The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment.

Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism) and testosterone therapy was held in Prague (Czech Republic) on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.

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Testosterone therapy in men with testosterone deficiency: are the benefits and cardiovascular risks real or imagined?

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00174.2016 ◽

2016 ◽

Vol 311 (3) ◽

pp. R566-R573 ◽

Cited By ~ 12

Author(s):

Abdulmaged M. Traish

Keyword(s):

Critical Analysis ◽

Clinical Evidence ◽

Medical Condition ◽

Male Hypogonadism ◽

Testosterone Deficiency ◽

Cardiovascular Risks ◽

Testosterone Therapy ◽

Beneficial Effects ◽

Adult Men ◽

Meta Analyses

In the adult male, testosterone (T) deficiency (TD) also known as male hypogonadism, is a well-established medical condition, which has been recognized for more than a century. T therapy in men with TD was introduced as early as 1940s and was reported to improve overall health with no concomitant serious adverse effects. A wealth of recent studies demonstrated that T therapy in men with TD is associated with increased lean body mass, reduced fat mass and waist circumference, improvement in glycemic control, and reduced obesity. T therapy is also associated with improvements in lipid profiles, amelioration of metabolic syndrome (Met S) components, reduced inflammatory biomarkers, reduced systolic and diastolic blood pressure, and improvements in sexual function. More importantly, T therapy is associated with amelioration of diabetes and reduced mortality. However, few studies, marred with serious methodological and analytical flaws reported between 2010 and 2014, suggested that T therapy is associated with increased cardiovascular (CV) risk. As summarized in this review, a thorough and critical analysis of these studies showed that the risks purported are unsubstantiated and such studies lacked credible scientific and clinical evidence. Moreover, recent observational, registry studies, clinical trials, and meta-analyses, all revealed no increase in CV risks in men receiving T therapy. In this review, the benefits of T therapy in adult men with TD and the lack of credible evidence suggesting that T therapy is linked to increased CV risks are discussed. It should be noted that the literature is replete with studies demonstrating beneficial effects of T therapy on CV and overall health.

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The Effect of Testosterone on Cardiovascular Disease

American Journal of Men s Health ◽

10.1177/1557988314522642 ◽

2014 ◽

Vol 8 (6) ◽

pp. 470-491 ◽

Cited By ~ 7

Author(s):

Jeannie J. Su ◽

Samuel K. Park ◽

T. Mike Hsieh

Keyword(s):

Cardiovascular Disease ◽

Vascular System ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Contemporary Literature ◽

Cardiovascular Function ◽

Well Being ◽

The United States ◽

Beneficial Effects ◽

System Data

Cardiovascular disease is the leading cause of death in the United States. Testosterone is the principal male sex hormone and plays an important role in men’s health and well-being. Historically, testosterone was believed to adversely affect cardiovascular function. However, contemporary literature has refuted this traditional thinking; testosterone has been suggested to have a protective effect on cardiovascular function through its effects on the vascular system. Data from modern research indicate that hypogonadism is closely related to the development of various cardiovascular risk factors, including hyperlipidemia and insulin resistance. Several studies have demonstrated beneficial effects of testosterone supplementation therapy on reversing symptoms of hypogonadism and improving cardiovascular disease risk profiles. In this review, we perform a critical analysis on the association between testosterone and cardiovascular disease.

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Abstract P087: Association of Psychological Well-Being With Cardiac Repolarization

Circulation ◽

10.1161/circ.125.suppl_10.ap087 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Amit J Shah ◽

Robert Carney ◽

Elsayed Z Soliman ◽

Viola Vaccarino

Keyword(s):

Psychological Health ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Well Being ◽

Left Ventricular ◽

Morbidity And Mortality ◽

Psychological Well Being ◽

Psychological Wellness ◽

Increased Risk ◽

The Mean

Background: Abnormal frontal T-axis is an independent predictor of mortality, and may be influenced by increased sympathetic tone and cardiovascular disease risk factors. Factors related to poor psychological health, such as depression, are associated with increased risk of CVD morbidity, although the mechanisms are not clear. We tested the hypothesis that: 1) reduced psychological wellness is associated with abnormal T-axis and 2) this association may help to explain the excess risk of CVD morbidity and mortality related to poor psychological health. Methods: We studied 4485 community-based adults aged 25–65 years without a history of CVD from NHANES I (1971–75) who were monitored for CVD hospitalization and death until 1993. Those with ECG evidence of previous MI, left ventricular hypertrophy, and major ventricular conduction defects (QRS interval ≥ 120 ms) were excluded. Frontal T-axis was obtained through 12-lead ECG, and a deviation of ≥ 30° from normal (45°) was considered abnormal. Psychological well-being was measured with the General Well-Being Scale (GWB). Results: The mean ± SD age was 43.1 ± 11.5 years and 55% were women. The mean ± SD GWB score was 80.5 ± 17.3, the median frontal T-axis was 51°, and 13% had an abnormal T-axis. In cross-sectional analysis adjusting for age, sex, and race, a 1-SD decrease in GWB was associated with an OR of 1.12 for abnormal T-axis (p=0.01). This effect was unchanged after adjusting for systolic blood pressure, smoking, diabetes, total cholesterol, and BMI. Abnormal T-axis was associated with CVD hospitalization/death (adjusted HR 1.29, p=0.01), as was GWB (adjusted HR 1.104 per 1-SD decrease, p=0.01). When both factors were included in the model, the HR of GWB decreased by 8% to 1.096 (p=0.02). Conclusion: Abnormal frontal T-axis is modestly but significantly associated with reduced psychological wellness. Although this association may help understand neurocardiac relationships, it does not substantially explain morbidity and mortality associated with reduced psychological wellness.

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Effect of Hesperidin on Cardiovascular Disease Risk Factors: The Role of Intestinal Microbiota on Hesperidin Bioavailability

Nutrients ◽

10.3390/nu12051488 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1488 ◽

Cited By ~ 3

Author(s):

Anna Mas-Capdevila ◽

Joan Teichenne ◽

Cristina Domenech-Coca ◽

Antoni Caimari ◽

Josep M Del Bas ◽

...

Keyword(s):

Risk Factors ◽

Gut Microbiota ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Current Evidence ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Beneficial Effects ◽

High Interindividual Variability

Recently, hesperidin, a flavonone mainly present in citrus fruits, has emerged as a new potential therapeutic agent able to modulate several cardiovascular diseases (CVDs) risk factors. Animal and in vitro studies demonstrate beneficial effects of hesperidin and its derived compounds on CVD risk factors. Thus, hesperidin has shown glucose-lowering and anti-inflammatory properties in diabetic models, dyslipidemia-, atherosclerosis-, and obesity-preventing effects in CVDs and obese models, and antihypertensive and antioxidant effects in hypertensive models. However, there is still controversy about whether hesperidin could contribute to ameliorate glucose homeostasis, lipid profile, adiposity, and blood pressure in humans, as evidenced by several clinical trials reporting no effects of treatments with this flavanone or with orange juice on these cardiovascular parameters. In this review, we focus on hesperidin’s beneficial effects on CVD risk factors, paying special attention to the high interindividual variability in response to hesperidin-based acute and chronic interventions, which can be partly attributed to differences in gut microbiota. Based on the current evidence, we suggest that some of hesperidin’s contradictory effects in human trials are partly due to the interindividual hesperidin variability in its bioavailability, which in turn is highly dependent on the α-rhamnosidase activity and gut microbiota composition.

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Obesity and Hypogonadism—A Narrative Review Highlighting the Need for High-Quality Data in Adolescents

Children ◽

10.3390/children6050063 ◽

2019 ◽

Vol 6 (5) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

Tasnim Mushannen ◽

Priscilla Cortez ◽

Fatima Cody Stanford ◽

Vibha Singhal

Keyword(s):

Reproductive System ◽

Disease Risk ◽

Current Knowledge ◽

Clomiphene Citrate ◽

Cardiovascular Disease Risk ◽

Quality Data ◽

Male Hypogonadism ◽

Hpg Axis ◽

Organ Systems ◽

Sexual Characteristics

The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system across age, highlighting the need for more data in children and adolescents. Male hypogonadism is commonly seen in patients with obesity and affects the onset, duration, and progression of puberty. Different pathophysiologic mechanisms include increased peripheral conversion of testosterone to estrone and increased inflammation due to increased fat, both of which lead to suppression of the hypothalamic-pituitary-gonadotropin (HPG) axis and delayed development of secondary sexual characteristics in adolescent males. Evaluation of the HPG axis in obesity includes a thorough history to exclude other causes of hypogonadism and syndromic associations. Evaluation should also include investigating the complications of low testosterone, including increased visceral fat, decreased bone density, cardiovascular disease risk, and impaired mood and cognition, among others. The mainstay of treatment is weight reduction, but medications such as testosterone and clomiphene citrate used in adults, remain scarcely used in adolescents. Male hypogonadism associated with obesity is common and providers who care for adolescents and young adults with obesity should be aware of its impact and management.

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Studies on PA in schizophrenia: What did we learn? What is effective?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.889 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S41-S41

Author(s):

G. de Girolamo ◽

V. Bulgari

Keyword(s):

Negative Symptoms ◽

Psychiatric Symptoms ◽

Disease Risk ◽

Meta Analysis ◽

Cardiovascular Disease Risk ◽

Well Being ◽

Cardiovascular Fitness ◽

Small Sample ◽

Attrition Rate ◽

Intention To Treat

Schizophrenia is frequently associated with abnormal physical activity (PA) per se (e.g., hypokinesia, motor retardation, etc.) or related to antipsychotic medications (e.g., extrapyramidal symptoms including bradykinesia, tremor, etc.). Daily amounts of PA for subjects diagnosed with schizophrenia tend to decrease over the illness course and contribute to metabolic and cognitive disturbances. PA intervention for schizophrenia patients may result in increased well-being, improved cognitive functioning, fewer negative symptoms and increased self-efficacy, leading to improved management of psychosocial life domains. However, PA trials conducted among people suffering from schizophrenia show several methodological limits: small sample sizes, lack of randomized patients’ allocation, heterogeneity of interventions and inappropriate outcome measures.Firth et al. (2015) have recently conducted a systematic review and meta-analysis of 11 trials on structured PA in schizophrenia (n = 659, median age of 33 years). The conclusions of this recent review are the following:– aerobic exercise (for instance exercise bike) of moderate-to-vigorous intensity done at least 90 minutes per week is effective in improving cardiovascular fitness; studies (n = 7) using VO2max as an assessment of fitness have reported clinically significant increases in VO2max, “defined as sufficient to reduce cardiovascular disease risk by 15% and mortality by 20%”;– several low-dose aerobic interventions did not shown any effect;– there was a “strong effect of exercise on total psychiatric symptoms” (both positive and negative symptoms were reduced);– total attrition rate was 32%. Group exercise showed a much lower attrition rate than solitary exercise;– caregivers’ supervision increased compliance as compared to unsupervised intervention;– in the only study that compared per-protocol and intention-to-treat analysis, a significant improvement in fitness, psychiatric symptoms and overall functioning only occurred in participants who attended > 50% of exercise sessions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Mediterranean diet and metabolic syndrome: the evidence

Public Health Nutrition ◽

10.1017/s1368980009990449 ◽

2009 ◽

Vol 12 (9A) ◽

pp. 1607-1617 ◽

Cited By ~ 105

Author(s):

Nancy Babio ◽

Mònica Bulló ◽

Jordi Salas-Salvadó

Keyword(s):

Metabolic Syndrome ◽

Mediterranean Diet ◽

Fruits And Vegetables ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Atherogenic Dyslipidemia ◽

Favourable Effect ◽

Processed Meat ◽

Beneficial Effects ◽

The Mediterranean

AbstractBackgroundThe Mediterranean diet has long been related to a lower cardiovascular disease risk; however, more recent evidences also indicate that it has a favourable effect on adiposity and type 2 diabetes.DesignReview of the available literature in relation to Mediterranean diet and metabolic syndrome.ResultsSeveral components of Mediterranean diet patterns have been inversely related with body mass index. They are considered to be modulators of insulin resistance, can exert beneficial effects on blood pressure, improve atherogenic dyslipidemia or attenuate the inflammatory burden associated with metabolic syndrome. Furthermore, a lower prevalence of metabolic syndrome has been associated with dietary patterns rich in fruits and vegetables, nuts, olive oil, legumes and fish, moderate in alcohol and low in red meat, processed meat, refined carbohydrates and whole-fat dairy products.ConclusionsThere is much evidence suggesting that the Mediterranean diet could serve as an anti-inflammatory dietary pattern, which could help to fight diseases related to chronic inflammation, including metabolic syndrome.

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LIFESTYLE PHYSICAL ACTIVITY IN OLDER WOMEN: ASSOCIATIONS OF CHANGE, SELF-EFFICACY, AND WELL-BEING

Innovation in Aging ◽

10.1093/geroni/igz038.609 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S171-S171

Author(s):

Leanne L Lefler ◽

Shelly Y Lensing ◽

Kimberly K Garner

Keyword(s):

Physical Activity ◽

Clinical Trial ◽

Older Women ◽

Self Efficacy ◽

Repeated Measures ◽

Social Role ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Well Being ◽

Lifestyle Physical Activity

Abstract Reduction of cardiovascular disease risk in undeserved populations, such as older women, is a top priority of the U.S. Our innovative trial tested a new approach to PA promotion for older women—motivational interviewing (MI), shifting the paradigm from structured exercise to self-selected activities. We present data comparing stage of change (SOC), self-efficacy for exercise (SEE), and well-being: 8 dimensions (physical, social, role limitations, emotional, general mental health, vitality, health perceptions and pain) and associations with physical activity outcomes in the Lifestyle Physical Activity for Women (LPAW) clinical trial. Methods: 106 women, > 60 years old, who did not engage in regular PA, and were not frail, participated in a clinical trial of a tailored MI intervention to increase PA. We report baseline, 3 and 6 month repeated measures and PA associations with SOC, SEE, and well-being (SF36). Results: Of 106 women, 36% were Black and 63% White, with a mean age of 69. Significant improvement in SOC in both arms noted but the proportion in action/maintenance was significantly higher in the PA arm at 3 mos (78% vs. 55%, P=0.045) and 6 mos (79% vs. 50%, P= 0.019). A decrease in SEE for control (p=.001), but not for PA arm (p=.45); at 6 months, The PA arm had greater SEE compared to control. There were significant arm difference for physical component scores of SF36 (p=.02), but not for mental scores. Associations with PA will be tabulated. Conclusions: Preliminary results support the PA intervention, more data to be presented.

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