Tropical Weight Loss
Tropical Weight Loss
Photo: Karolina Grabowska
An initial weight gain in response to T therapy may be a result of water retention, which is transient. Indeed, we measured a moderate weight gain in some of our patients after 3–6 months of T therapy, which, however, was a transient phenomenon.
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Read More »In this study, we report that in men with various classes of obesity and TD, long-term T therapy produced significant and sustained WL, together with marked reductions in WC and BMI. Furthermore, we demonstrate that long-term T therapy in men with various classes of obesity reduced blood glucose, HbA 1c , SBP and DBP, CRP and improved lipid profiles. We also note that long-term T therapy in men with various classes of obesity resulted in significant reduction in alanine and aspartate transaminases suggesting reduced fat content in the liver and improvement in liver function. The marked and significant improvements in various metabolic parameters clearly indicate improvement in metabolic function, as reflected by decrease in inflammatory biomarkers and improved liver function. These findings combined with the improvement in lipid profiles, blood sugar, blood pressure and urogenital function support the reported improvement in quality of life assessed by the AMS questionnaire and the improvement in lower urinary tract symptoms assessed by the IPSS questionnaire. Equally important is the improvement observed in erectile function, assessed by the IIEF (EF) scale. The data from subgroup analyses in patients ⩽65 years old or >65 years old demonstrated that T therapy is equally effective in improving the anthropometric parameters as well as the metabolic functions in both subgroups, irrespective of age, as suggested previously.46 Therefore we emphasize that long-term T therapy is effective in younger as well as older patients, contrary to some previous claims. This is an important finding that indicates benefits of T therapy are not limited by age. The improvements in the cardio-metabolic risk factors are, in part, attributed to improved metabolism, mitochondrial function, increased energy utilization, reduced inflammation, increased motivation and vigor resulting in improved cardio-metabolic function and enhanced physical activity.45 The improved motivation, vigor, energy and reduced fatigue associated with long-term T therapy is likely to have contributed, in part, to the observed WL in obese men.23, 25, 26, 31, 34, 36, 37, 38, 47, 48 The significance of our findings is that long-term T therapy in hypogonadal men with varying classes of obesity may represent a novel effective and safe intervention strategy in management of obesity in hypogonadal men.49 As obesity is a chronic disease, necessitating medical intervention and long-term therapy, it is imperative to develop new approaches to the management of obesity.2 Recently, treatment with liraglutide coupled with a diet and exercise resulted in sustained and significant WL. This treatment also reduced cardiovascular risk in obese nondiabetic adults. Treatment with liraglutide produced reductions in SBP and fasting blood glucose, HbA 1c and reductions in CRP concentrations.50 One of the recent advances in management of obesity is bariatric surgery. This approach has produced substantial and sustained WL and ameliorated several obesity-related comorbidities.15 Bariatric surgery produces improvements in the CVD risk-factor profile, including metabolic syndrome, a lower risk of ischemic heart disease and mortality. Bariatric surgery also prevents new cases of diabetes compared with lifestyle treatment. A robust finding in many studies, independent of bariatric procedure, has been the improvement or remission of T2DM, before any significant WL. On the basis of several studies it is suggested that bariatric surgery serves as an alternative approach to intervention in obesity and this strategy may represent an effective treatment with concomitant reduction in T2DM, obesity-related comorbidities and reduced mortality.51 Bariatric surgery increases levels of total T and free T concomitant with reduction in weight, BMI and WC. Also fasting blood glucose and fasting insulin levels were significantly reduced. These findings strongly suggest that weight reduction via bariatric surgery is associated with normalization of hormonal profiles in obese men.52 It should be emphasized that only carefully selected patients can be subjected to bariatric surgery and patients need to be followed-up very closely and carefully. More research is needed to understand the long-term consequences of bariatric procedures in obese patients.15 Current strategies for the treatments for obesity include diets, exercise, behavioral lifestyle changes, pharmaco-therapeutic agents and bariatric surgery.53, 54 T therapy is another novel approach to treatment of obesity, as it reduces fat mass and improves lean body mass. This is of critical importance, as balance in the body composition relates to metabolic function.55 We believe that T therapy represents a novel pharmaco-therapeutic approach in the treatment of underlying patho-physiological conditions of obesity. We should also point out that treatment adherence is a major concern in managing chronic diseases such as obesity. We report that adherence and compliance to T therapy with TU 3-monthly injections was remarkable in previous studies. In this study, only one patient was dropped out in 8 years, due to moving to a new geographical location.
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Read More »Pharmaco-therapeutics used to treat obesity must meet several important criteria, including (a) long-term WL and weight maintenance, (b) should be well tolerated and exhibit no major safety concerns, (c) patients would adhere to the therapy and remain compliant. One most noted observation is that with nonsurgical WL interventions including pharmacotherapy, most WL occurs in the first 6 months after which there is a weight plateau, or a small degree of WL or gain when followed-up for longer term. Thus, T therapy for treatment of obesity meets the aforementioned criteria. Simply, T therapy produces WL, is well -tolerated and safe, and no weight regain, and patient compliance is very high. Most importantly, this therapy improves mood, energy, vigor and overall quality of life. It should be pointed out that labels of testosterone preparations list weight increase as a potential adverse effect of T therapy. An initial weight gain in response to T therapy may be a result of water retention, which is transient. Indeed, we measured a moderate weight gain in some of our patients after 3–6 months of T therapy, which, however, was a transient phenomenon. Only three men (<1%) had gained weight at the end of the observation time. It is, however, important that T therapy in hypogonadal men will not result in rapid WL. The US Food and Drug Administration (FDA) used to require a quick effect of weight-loss drugs, although more recently it was acknowledged that long-term effects over 1–2 years should be proven.51 We would like to point out that in all the reported studies to date, T therapy resulted in increase in lean body mass suggesting that T therapy should result in weight gain not WL. However, the reduction in fat mass, coupled with improved metabolic function and increased vigor and physical activity over time in response to T therapy produces the observed WL. We should emphasize that the increases in prostate volume noted in this study were expected as hypogonadism results in decreased prostate volume and T therapy restores prostate growth to its mature size. In addition, the increases in prostate-specific antigen are also similar to that reported previously with T therapy.56 T therapy is always met with a number of challenges. Among these are the myths that T causes prostate cancer. Although this myth has been debunked,56, 57, 58, 59 the continued fear and apprehension of physicians from litigation remains a huge challenge to T therapy in men with obesity. Indeed, eight patients were diagnosed with low-grade prostate cancer in this study. This incidence rate is low compared with an untreated population of a similar age, as reported previously.56 It should be made clear that all patients were monitored closely, according to the guidelines of the European Association of Urology. Other challenges including the recent hysteria regarding T therapy and cardiovascular risk was addressed in a recent comprehensive review by Morgentaler et al.60 Although such reports suffer from serious methodological flaws and poor scientific evidence, the purported information that T therapy is harmful has confounded the knowledge gained from more than seven decades of clinical experience with T therapy, and is in direct contradiction with a large body of actual patient data.60 Such challenges need to be overcome with concerted effort of education and scientific exchange.
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