- BASIL & SPICE OPINION

Entries in Morgentaler, Abraham (4)

Wednesday

Nov192008

Testosterone And Diabetes--Is There An Important Link?

Nov 19, 2008

Abraham Morgentaler, MD is a prominent urologist and men’s health specialist. He is the author of Testosterone for Life. Testosterone for Life is the first book about the common men's medical condition of low testosterone by a noted specialist in the field. The book explains every aspect of low testosterone from symptoms, myths, diagnoses, and treatment, to the benefits (and rare risks) of T therapy. Dr. Morgentaler is also author of The Male Body and The Viagra Myth. He is an Associate Clinical Professor of urology at Harvard Medical School, and the founder of Men’s Health Boston, a center focusing on sexual and reproductive health for men.

Abraham Morgentaler--

November is American Diabetes Month, an attempt by groups such as the American Diabetes Association to increase the public’s awareness of one of the most important medical conditions affecting our health. The problem with blood sugar control causes a number of symptoms and problems all by itself, but diabetes is also a risk factor for other problems down the road, including heart attacks and stroke. One of the more interesting relationships now being uncovered is how testosterone interacts with diabetes.

Until fairly recently, low testosterone in men (I call it “low T”) was only treated for men with severe and obvious T deficiencies, such as men with congenital hormonal conditions that affected their pituitary glands in their brains, or men who lost both testicles due to trauma, tumors, or infections. However, as the medical community has learned more about the benefits of T therapy in men with less obvious causes of low T (eg, improved sexual desire and function, energy, body composition), there has been concomitant interest in how T relates to other medical conditions, including diabetes. It turns out that the relationship between low T and diabetes is quite involved, although the final chapter on the ultimate nature of the relationship is still to be written.

One key observation is that there is a very high prevalence of low T among men with diabetes. In a study (the HIM study: Hypogonadism in Males) of approximately 300 general medical offices, patients were asked to provide their entire medical history, and then underwent a blood test for testosterone. The fraction of men with T concentrations less than the FDA’s threshold for normal T levels, ie <300 ng/dl, was greatly increased in men with certain medical conditions compared with men without those conditions. Approximately 50% of men with diabetes had low T, and the overall risk of low T in this population was more than double the risk seen in men without diabetes.

OK- so this study (and others with similar results) suggest that men with diabetes are at higher risk of having low T. So what? Well, the story gets more interesting. There is a very sophisticated type of study, called longitudinal studies, in which individuals give a blood sample, which is then frozen, and these individuals are then followed for many years. At the end of the study the researchers can test the frozen blood samples to determine whether hormone levels like testosterone, for example, predicted the development of medical conditions such as diabetes. It turns out that men with the lowest 25% of T concentrations in the study population were at increased risk of developing diabetes. In other words, having a relatively low concentration of T in the blood increased the probability of being diagnosed with diabetes sometime later. The risk was also increased for development of metabolic syndrome, a group of items (including diabetes) that predicts subsequent risk of heart attack and stroke.

The final (so far) piece to this story is that treatment of low T with T therapy appears to improve the body’s ability to handle glucose and its partner, insulin. This has been shown in some studies, but not others, so at this point we can only say that the data are suggestive that normal T is helpful for diabetes control. A related fact, though, is that T therapy increases muscle mass and lowers body fat, and both of these changes are helpful with blood sugar control. This piece supports the idea that normalizing T may be helpful for diabetes.

What’s the bottom line, then, regarding T and diabetes? The practical issue is that men with diabetes are at high risk of already having low T, and should therefore be checked for it. Certainly if diabetic men have symptoms of low sex drive, weak erections, chronic fatigue, depressed mood, or osteoporosis, blood tests for T should be obtained and treatment considered if T is low. A more general issue is that we may eventually learn from larger, prospective studies whether T therapy may be indicated in men even without symptoms, for overall health, and possibly for warding off the risk of one day developing diabetes.

Short Stature May Protect Against Prostate Cancer

Surveillance Is Key In The World of Prostate Cancer

Update on Nov 20, 2008 by

At Basil & Spice

Western Star!

Short Stature May Protect Against Prostate Cancer

Sep 8, 2008

Abraham Morgentaler, MD is a prominent urologist and men’s health specialist. He is the author of Testosterone for Life, due out in December 2008 (currently available for pre-order on Amazon.com). Testosterone for Life is the firstbook about the common men's medical condition of low testosterone by a noted specialist in the field. The book explains every aspect of low testosterone from symptoms, myths, diagnoses, and treatment, to the benefits (and rare risks) of T therapy. Dr. Morgentaler is also author of The Male Body and The Viagra Myth. He is an Associate Clinical Professor of urology at Harvard Medical School, and the founder of Men’s Health Boston, a center focusing on sexual and reproductive health for men.

Abraham Morgentaler--

An article published this month reported that height was associated with prostate cancer risk. How’s that for a study result to make people nervous? But for readers over six feet, no need yet to start stooping over so quickly, or to lobby your doctor to do a prostate biopsy based only on your height.

This study from England, published in the September issue of Cancer Epidemiology, Biomarkers & Prevention, looked at data from more than 9,000 men with and without prostate cancer and estimated that the risk of developing the disease rose by six percent for every 10 centimeters (3.9 inches) of height over the shortest group of men in the study. The strength of the association was increased for high-grade cancers.

In science, the devil is in the details, and there are a few details of great importance in this study. One is that review of the data shows that the average height for men with cancer was nearly identical to the control group without cancer. A second is that the reported 6% increased risk for every 10 centimeters was not statistically significant. This means that based on statistical tests, there is a reasonable likelihood that the increased risk was due to chance alone. Only the results for high-grade tumors were statistically significant.

In looking at the high-grade tumors, another interesting detail turns up. To determine whether there was an increased risk with increased height, the investigators grouped men into four groups, called quartiles, based on height, from lowest to highest stature. In reviewing the actual listed results, the risk for the three highest quartiles was all somewhat higher than the lowest quartile, but not very different from each other. This means that height may not be the real culprit. An alternative, and possibly more accurate, way of describing this is that short stature may be protective against prostate cancer!

Regardless of how one views the results, it is highly unlikely that height itself is the culprit, as the authors themselves conclude. The question is whether height is a marker, an indicator of something else that truly causes greater or lower risk of prostate cancer.

One possibility that comes to mind is nutrition. An interesting fact about prostate cancer is that there is a strong connection between race and risk. Japanese, for example, have a very low rate of prostate cancer compared to white North Americans. Yet, men of Japanese origin who move to Hawaii have a somewhat increased prostate cancer risk, and those who have made the move all the way to the US mainland have an even greater risk. A plausible explanation for this shift in risk is diet.

In my own family, I am 5 inches taller than both my parents, who were born to relatively poor families in Europe, whereas I was born in Canada. And my father was several inches taller than his own parents. Better nutrition is a likely factor in this rapid increase in height over just two generations within the same family. Thus height may be a marker for dietary influences, which in turn appears to have some impact on prostate cancer risk.

Call me a glass-half-full kind of guy, but instead of seeing these results as a concern for tall men, I seem them providing some reassuring information for men who are below average in height.

Surveillance Is Key In The World of Prostate Cancer

Eric Shanteau--Cancer or Beijing--What's His Risk?

Update on Sep 8, 2008 by

At Basil & Spice

Reuters!

Reuters UK!

JournalNews! Fairfield Echo!

Surveillance Is Key In The World Of Prostate Cancer

Aug 8, 2008

book about the common men's medical condition of low testosterone by a noted specialist in the field. The book explains every aspect of low testosterone from symptoms, myths, diagnoses, and treatment, to the benefits (and rare risks) of T therapy. Dr. Morgentaler is also author of The Male Body and The Viagra Myth. He is an Associate Clinical Professor of urology at Harvard Medical School, and the founder of Men’s Health Boston, a center focusing on sexual and reproductive health for men.

Abraham Morgentaler--

Even as a urologist, the various news stories about prostate cancer make my head spin. The latest is a report from the US Preventive Task Force concluding that men 75 years of age and older should no longer be screened for prostate cancer. The justification is that it takes an average of 10 years for prostate cancer to cause trouble, and men at age 75 have, on average, 10 years of life expectancy. The Task Force concluded that looking for prostate cancer in these men is more harmful to their health than not looking.

The confusing part of this new report is that prostate cancer vies with colon cancer as the second most common cause of cancer deaths in US men (lung cancer is #1), and is especially common among men over age 75. How does it make any sense to purposefully avoid attempting to detect a disease that is curable when diagnosed early, and that affects so many men?

The answer lies in the fact that only a fraction of men diagnosed with prostate cancer will ever die from it, because other medical conditions, eg heart disease, come into play as men age. And since the PSA (prostate specific antigen) blood test used for screening is imperfect, this means that many men will undergo biopsy when they don’t have cancer. Ultimately, the real concern is that we tend to over-treat prostate cancer, subjecting too many men to invasive procedures and their side effects when many of them would never have had a moment’s difficulty if only we hadn’t looked for prostate cancer in the first place.

The trick is figuring out who might have an aggressive cancer worth treating. The big change in the world of prostate cancer is something called “surveillance.” For many men with small tumors that appear to be well-behaved, based on their microscopic appearance, treatment is deferred until the PSA starts to climb rapidly, or a later biopsy reveals worrisome changes. This individualized approach reduces overtreatment, solving the greatest concern of the US Preventive Task Force.

In my own practice, I’m much more comfortable with an individualized approach to medicine than rigid recommendations based on “the average man.” Irving is a good example. At 77 years, he is sharp as a tack, takes no medications, and exercises every day. Two years ago he was referred to me with an abnormally high PSA, and biopsy revealed a small, well-behaved prostate cancer. Close follow-up has provided no indication of progression “It’s strange to know I have a cancer inside me,” Irving said at a recent visit. “I don’t want treatment if I don’t need it, but if the cancer starts to grow, I definitely want it treated. I figure I have a lot of good years left.” If we never looked, Irving would never have had a choice, until perhaps it might have been too late.

Eric Shanteau--Cancer Or Beijing--What's His Risk?

Update on Aug 10, 2008 by

At Basil & Spice

Google News! Reuters!

Eric Shanteau--Cancer Or Beijing--What's His Risk?

Jul 28, 2008

Abraham Morgentaler, MD is a prominent urologist and men’s health specialist. He is the author of Testosterone for Life, due out in December 2008 (currently available for pre-order on Amazon.com). Testosterone for Life is the first book about the common men's medical condition of low testosterone by a noted specialist in the field. The book explains every aspect of low testosterone from symptoms, myths, diagnoses, and treatment, to the benefits (and rare risks) of T therapy. Dr. Morgentaler is also author of The Male Body and The Viagra Myth. He is an Associate Clinical Professor of urology at Harvard Medical School, and the founder of Men’s Health Boston, a center focusing on sexual and reproductive health for men.

Abraham Morgentaler--

Olympic swimmer Eric Shanteau postpones testis cancer treatment: One Urologist’s Opinion

Despite being a urologist, when I learned in the news that 24- year old US swimmer Eric Shanteau was delaying treatment for newly diagnosed testis cancer until after the Olympic Games in Beijing, my initial response was probably similar to what many other readers thought: “What the heck is he doing that for? Why doesn’t he do the ‘right thing’ and realize his health comes first!” But after a moment, reason kicked in. I get it, and I suspect if faced with the same situation, I might just do the same thing. It all comes down to the difficulty in assessing risk, and substituting our own value judgments on others. We all seem to have it down when it comes to knowing the right thing for other people to do.

Testis cancer is the most common cancer among young men aged 18-35, after which time this form of cancer becomes considerably less common. The most common symptom is a painless lump involving the testis itself. In nearly all cases treatment includes removing the entire testicle, and possibly undergoing additional treatment with surgery, chemotherapy or radiation depending on the kind of tumor and whether or not it has spread. Despite this mortifying tableau, the treatment of testis cancer is one of the great success stories in medicine over the last 50 years. Cure rates- real cure rates, meaning the disease won’t come back even after the “traditional” 5 year waiting period- are well over 90%, and approach this figure even when the cancer has spread to lymph nodes or the lungs. By report, Lance Armstrong is one example of cure after widespread metastases from testis cancer.

What does this mean for Eric Shanteau? We tend to think of testis cancer as a rapidly growing cancer, which should mean that the best chance for cure- as well as the need for less aggressive or extensive treatment- is early treatment. Realistically, though, a delay of several weeks or a month is unlikely to make a big difference in the spread of cancer. About 7 years ago I saw a man in the office for infertility, and on examination the right testicle was so large and irregular that it was twice the size of the left one. When I asked him to feel the testis he told me it had felt abnormal and had been growing for over one year! Fear that he might have cancer had prevented him from seeing a doctor until his wife made him see me for the fertility problem. Despite the delay in diagnosis, he underwent successful treatment, and is cured. He and his wife adopted two baby girls.

Infertility doesn’t always accompany treatment for testis cancer. In many men, sperm numbers and testosterone production are normal. Not long ago I performed a vasectomy on a man who had undergone successful treatment for testis cancer and fathered two children afterwards. Some men choose to have a testicular implant placed in the scrotum after the testicle is removed, to make them look like they “still have two,” but many men just don’t care about this, or simply feel proud of beating cancer.

So, after a moment’s reflection, I’m not as worried about Eric Shanteau’s decision to defer his treatment for testis cancer as I had been initially. After all, the additional risk is small, and he’s been working towards his Olympic goal for many years. Who are we to say the dream isn’t worth the small additional health risk? It seems to me that the biggest issue for Eric may be the psychological burden of walking around with the knowledge that he has a cancer growing inside him. Yet denial is not just a river in Egypt, but can also be a successful coping strategy in the short-term. In this case it may just turn out to be the ticket to fulfillment of a life’s goal.

Olympic Issues:

Will The Olympics In China Be Doomed By Smog?

Gold Medal Mindset--The Mind of An Olympian

Update on Jul 29, 2008 by

At Basil & Spice

Google News! Linked at US News!

2 Comments | |

Email Article |

Permalink

Beijing,

Cancer,

Eric Shanteau,