reduces the amount of food consumed by decreasing the size of your stomach to that of an egg. It also makes you lose your hunger and decreases the absorption of some vitamins and minerals. The Roux-en-Y gastric bypass effectively helps patients lose about 70 percent of their excess weight in the long term and reverses several of the health problems associated with severe obesity.

2

Sleeve Gastrectomy: This operation reduces the stomach size by surgically removing about 80 percent of the stomach. It also decreases hunger sensation and does not require manipulation of the intestines. It leads to roughly 60 percent excess weight loss in the long term and leads to improvements of health problems associated with severe obesity.

3

Gastric Band: This operation uses an Adjustable Gastric Band to restrict food intake by making it harder for food to transverse the band. It does not require cutting of the stomach or the intestines and does not lead to malabsorption. Patients lose about 40 percent of their excess weight.

4

Revisional Surgery: This is corrective surgery to alter or repair previous weight loss surgeries that may have failed. Patients whose previous bariatric surgery produced undesirable or inherent limited outcomes are possible candidates for revisional surgery.

What are the non-surgical treatment options?

Surgery is not for everyone. Not all insurance plans cover it, and not all overweight patients qualify for it.

IU Health offers comprehensive non-surgical weight loss treatment plans, supervised by health care professionals. We begin by conducting a complete physical exam, including blood tests and an electrocardiogram to gauge your current health and the best tactics to help you accomplish your weight loss goals. In addition to ongoing medical monitoring, treatment may consist of fitness, nutritional and behavioral counseling; medication; support groups and cooking classes.

If you have had limited success in losing weight and keeping it off, there are a bevy of options available to help get you back on the road to better health, and a program can be created just for you.

What resources would you recommend to someone exploring medical weight loss treatments?

The IU Health Bariatric Program provides numerous resources to people regarding weight loss treatments. Besides the procedures our surgical team offers, a visit with our medical bariatrician Dr. Ashley Gilmore can help you determine which non-surgical weight loss option might be best for you.

You can always visit the programs website (iuhealth.org/bariatrics), which includes several links to additional online resources, or other online resources are available on the Obesity Society website (obesity.org/home) and the American Society for Metabolic and Bariatric Surgery (asmbs.org).

Dr. Dimitrios Stefanidis is director, MIS/Bariatric Surgery, at IU Health.

Continued here:
Ask the IU Health Expert: Battle against the bulge - Indianapolis Recorder

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Im a fitness trainer, certified group fitness instructor, and health blogger and of all the things Ive learned about exercise and fitness, this is the thing I wish people knew the most.

Obviously, if you walk for 30 minutes, its not going to burn as many calories as 30 minutes of high-intensity interval training (HIIT). But heres a crazy concept: Maybe, if were looking for optimal health benefits, we shouldnt be focusing on calorie burn.

Walking wont necessarily make you lose more weight than HIIT we cant promise that. But it is actually a way healthier option. Im telling you this as someone who engages in high-intensity exercise on most days. I dont do HIIT for the health of it; I dont do it for the calorie burn or the weight loss. I do it because I love it but heres why its probably not the best thing for me.

The Drawbacks of HIIT Nobody Talks AboutHigh-intensity interval training is exactly what it sounds like: High-intensity exercise performed over short intervals. High-intensity movements are movements that leave you gasping for air. Often, they involve jumping, sprinting, and performing full-body, compound movements that couldnt be sustained over a long period of time.

These movements are stressful. And stress, inherently, is bad for the body. The pressure of these exercises can increase cortisol (the bodys stress hormone) and wear the body down over time. For many exercisers, the collective impact results in strain, pain, and even injury. As an instructor, Ive seen it happen many times. Crutches, ACL tears, and stress fractures are all too common in frequent gym-goers.

By definition, being injured is not being healthy.

Even if you manage to evade an injury, high-intensity exercise has some significant health drawbacks. All that impact adds up, and often exercisers arent aware of how much high-intensity movement is too much. They read that HIIT is better (for the calorie burn, the metabolism boost, the efficiency, etc.) and they start to do it all the time.

Without realizing it, caught up in glimmering promises of calorie burn and fat loss, they fall into a seductive but dangerous trap: overtraining.

Its not just something athletes do. More and more often, average people are falling victim to going too hard at the gym, and too often. The consequences of over-exercise range from fatigue and irritability to a lowered heart rate and a dragging metabolism. It could actually cause you to hold on to fat cells. Theres nothing about training intensely all the time thats good for you despite the calories it burns.

Thats not to discount the benefits of working out intensely sometimes. You get stronger, build endurance, speed up your metabolism, and feel more energized on the daily. Unless, of course, you overdo it.

Benefits of WalkingRegardless of the danger of overtraining, many people simply dont enjoy high-intensity exercise in any capacity. Its difficult and if you dont have a true passion for it, it can become miserable to drag yourself to the gym day after day to trudge through a grueling workout.

I happen to enjoy it. So I do it, and do it often.

If I were to try to weightlift consistently, I wouldnt have much success. I dont enjoy heavy weightlifting and would therefore have a really hard time dragging myself to the squat rack. The best exercise regimen and the only kind thats proven to actually work over time is one you enjoy.

The science is pretty clear about exercise: Similar health benefits (measured by disease prevention and longevity) result from any amount of exercise that exceeds 150 minutes of low-intensity activity each week.

So if you enjoy going for an evening stroll maybe alone, maybe with your pet, or maybe with some podcasts youre reaping the same health benefits you would if you engaged in high-intensity exercise. The difference is that you would avoid all those very real dangers of intense workouts.

This might sound confusing. After all, people have been in love with HIIT training for some time now, hailing it as a quick fix for weight loss. And thats exactly where things got muddled.

The mix-up happened because of societys focus on weight loss. A lower weight often gets equated with a healthier body in actuality, weight has little to do with the actual health of the person in question. For many people, a higher weight results in better health outcomes. For others, the measures they need to take to maintain a lower weight can severely damage their health in the long term.

My takeaway for you? Walking is healthier because its less risky and, for many people, its more fun. If youre exercising for the health of it, stick with the only principle thats bound to hold up for the long term: Any kind of movement you look forward to doing is the kind you should do.

Excerpt from:
Walking Might Be Healthier Than High-Intensity Training - The Daily Meal

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