Items filtered by date: Wednesday, 08 January 2020

Wednesday, 08 January 2020 21:27

Testosterone Therapy: New guidelines released

Millions of men take testosterone supplements each year in the U.S.  Low testosterone, or “Low T”, can manifest in a variety of symptoms including:

  • fatigue
  • erectile dysfunction
  • depression
  • lack of sex drive
  • muscle loss
  • loss of strength
  • decrease muscle strength
  • loss of fertility
  • osteoporosis (decrease bone mass)
  • and may contribute to many other issues.

The most popular forms of testosterone are injections and gels. Pill forms are available but are not as effective.

Testosterone slowly decreases with age at a rate of 1.6 % per year beginning in one’s 30’s. A man with significant testosterone loss, however could  signify a more serious health issue such as diabetes.  So many physicians don’t hesitate when it comes to supplementing this vital hormone.

However, its not without its risks.   Risks of testosterone therapy include:

  • Increasing risk of prostate size
  • risk of prostate cancer
  • polycythemia (increase red blood cell levels)
  • mood issues
  • sleep apnea
  • acne
  • and multiple studies have found it increases risk of heart attacks and stroke.

This week the American College of Physicians released new guidelines on testosterone replacement.

They suggest to only use testosterone therapy when treating sexual dysfunction but not for the other aforementioned conditions as the evidence is not supportive.

Recommendation 1a:

ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient’s preferences.

Recommendation 1b:

ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence).

Recommendation 1c:

ACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar.

Recommendation 2:

ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence).

They also prefer intramuscular forms over transdermal preparations due to cost.

Testosterone therapy linked to blood clots

 

In 2016 researchers found a 63% increase risk of blood clots within the first 6 months of testosterone therapy. These are deadly as they increase the risk of heart disease, stroke, pulmonary embolism and organ damage.  They form in veins, deep veins, and thus have an obstructed path to reach vital organs and prevent blood flow.  This is not the first time venous thromboembolism (VTE) has been linked to testosterone therapy. Back in 2014 the FDA recommended warning labels on testosterone products.

According to researchers at Icahn School of Medicine at Mount Sinai in New York City state the overall risk is still low, one case per 1000 men a year, but could be of huge concern for those at risk of blood clots.  Lead researcher, Dr.Carlos Martinez, states, “Risk peaks rapidly in the first six months of treatment and lasts for about nine months, and fades gradually thereafter.” So a promising finding is the risk falls as time passes since therapy.

  • Risk factors for VTE include:
  • genetic predisposition
  • prior blood clots
  • cancer
  • prolonged immobility (long flights, hospitalization stays)
  • pregnancy (women)
  • smoking
  • and of course risk increases with age.

Study author Dr. Mark Creager states, “My advice is to review the patient’s underlying risk factors for VTE, and weigh that risk against the potential benefit of testosterone therapy,” Creager said. “These individuals should at least be made aware of the fact that their risk would be even higher with testosterone.”

This study was published online 11/30/2016 in the BMJ (British Medical Journal)

 

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in Health
Wednesday, 08 January 2020 21:15

Iran, War, History and International Relations

I try to be well informed on many public policy matters, but I pretend no great expertise on international relations and conflict.  That said, some thoughts on those subjects in light of the current conflict in the Middle East.

As my daughter is learning in her government class, a fundamental duty of national governments is to protect their people from external threats.  After World War I, some Republicans became isolationist, claiming we had little or no stake in many international affairs, and the Great War showed the costs and risks of getting involved.

They were certainly right about the costs and risks.  If all recorded history had not been sufficient to teach us the horrors of war, the Great War certainly should have done so.   The loss of human lives and damage to many survivors and their families, the destruction of cities and towns, of economies, infrastructure and cultures is on its face insane unless it is the only way to avoid even worse developments.

We did not get the worst of that war, although we got plenty.  But Europeans who fought it from start to finish and on their own grounds should have learned because they did.  Nonetheless, they had little choice but to fight World War II because the aggressive evil of racist German National Socialism and Italian fascism attacked them viciously, leaving no alternative.

The isolationists thought we could stay out of that war because we had oceans between us and it.  Some folks believed then and now that if we’re peaceful, non-interventionist and amicable with other countries, they’ll respond in kind.  These views were definitively shattered by the murderous, racist, aggressive Japanese militarism in Asia and then Pearl Harbor.

Two things were clear after WWII.  First, there are significant numbers of evil people and ideas in the world and they sometimes control the means to wreak great destruction.  So, we must be ready to fight and defeat them.

Second, mountains and oceans are no longer significant barriers behind which to hide.  Moreover, there is a compelling positive reason to actively engage with other nations: the huge economic and cultural benefits we get from trade and international relations.

So, we need to maintain a substantial, ready national defense.

The expansionist, totalitarian and murderous evils of Soviet, Korean, Cuban and Chinese communism proved such malign forces were not wiped out in two world wars.  It seems there’s always another one waiting around the corner.

However, with the end of the world wars and the rise of communism following hard on, engaging in war and preparation for it became normal.  Indeed, as President Eisenhower warned, a military-industrial complex had grown from these circumstances and now had an interest in arms production and fomenting conflict.  The MIC is still as powerful, influential and pernicious as ever.

One important lesson of the fall of the Soviet empire is that evil doctrines, if contained, will fail from their own evil.  Thus, the implosion of the Soviet Union because it could not compete with democratic market liberalism.  (For a while, China took a capitalist road, but returned to ruthless authoritarianism.)

Some academics proclaimed this triumph brought the end of history.  They forgot there are always new evil doctrines.

In the last half century, Islamofascism has metastasized because it originated in the Mideast, where the unearned endowment of oil and gas riches, shared by the Saudis with Islamofascists as a defensive measure, allowed it.  Islamofascism is evil because it is in its essence hostile to individual liberty and markets.  And because it views terrorism as a legitimate element of war.

President Bush 43 erred in embracing nation building as a counter-measure. President Trump got things right in promising to stop the endless wars where we have no real interests at stake.  That means most of the Middle East, not including Israel.  His surgical strike to kill Major General Soleimani was an ideal response to Iran, especially after foregoing drone strikes.

Now he must find a way to end most of our involvement there and bring most troops home while proportionately parrying Iran’s counterstrikes.

 

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Ron Knecht is a contributing editor to the Penny Press - the conservative weekly "voice of Nevada." His views and opinions are his own. You can subscribe at www.pennypressnv.com. This is an edited version of his column which has been reprinted with permission. 

 

Published in World

I am not what you would call an observant Jew.

 

But, being a baby boomer, I received the full Sunday School treatment from my parents and got, in those 10 years, what would probably be today an advanced degree in Judaism and the history of the Jews. 

 

And I got from my late Father, a World War II Navy veteran, a firm connection to one of the darkest periods of our modern world’s history.

 

Additionally, I met a distant cousin who the Allies liberated from Auschwitz and, subsequently, moved to the United States.

 

The impact on a young boy of seeing a serial number tattooed on a forearm cannot be underestimated.

 

For those of you Jews who have no real connection to World War Two and the Holocaust, you are making a huge mistake by merely assuming it could never happen again and certainly not in the United States.

 

Understand this:

 

The Holocaust was NOT played out on a Hollywood sound stage.  If you think it was, you are even dumber than the Germans who allowed it to happen.  It happened.

 

The First Amendment is a beautiful thing.  But what keeps us safe from the excesses of the First Amendment is the Second.  And who wants to take away our guns? Germany didn’t have a Second Amendment and the first thing Hitler did when he came to power is to remove private gun ownership but thankfully, here in America, we are pretty well armed.

 

West of the Hudson River, East of the Los Angeles County line and South of the Cook County line is a whole nation which is totally unwilling to give up our second Amendment rights.

 

And, I’m guessing that most of Israel’s support comes from that same large area.

 

Israel was established with the concept that Jews should have a homeland where another Holocaust could NEVER happen.  They became fierce warriors to insure that.

 

For some reason, the farther people get from an event like the Holocaust the less they are concerned with the consequences.

 

 As for Iranian retaliation, that’s what happens when a Little League team takes on the Yankees.  The truth is that one button levels Tehran.  Another can level the Quds force.

 

And that’s before Israel gets involved.

 

Iran has plenty of American blood on its hands.  It seems only fair to make it pay.

 

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Fred Weinberg is a guest columnist and the CEO of USA Radio Network. His views and opinions are his own and do not necessarily reflect the opinions of GCN. Fred's weekly column can be read all over the internet. You can subscribe at www.pennypressnv.com. This is an edited version of his column, reprinted with permission. 

Published in Opinion