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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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Women Rowing North – by Dr. Mary Pipher
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Ageism is rife, as is misogyny. And those can be internalized too, and compounded as they intersect.
Clinical psychologist Dr. Mary Pipher, herself 75, writes for us a guidebook of, as the subtitle goes, “navigating life’s currents and flourishing as we age”.
The book does assume, by the way, that the reader is…
- a woman, and
- getting old (if not already old)
However, the lessons the book imparts are vital for women of any age, and valuable as a matter of insight and perspective for any reader.
Dr. Pipher takes us on a tour of aging as a woman, and what parts of it we can make our own, do things our way, and take what joy we can from it.
Nor is the book given to “toxic positivity” though—it also deals with themes of hardship, frustration, and loss.
When it comes to those elements, the book is… honest, human, and raw. But also, an exhortation to hope, beauty, and a carpe diem attitude.
Bottom line: this book is highly recommendable to anyone of any age; life is precious and can be short. And be we blessed with many long years, this book serves as a guide to making each one of them count.
Click here to check out Women Rowing North—it really is worth it
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Dr. Greger’s Anti-Aging Eight
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Dr. Greger’s Anti-Aging Eight
This is Dr. Michael Greger. We’ve featured him before: Brain Food? The Eyes Have It!
This time, we’re working from his latest book, the excellent “How Not To Age”, which we reviewed all so recently. It is very information-dense, but we’re going to be focussing on one part, his “anti-aging eight”, that is to say, eight interventions he rates the most highly to slow aging in general (other parts of the book pertained to slowing eleven specific pathways of aging, or preserving specific bodily functions against aging, for example).
Without further ado, his “anti-aging eight” are…
- Nuts
- Greens
- Berries
- Xenohormesis & microRNA manipulation
- Prebiotics & postbiotics
- Caloric restriction / IF
- Protein restriction
- NAD+
As you may have noticed, some of these are things might appear already on your grocery shopping list; others don’t seem so “household”. Let’s break them down:
Nuts, greens, berries
These are amongst the most nutrient-dense and phytochemical-useful parts of the diet that Dr. Greger advocates for in his already-famous “Dr. Greger’s Daily Dozen”.
For brevity, we’ll not go into the science of these here, but will advise you: eat a daily portion of nuts, a daily portion of berries, and a couple of daily portions of greens.
Xenohormesis & microRNA manipulation
You might, actually, have these on your grocery shopping list too!
Hormesis, you may recall from previous editions of 10almonds, is about engaging in a small amount of eustress to trigger the body’s self-strengthening response, for example:
Xenohormesis is about getting similar benefits, second-hand.
For example, plants that have been grown to “organic” standards (i.e. without artificial pesticides, herbicides, fertilizers) have had to adapt to their relatively harsher environment by upping their levels of protective polyphenols and other phytochemicals that, as it turns out, are as beneficial to us as they are to the plants:
Hormetic Effects of Phytochemicals on Health and Longevity
Additionally, the flip side of xenohormesis is that some plant compounds can themselves act as a source of hormetic stress that end up bolstering us. For example:
In essence, it’s not just that it has anti-oxidant effect; it also provides a tiny oxidative-stress immunization against serious sources of oxidative stress—and thus, aging.
MicroRNA manipulation is, alas, too complex to truly summarize an entire chapter in a line or two, but it has to do with genetic information from the food that we eat having a beneficial or deleterious effect to our own health:
Diet-derived microRNAs: unicorn or silver bullet?
A couple of quick takeaways (out of very many) from Dr. Greger’s chapter on this is to spring for the better quality olive oil, and skip the cow’s milk:
- Impact of Phenol-Enriched Virgin Olive Oils on the Postprandial Levels of Circulating microRNAs Related to Cardiovascular Disease
- MicroRNA exosomes of pasteurized milk: potential pathogens of Western diseases
Prebiotics & Postbiotics
We’re short on space, so we’ll link you to a previous article, and tell you that it’s important against aging too:
Making Friends With Your Gut (You Can Thank Us Later)
An example of how one of Dr. Greger’s most-recommended postbiotics helps against aging, by the way:
- The mitophagy activator urolithin A is safe and induces a molecular signature of improved mitochondrial and cellular health in humans
- Urolithin A improves muscle strength, exercise performance, and biomarkers of mitochondrial health in a randomized trial in middle-aged adults
(Urolithin can be found in many plants, and especially those containing tannins)
See also: How to Make Urolithin Postbiotics from Tannins
Caloric restriction / Intermittent fasting
This is about lowering metabolic load and promoting cellular apoptosis (programmed cell death; sounds bad; is good) and autophagy (self-consumption; again, sounds bad; is good).
For example, he cites the intermittent fasters’ 46% lower risk of dying in the subsequent years of follow-up in this longitudinal study:
For brevity we’ll link to our previous IF article, but we’ll revisit caloric restriction in a main feature on of these days:
Fasting Without Crashing? We sort the science from the hype!
Dr. Greger favours caloric restriction over intermittent fasting, arguing that it is easier to adhere to and harder to get wrong if one has some confounding factor (e.g. diabetes, or a medication that requires food at certain times, etc). If adhered to healthily, the benefits appear to be comparable for each, though.
Protein restriction
In contrast to our recent main feature Protein vs Sarcopenia, in which that week’s featured expert argued for high protein consumption levels, protein restriction can, on the other hand, have anti-aging effects. A reminder that our body is a complex organism, and sometimes what’s good for one thing is bad for another!
Dr. Greger offers protein restriction as a way to get many of the benefits of caloric restriction, without caloric restriction. He further notes that caloric restriction without protein restriction doesn’t decrease IGF-1 levels (a marker of aging).
However, for FGF21 levels (these are good and we want them higher to stay younger), what matters more than lowering proteins in general is lowering levels of the amino acid methionine—found mostly in animal products, not plants—so the source of the protein matters:
For example, legumes deliver only 5–10% of the methionine that meat does, for the same amount of protein, so that’s a factor to bear in mind.
NAD+
This is about nicotinamide adenine dinucleotide, or NAD+ to its friends.
NAD+ levels decline with age, and that decline is a causal factor in aging, and boosting the levels can slow aging:
Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence
Can we get NAD+ from food? We can, but not in useful quantities or with sufficient bioavailability.
Supplements, then? Dr. Greger finds the evidence for their usefulness lacking, in interventional trials.
How to boost NAD+, then? Dr. Greger prescribes…
Exercise! It boosts levels by 127% (i.e., it more than doubles the levels), based on a modest three-week exercise bike regimen:
Skeletal muscle NAMPT is induced by exercise in humans
Another study on resistance training found the same 127% boost:
Take care!
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Alpha, beta, theta: what are brain states and brain waves? And can we control them?
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There’s no shortage of apps and technology that claim to shift the brain into a “theta” state – said to help with relaxation, inward focus and sleep.
But what exactly does it mean to change one’s “mental state”? And is that even possible? For now, the evidence remains murky. But our understanding of the brain is growing exponentially as our methods of investigation improve.
Brain-measuring tech is evolving
Currently, no single approach to imaging or measuring brain activity gives us the whole picture. What we “see” in the brain depends on which tool we use to “look”. There are myriad ways to do this, but each one comes with trade-offs.
We learnt a lot about brain activity in the 1980s thanks to the advent of magnetic resonance imaging (MRI).
Eventually we invented “functional MRI”, which allows us to link brain activity with certain functions or behaviours in real time by measuring the brain’s use of oxygenated blood during a task.
We can also measure electrical activity using EEG (electroencephalography). This can accurately measure the timing of brain waves as they occur, but isn’t very accurate at identifying which specific areas of the brain they occur in.
Alternatively, we can measure the brain’s response to magnetic stimulation. This is very accurate in terms of area and timing, but only as long as it’s close to the surface.
What are brain states?
All of our simple and complex behaviours, as well as our cognition (thoughts) have a foundation in brain activity, or “neural activity”. Neurons – the brain’s nerve cells – communicate by a sequence of electrical impulses and chemical signals called “neurotransmitters”.
Neurons are very greedy for fuel from the blood and require a lot of support from companion cells. Hence, a lot of measurement of the site, amount and timing of brain activity is done via measuring electrical activity, neurotransmitter levels or blood flow.
We can consider this activity at three levels. The first is a single-cell level, wherein individual neurons communicate. But measurement at this level is difficult (laboratory-based) and provides a limited picture.
As such, we rely more on measurements done on a network level, where a series of neurons or networks are activated. Or, we measure whole-of-brain activity patterns which can incorporate one or more so-called “brain states”.
According to a recent definition, brain states are “recurring activity patterns distributed across the brain that emerge from physiological or cognitive processes”. These states are functionally relevant, which means they are related to behaviour.
Brain states involve the synchronisation of different brain regions, something that’s been most readily observed in animal models, usually rodents. Only now are we starting to see some evidence in human studies.
Various kinds of states
The most commonly-studied brain states in both rodents and humans are states of “arousal” and “resting”. You can picture these as various levels of alertness.
Studies show environmental factors and activity influence our brain states. Activities or environments with high cognitive demands drive “attentional” brain states (so-called task-induced brain states) with increased connectivity. Examples of task-induced brain states include complex behaviours such as reward anticipation, mood, hunger and so on.
In contrast, a brain state such as “mind-wandering” seems to be divorced from one’s environment and tasks. Dropping into daydreaming is, by definition, without connection to the real world.
We can’t currently disentangle multiple “states” that exist in the brain at any given time and place. As mentioned earlier, this is because of the trade-offs that come with recording spatial (brain region) versus temporal (timing) brain activity.
Brain states vs brain waves
Brain state work can be couched in terms such as alpha, delta and so forth. However, this is actually referring to brain waves which specifically come from measuring brain activity using EEG.
EEG picks up on changing electrical activity in the brain, which can be sorted into different frequencies (based on wavelength). Classically, these frequencies have had specific associations:
- gamma is linked with states or tasks that require more focused concentration
- beta is linked with higher anxiety and more active states, with attention often directed externally
- alpha is linked with being very relaxed, and passive attention (such as listening quietly but not engaging)
- theta is linked with deep relaxation and inward focus
- and delta is linked with deep sleep.
Brain wave patterns are used a lot to monitor sleep stages. When we fall asleep we go from drowsy, light attention that’s easily roused (alpha), to being relaxed and no longer alert (theta), to being deeply asleep (delta).
Can we control our brain states?
The question on many people’s minds is: can we judiciously and intentionally influence our brain states?
For now, it’s likely too simplistic to suggest we can do this, as the actual mechanisms that influence brain states remain hard to detangle. Nonetheless, researchers are investigating everything from the use of drugs, to environmental cues, to practising mindfulness, meditation and sensory manipulation.
Controversially, brain wave patterns are used in something called “neurofeedback” therapy. In these treatments, people are given feedback (such as visual or auditory) based on their brain wave activity and are then tasked with trying to maintain or change it. To stay in a required state they may be encouraged to control their thoughts, relax, or breathe in certain ways.
The applications of this work are predominantly around mental health, including for individuals who have experienced trauma, or who have difficulty self-regulating – which may manifest as poor attention or emotional turbulence.
However, although these techniques have intuitive appeal, they don’t account for the issue of multiple brain states being present at any given time. Overall, clinical studies have been largely inconclusive, and proponents of neurofeedback therapy remain frustrated by a lack of orthodox support.
Other forms of neurofeedback are delivered by MRI-generated data. Participants engaging in mental tasks are given signals based on their neural activity, which they use to try and “up-regulate” (activate) regions of the brain involved in positive emotions. This could, for instance, be useful for helping people with depression.
Another potential method claimed to purportedly change brain states involves different sensory inputs. Binaural beats are perhaps the most popular example, wherein two different wavelengths of sound are played in each ear. But the evidence for such techniques is similarly mixed.
Treatments such as neurofeedback therapy are often very costly, and their success likely relies as much on the therapeutic relationship than the actual therapy.
On the bright side, there’s no evidence these treatment do any harm – other than potentially delaying treatments which have been proven to be beneficial.
Susan Hillier, Professor: Neuroscience and Rehabilitation, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sweet Cinnamon vs Regular Cinnamon – Which is Healthier?
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Our Verdict
When comparing sweet cinnamon to regular cinnamon, we picked the sweet.
Why?
In this case, it’s not close. One of them is health-giving and the other is poisonous (but still widely sold in supermarkets, especially in the US and Canada, because it is cheaper).
It’s worth noting that “regular cinnamon” is a bit of a misnomer, since sweet cinnamon is also called “true cinnamon”. The other cinnamon’s name is formally “cassia cinnamon”, but marketers don’t tend to call it that, preferring to calling it simply “cinnamon” and hope consumers won’t ask questions about what kind, because it’s cheaper.
Note: this too is especially true in the US and Canada, where for whatever reason sweet cinnamon seems to be more difficult to obtain than in the rest of the world.
In short, both cinnamons contain cinnamaldehyde and coumarin, but:
- Sweet/True cinnamon contains only trace amounts of coumarin
- Regular/Cassia cinnamon contains about 250x more coumarin
Coumarin is heptatotoxic, meaning it poisons the liver, and the recommended safe amount is 0.1mg/kg, so it’s easy to go over that with just a couple of teaspoons of cassia cinnamon.
You might be wondering: how can they get away with selling something that poisons the liver? In which case, see also: the alcohol aisle. Selling toxic things is very common; it just gets normalized a lot.
Cinnamaldehyde is responsible for cinnamon’s healthier properties, and is found in reasonable amounts in both cinnamons. There is about 50% more of it in the regular/cassia than in the sweet/true, but that doesn’t come close to offsetting the potential harm of its higher coumarin content.
Want to learn more?
You may like to read:
- A Tale Of Two Cinnamons ← this one has more of the science of coumarin toxicity, as well as discussing (and evidencing) cinnamaldehyde’s many healthful properties against inflammation, cancer, heart disease, neurodegeneration, etc
Enjoy!
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Coach’s Plan – by Mike Kavanagh
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A sports coach’s job is to prepare a plan, give it to the player(s), and hold them accountable to it. Change the strategy if needs be, call the shots. The job of the player(s) is then to follow those instructions.
If you have trouble keeping yourself accountable, Kavanagh argues that it can be good to separate how you approach things.
Not just “coach yourself”, but put yourself entirely in the coach’s shoes, as though you were a separate person, then switch back, and follow those instructions, trusting in your coach’s guidance.
The book also provides illustrative examples and guides the reader through some potential pitfalls—for example, what happens when morning you doesn’t want to do the things that evening you decided would be best?
The absolute backbone of this method is that it takes away the paralysing self-doubt that can occur when we second-guess ourselves mid-task.
In short, this book will fire up your enthusiasm and give you a reliable fall-back for when your motivation’s flagging.
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Meningitis Outbreak
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Don’t Let Your Guard Down
In the US, meningitis is currently enjoying a 10-year high, with its highest levels of infection since 2014.
This is a big deal, given the 10–15% fatality rate of meningitis, even with appropriate medical treatment.
But of course, not everyone gets appropriate medical treatment, especially because symptoms can become life-threatening in a matter of hours.
Most recent stats gave an 18% fatality rate for the cases with known outcomes in the last year:
CDC Emergency | Increase in Invasive Serogroup Y Meningococcal Disease in the United States
The quick facts:
❝Meningococcal disease most often presents as meningitis, with symptoms that may include fever, headache, stiff neck, nausea, vomiting, photophobia, or altered mental status.
[It can also present] as meningococcal bloodstream infection, with symptoms that may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash.
While initial symptoms of meningococcal disease can at first be non-specific, they worsen rapidly, and the disease can become life-threatening within hours. Immediate antibiotic treatment for meningococcal disease is critical.
Survivors may experience long-term effects such as deafness or amputations of the extremities.❞
~ Ibid.
The good news (but still don’t let your guard down)
Meningococcal bacteria are, happily, not spread as easily as cold and flu viruses.
The greatest risks come from:
- Close and enduring proximity (e.g. living together)
- Oral, or close-to-oral, contact (e.g. kissing, or coughing nearby)
Read more:
CDC | Meningococcal Disease: Causes & How It Spreads
Is there a vaccine?
There is, but it’s usually only offered to those most at risk, which is usually:
- Children
- Immunocompromised people, especially if HIV+
- People taking certain medications (e.g. Solaris or Ultomiris)
Read more:
CDC | Meningococcal Vaccine Recommendations
Will taking immune-boosting supplements help?
Honestly, probably not, but they won’t harm either. The most important thing is: don’t rely on them—too many people pop a vitamin C supplement and then assume they are immune to everything, and it doesn’t work like that.
On a tangential note, for more general immune health, you might also want to check out:
Beyond Supplements: The Real Immune-Boosters!
The short version:
If you or someone you know experiences the above-mentioned symptoms, even if it does not seem too bad, get thee/them to a doctor, and quickly, because the (very short) clock may be ticking already.
Better safe than sorry.
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Learn to Age Gracefully
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