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HORMONE REPLACEMENT THERAPY

Enjoy a preview of this lecture from the 16th A4M Conference in Washington DC, Sponsored by A4M. 

Abraham Morgentaler, MD 

Low Testosterone in Men:

The Next Big Thing in Medicine

16th A4M Conference.

Eric Braverman, MD. 

Increasing IGF-1 Levels to the Upper Range of Normal to Fight Disease

2009 A4M Orlando Conference.

Testosterone Therapy Helps Trim Men's Waistlines

Previous studies of testosterone replacement therapy (TRT) have shown changes in body composition, usually in the form of increased lean mass and decreased fat mass.  Farid Saad, from Bayer Pharma (Germany), and colleagues reviewed data in a prospective registry of middle-age and older men, mean age 60.6 years, who received TRT for at least 2 years and for as long as 5 years. More than half of the patients had 4 years of follow-up.  The objective was to determine the long-term effects of normalization of testosterone levels in the men. Standard treatment was 1,000 mg initial dose, followed 6 weeks later by 1,000 and then 1,000 mg every 12 weeks after.  The baseline testosterone level averaged 287 ng/dL. Baseline weight averaged 236 lbs., and 95% of the men had a baseline body mass index (BMI) >25, including 71% of men who obese (BMI 30 to 40) or morbidly obese (≥40). The men had a median waist circumference of 42.2 inches Similarly to weight distribution, 4% of the men had a waist <37 inches, and 68% had a waist circumference ≥40 inches thick.  Testosterone levels normalized (≥350 ng/dL) within 6 to 9 months and remained stable throughout follow-up. Annual measurements showed that testosterone levels significantly exceeded baseline values (P<0.0001) beginning at 12 months and continuing to the end of follow-up. Similarly, body weight declined significantly within 12 months and continued to decline for as long as 5 years.  As well, weight declined significantly between annual measurements, beginning at year 2.  More than half of the men (53%) lost at least 33 lbs., and almost a third lost 44 lbs. or more weight. Similarly, 86% of the men had a least a 2-inch reduction in waist circumference, and 46% dropped 6 inches or more. Commenting that: ""I don't know many treatments where more than 90% of patients respond in a positive way to the treatment," the lead study author emphasizes that: ""There is no evidence of an increased risk of prostate cancer in testosterone-treated men.


Saad F, et al. "Restoring testosterone to normal levels in elderly men is efficacious in weight reduction. A follow-up study over 5 years" [Abstract SAT-118].  Presented at ENDO 2012, June 23, 2012.

Testosterone May Exert Benefits for Heart Failure

Testosterone supplementation may help improve exercise capacity and metabolic factors in patients with heart failure.  Justin Ezekowitz, from the University of Alberta (Canada), and colleagues completed a meta-analysis of four small, randomized, placebo-controlled trials involving a total of198 patients (84% male, mean age 67 years), with the majority of the patients (71%) having experienced ischemic heart failure.  The data showed that testosterone therapy associated with 16% to 23% relative improvements in walking distance and peak oxygen consumption. Specifically, on average, patients on testosterone walked 54 meters (16.7%) longer on the 6-minute walk test and 46.7 meters (15.9%) longer on the incremental shuttle walk test. Peak oxygen consumption (VO2) improved by 2.70 mL/kg/min (22.7%).  Although there were no effects on left ventricular ejection fraction, the percentage of patients who improved at least on New York Heart Association class was greater with testosterone (35% versus 9.8%).  The researchers noted that there were no major safety concerns, but acknowledged the small sample sizes and short lengths of follow-up.  The study authors conclude that: "Given the unmet clinical needs, testosterone appears to be a promising therapy to improve functional capacity in [heart failure] patients."


Mustafa Toma, Finlay A. McAlister, Erin E. Coglianese, Venketesan Vidi, Samip Vasaiwala, Justin A. Ezekowitz, et al.  “Testosterone Supplementation in Heart Failure: A Meta-Analysis.”  Circ Heart Fail., April 17, 2012.

Age-Related Protein Decline is Reversible

Nine proteins, isolated from blood, decline with age, but researchers from Boston University School of Medicine and University of Texas Medical Branch  have found that the profile of some of these proteins can be reversed by testosterone treatment. The team compared protein levels in serum samples from two groups of healthy men - young men ages 18-35 years and older men ages 60-75 years. Seven proteins, which were either growth factors (IGF-1, IL-7, IL-12p40, PDGF[beta]), or were involved in immune response (ENA78, MIP-1[beta], IP-10), and pro-collagen (PIIINP) were all reduced in older men. In contrast the monokine MIG, also involved in immune activity, was elevated.  The team found that testosterone treatment increased lean muscle mass, and levels of the appetite suppressing hormone leptin, for both groups of men. Testosterone also increased levels of PIIINP and IGF-1 in young men and the researchers saw a similar increase in a small group of older men. The authors conclude that: “Results from this study suggest that there are potential phenotypic biomarkers in serum that can be associated with healthy aging and that some but not all of these biomarkers reflect gains in muscle mass upon testosterone administration.”


Banerjee C, Ulloor J, Dillon EL, Dahodwala Q, Franklin B, Sebastiani P, Sheffield-Moore M, Urban RJ, Bhasin S, Montano M.  “Identification of serum biomarkers for aging and anabolic response.” Immunity & Ageing 2011, 8:5, 20 June 2011.

DHEA Helps to Improve Symptoms of Menopause

Dehydroepiandrosterone, better known as DHEA, is the most abundant steroid in the human body involved and is involved in the manufacture of testosterone, estrogen, progesterone, and corticosterone.  DHEA levels continue to rise up to about age twenty-five, when production drops off sharply: by age 65, the human body makes only 10 to 20% of what it did at age 20. Andrea Genazzani, from the University of Pisa (Italy), and colleagues followed a group of 48 post-menopausal women troubled by symptoms including hot flushes, night sweats, loss of sex drive and mood swings.  Over a one-year period, 12 women took vitamin D and calcium, 12 took DHEA, 12 took standard hormone replacement therapy (HRT), and 12 took a synthetic steroid called tibolone (used to alleviate menopausal symptoms).   The women's menopausal symptoms, sexual interest and activity were measured using a standard questionnaire. After 12 months, all the women on both DHEA and HRT had improvements in menopausal symptoms, but those taking vitamin D and calcium did not show any significant improvement. At the start of the trial, all groups had similar sexual activity, but after the year, those taking calcium and vitamin D scored an average of 34.9 on the questionnaire scale, while those taking DHEA had a score of 48.6, showing that those on DHEA had more sexual interest and activity. The study authors report that: “Daily oral DHEA therapy … provided a significant improvement in comparison with vitamin D in sexual function and in frequency of sexual intercourse in early postmenopausal women.”

Dehydroepiandrosterone, better known as DHEA, is the most abundant steroid in the human body involved and is involved in the manufacture of testosterone, estrogen, progesterone, and corticosterone.  DHEA levels continue to rise up to about age twenty-five, when production drops off sharply: by age 65, the human body makes only 10 to 20% of what it did at age 20. Andrea Genazzani, from the University of Pisa (Italy), and colleagues followed a group of 48 post-menopausal women troubled by symptoms including hot flushes, night sweats, loss of sex drive and mood swings.  Over a one-year period, 12 women took vitamin D and calcium, 12 took DHEA, 12 took standard hormone replacement therapy (HRT), and 12 took a synthetic steroid called tibolone (used to alleviate menopausal symptoms).   The women's menopausal symptoms, sexual interest and activity were measured using a standard questionnaire. After 12 months, all the women on both DHEA and HRT had improvements in menopausal symptoms, but those taking vitamin D and calcium did not show any significant improvement. At the start of the trial, all groups had similar sexual activity, but after the year, those taking calcium and vitamin D scored an average of 34.9 on the questionnaire scale, while those taking DHEA had a score of 48.6, showing that those on DHEA had more sexual interest and activity. The study authors report that: “Daily oral DHEA therapy … provided a significant improvement in comparison with vitamin D in sexual function and in frequency of sexual intercourse in early postmenopausal women.”


A. R. Genazzani, M. Stomati, V. Valentino, N. Pluchino, E. Potì, E. Casarosa, S. Merlini, A. Giannini, M. Luisi.  “Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality.”  Climacteric, Dec 2011, Vol. 14, No. 6, Pages 661-668.

Ronald Rothenberg, MD

Thyroid Replacement Therapy

16th annual A4M conference

Human Growth Hormone on Trial - James W. Forsythe, MD, HMD

James W. Forsythe, MD, HMD speaks on the Human Growth Hormone on Trial: The United States vs James W. Forsythe at the 16th annual A4M conference in Las Vegas, Nevada. More: Covers major legal aspects of prescribing HGH and discusses the National HGH Protocol. Reviews appropriate testing, biochemistry and physiology, clinical applications and patient administration of HGH.

Hormone Therapy Helps to Improve Cognition


Growth hormone-releasing hormone (GHRH), growth hormone (GH), and insulin-like growth factor 1 (IGF-1) exert potent effects on brain function, but their levels decrease with advancing age.  Growth hormone-releasing hormone (GHRH) is key to the production of both GH and IGF-1. Previously, a number of studies suggest that elevating levels of these hormones in people at risk for cognitive impairment might prevent mental decline or improve function.  Laura Baker, from the University of Washington School of Medicine (Washington, USA), and colleagues enrolled 152 adults, ages 55 to 87 years, including 66 with mild cognitive impairment (MCI). Subjects were randomly assigned to receive either daily subcutaneous injections of GHRH, or placebo.  The primary outcome was cognitive change measured by a battery of standard tests at baseline and weeks 10, 20, and 30 (following a 10-week washout period). The researchers also conducted blood tests at those intervals to measure circulating levels of the three hormones, finding that GHRH increased insulin-like growth factor 1 levels by an average factor of 2.17 –within the normal physiological range. Those taking GHRH exhibit a significant improvement in overall cognition that was comparable among both healthy participants and those with MCI. Importantly, GHRH significantly improved executive function, and appeared to improve verbal memory as well. Further, GHRH also reduced body fat by 7.4% .  Reporting that adverse events were mild, the study authors conclude that: "Twenty weeks of [growth hormone-releasing hormone] administration had favorable effects on cognition in both adults with [mild cognitive impairment] and healthy older adults. “


Laura D. Baker, Suzanne M. Barsness, Soo Borson, George R. Merriam, Seth D. Friedman, Suzanne Craft, Michael V. Vitiello. “Effects of Growth Hormone-Releasing Hormone on Cognitive Function in Adults With Mild Cognitive Impairment and Healthy Older Adults: Results of a Controlled Trial.”  Arch Neurol, August 6, 2012.

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