Nelson Vergel's Blog, page 11

Ethnicity, Smoking and Body Composition Influence Testosterone and Estradiol Levels in Healthy Young Adult Men in Malaysia: A Pilot Study

Background: Variations in sex hormone levels can be caused by differences in ethnicity, smoking habits, and body composition and may be related to racial differences in the prevalence of certain diseases. 
Objectives: This study examined the effects of ethnicity, smoking, and body composition on testosterone and estradiol levels in a group of young Malaysian men. 
Materials and Methods: In this cross-sectional study, 189 Malay and Chinese men aged 20-39 years answered a detailed questionnaire, underwent body anthropometric measurements, and had their blood drawn for hormone assays. 
Results: The results indicated no differences in testosterone levels between races (P>0.05), but estradiol levels were significantly higher among Malay compared with Chinese men (P<0.05). No difference was detected in sex hormone levels between smokers and non-smokers (P>0.05). However, smokers with more than 10 years of cigarette smoke exposure had a significantly higher estradiol level than smokers with 1-5 years of exposure (P<0.05). Testosterone (total, free, and non-SHBG-bound) levels correlated inversely and significantly (P<0.05) with body mass index (BMI), waist-to-hip circumference ratio (WHR), and percentage of body fat. By multiple stepwise regression, body fat percentage was the most influential predictor of testosterone (β=-0.456 for total, β=-0.279 for free, β= -0.297 for non-SHBG-bound fraction) and SHBG levels (β=-0.172). 
Conclusions: Estradiol levels are influenced by ethnicity and duration of smoking, whereas testosterone levels are governed by body fat percentage in Malaysian young adult males.

Ref: http://endometabol.com/?page=article&article_id=3937[image error]

Can Accutane Cause Negative Hormone Effects?

Young people and men on testosterone and/or anabolic steroids sometimes suffer from acne.  Accutane is one of the most commonly prescribed and effective drugs for acne. But there are concerns that it may affect hormones. No one knows how long after drug cessation things normalize, but I have had two men consult with me who saw a significant and permanent drop in blood levels of testosterone after its use.
I take zinc/copper, wash with Nizoral shampoo, get some sun and limit greasy food and that was worked well for me to stop the acne on my back.

These two studies show concerns:

Accutane can affect growth hormone's effect.

Reference:
Short-term isotretinoin (accutane) treatment decreases insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels: does isotretinoin affect growth hormone physiology? - Karadag - 2010 - British Journal of Dermatology - Wiley Online Library Short-term isotretinoin treatment decreases insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels: does isotretinoin affect growth hormone physiology? - Karadag - 2010 - British Journal of Dermatology - Wiley Online Lib

Accutane can also affect pituitary hormones (LH, FSH) which affect testosterone levels:

Reference: Isotretinoin Influences Pituitary Hormone Levels in Acne Patients. Authors: Karadag, Ayse Serap; Ertugrul, Derun Taner; Tutal, Emre; Akin, Kadir Okhan Source: Acta Dermato-Venereologica, Volume 91, Number 1, January 2011 , pp. 31-34(4)

Great video that explains how testosterone is produced

This animation represents a visual interpretation of the production of testosterone and is not indicative of clinical effectiveness. 


Click here for a great video that explains how testosterone is produced and its function

What Should Be the Cut-Off Total Testosterone Blood Level for Men with Diabetes?

Diabetes mellitus is a common chronic disease, affecting 0.5–2% worldwide. The Massachusetts Male Aging Study reported that up to 75% of men with diabetes have a lifetime risk of developing ED. Type 2 diabetes is associated with low total serum testosterone (TT) identified in several cross-sectional studies and systemic analyses. There is a lack of consensus regarding what constitutes the lowest level of testosterone within the boundaries of normality.


This study proposes a cut-off value of 403.5 ng/dl of TT blood levels as an indicator for initiation of testosterone replacement therapy in diabetic men with ED.
What Should Be the Cut-Off Total Testosterone Blood Level for Men with Diabetes?

Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study.

Aging Male. 2012 Mar 23. [Epub ahead of print]Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study.Aversa A, Bruzziches R, Francomano D, Greco EA, Fornari R, Luigi LD, Lenzi A, Migliaccio S.SourceDepartment of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology Section, "Sapienza" University of Rome , Rome , Italy.


Abstract

 We evaluated the effects of long-term testosterone replacement therapy (TRT) on the bone mineral density (BMD) in obese patients with metabolic syndrome (MS) and late-onset hypogonadism (LOH). Sixty men (mean age 57 ± 10) with low serum testosterone (T equal or less than 320 ng/dL) and MS regardless the presence of osteoporosis were enrolled. Forty men received intramuscular T-undecanoate (TU) four times/year for 36 months and 20 age-matched hypogonadal men with MS in whom T treatment was contraindicated were used as controls. Hormonal, biochemical markers, vertebral and femoral BMD by dual-energy x-ray absorptiometry were measured. At baseline, overall patients had mild osteopenia (lumbar BMD= 0.891 ± 0.097 g/cm(2); femoral BMD= 0.847 ± 0.117 g/cm(2)). TU induced a significant improvement of bone mass after 36 months (lumbar BMD = 1.053 ± 0.145 g/cm(2); p < 0.002; femoral BMD = 0.989 ± 0.109; p <0.003 g/cm(2)) with a 5%/year increase and a significant reduction in hs-CRP without changes in body mass index. A direct relationship between serum T and BMD increments at the lumbar (r(2) = 0.66, p < 0.0001) and femoral (r(2) = 0.52, p < 0.0001) sites was demonstrated. Study adherence was 50% without serious side effects. Long-term TRT in middle-aged men with LOH and MS determines a significant increase in both vertebral and femoral BMD related to increased serum T levels, probably independently from estradiol modifications.




Comment from Nelson Vergel (author of  Testosterone: A Man's Guide- available on www.testosteronewisdom.com ) 




 Testosterone undecanoate injections are known as the brand name Nebido around the world. In the United States it will be called Aveed. Aveed is currently under review for approval by the FDA. This ester may stay longer in your system so that less frequent injections may be needed. The injection is usually given once every 10 to 14 weeks, though the frequency will depend on your individual testosterone levels. After your first injection you may be asked to come back for another injection at week six. For use in the United States, the company claims that only five injections a year are needed (compared to 48 injections per year for a 100 mg per week regimen).

 In other countries, a large injection dose of 1000 mg are allowed. The FDA did not allow the manufacturer to use this dose in studies done in this country due to fears of side effects.In an open-label study which enrolled 130 hypogonadal men with blood total testosterone levels below 300 ng/dL at study entry, Aveed was dosed as an intramuscular injection (750 mg) at baseline, at week four, and then every 10 weeks throughout the remainder of the 21-month study. Approximately 70 percent of patients completed all injections and 94 percent of them had total testosterone from 300 to 1,000 nanograms/ml through the entire study.After Nebido was approved in Europe a small number of European patients experienced respiratory symptoms immediately following an intramuscular injection of 1000 mg in a 4 cc injection volume, (versus the 750 mg, 3 cc injection volume used in the United States). The makers of Nebido believe, and the FDA concurs, that the reaction is likely the result of a small amount of the oily solution immediately entering the vascular system from the injection site. This known yet uncommon complication of oil-based depot injections may be related to inappropriate injection technique or site.The problem is characterized by short-term reactions involving an urge to cough or a shortness of breath. In some rare cases the reaction had been classified as serious or the patient had experienced other symptoms such as dizziness, flushing or fainting.

In U.S. clinical trials of Nebido 750 mg (3 cc injection volume), the proposed dose in the U.S., there was a single, mild, non-serious case of oil-based coughing.The U.S. manufacturer, Endo Pharmaceuticals, is gathering data to address concerns about the respiratory symptoms. It is not known how much longer it will take the get this product approved in the United States as of June 2010. And even if it gets approved, it may not be widely available for people to buy through private health insurance if the company decides to price it as high as gels.

Smart Nutrition for Great Hormone Balance

There is so much confusing and contradictory information out there about healthy eating.  I will try to summarize what I have learned as a bodybuilder who wants to stay healthy as I age.  The choices of foods that we can now can have a significant effect not only on our body shape and quality of life, but also  mortality and on how well we age.The components of whole food.
Foods are made up of many different components—some are "micro" or smaller quantity nutrients, like vitamins, and some are "macro" or larger quantity nutrients. The three macro groups that compose the majority of our diets are carbohydrates, proteins, and fats. These three units are the basic materials that fuel our activities and metabolism and maintain body composition. Selecting the best sources and amounts of these three macronutrients may help to minimize metabolic disorders (such as high cholesterol and blood sugar) and prevent loss of lean body mass and accumulation of body fat.)The best carbohydrates.
Carbohydrates provide our body's main source of quick energy. After carbohydrates are digested and after some processing by the liver, they are released into the bloodstream as a sugar called glucose to be delivered to the cells.Throughout the majority of the last million years of our evolution, the human diet consisted of animal carcasses, some seeds, nuts, and fibrous vegetable and fruit carbohydrate sources that are generally nutrient-rich with lots of water, but are not calorie-dense like processed foods of today. The majority of these carbohydrate sources are vegetables, leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends to slow down digestion, a majority of the carbohydrates in these foods are absorbed relatively slowly, inducing less blood sugar (glucose) and insulin spikes than processed sweets that contain no fiber. Some people call these "slow carbs."It was only after the advent of agriculture that human beings were introduced to higher intakes of grains as carbohydrate sources. Higher intakes of grains deliver lots of calories. Additionally, some grains deliver their sugar energy relatively quickly, especially if the grain is milled (which removes the fiber that slows down sugar absorption), as are the grains in breads and pasta. Unless you are very active and exercise enough to metabolize nutrients more rapidly, this quick glucose release into the bloodstream can create a dysfunctional hormonal environment that can ultimately promote obesity, cardiovascular disease, and diabetes. This hormonal shift also has a profound effect on lean body mass and fat metabolism, and possibly immune function. The key hormone involved in this problem is called insulin, produced by an organ called the pancreas.Insulin and insulin resistance.
The hormone insulin is produced by the pancreas to control blood sugar and store it in muscles for later use as glycogen. Insulin's main job in the body is to promote the delivery of sugar energy as glucose to cells. When a small amount of glucose is delivered into the bloodstream, a small amount of insulin is produced by the pancreas to accompany it. When there is a large amount of glucose, the pancreas works to produce a large amount of insulin to facilitate its delivery so that cells can take in as much glucose as possible. Extra glucose that cannot be taken in by the cells circulates in the bloodstream and can be toxic to brain cells, so under normal circumstances, most of it is soon converted into triglycerides (fat) in the liver to be stored for later use. But we have to be careful with high blood levels of triglycerides, since they are what feed fat cells.The correct amount of carbohydrate sources will provide enough sugar to give a healthy amount of glucose to the cells, but not too much at once. Thus, levels of glucose and insulin in the bloodstream are not unusually elevated for any long period of time. The pancreas works, but it is not overworked trying to keep up with an unusual demand for insulin.  However, in the U.S., much of the diet consists not only of large amounts of high-calorie carbohydrate sources, but also of carbohydrates from sweets and sodas, which are very concentrated sources of sugar. The net effect that intake of these calorie-dense carbohydrate foods creates is a bloodstream that is occasionally flooded with large amounts of glucose, a pancreas that is overworked, and large amounts of insulin and triglycerides circulating in the bloodstream. Note that excess insulin causes increased production of cholesterol.Over time, these occasional glucose, triglyceride, and insulin floods can cause a decrease in the sensitivity of the cells' response to insulin, which reduces the cells' ability to take in glucose. Insensitivity to insulin is called insulin resistance, and it is a serious consideration in metabolic problems. Some HIV medications can worsen insulin resistance, so we need to be aware of nutritional considerations that can help. Ways to decrease insulin resistance are to exercise, follow a proper diet, and taking medications that improve insulin response. For instance, several studies have found that people consuming an overall high-quality diet, rich in fiber and adequate in energy and protein, were less likely to gain fat. This is why it is best to select the majority of your carbohydrate intake from fiber-rich, slow-releasing carbohydrate sources that do not contain an excessive amount of calories. And these good carbs should be accompanied by good sources of protein and fats.Combining carbohydrates with protein, fiber, and fat.
Protein, fiber, or fat will slow the absorption into the blood of glucose from carbohydrates, which helps to reduce the rise in blood sugar and insulin spikes. So, mixing carbohydrates with protein, fiber, and good fats is one way to reduce their problematic effect on blood sugar and insulin. Ensure that every meal and snack you consume has a mix of these three macronutrients. But what are the best fats, protein, and high-fiber carbohydrates sources out there?Fats and oils.
There are a number of different kinds of fats. There is motor oil, there is butter, and there are essential fatty acids. The most important oil to keep a Honda running right is not the kind with essential fatty acids (EFAs), but if you want to help your body stay healthy and your immune system operating at its best, you had better consider getting these EFAs on a daily basis. They are called "essential" because your body cannot manufacture them, and must obtain them from an outside source, like food or supplements. These oils are necessary for every critical function in your metabolism, including building lean body mass and fighting infections.The main point is that since we need EFAs and other fats for health, we should be getting them in our diets from fresh, high-quality sources. A proper diet reduces the amount of starchy carbohydrates while maintaining a certain amount of healthy fats so that there is a different macronutrient balance than the old high-carbohydrate, high-protein, low-fat diets contained. This means striving to get fatty acids from several sources, the least of which are the saturated fats in butter or animal fat. Understand that saturated fats are not the demons we have been led to believe. When we realize that we evolved getting a certain amount of saturated fat from foods in the wild, it is only logical that they would have a place in a healthy diet. One recent study showed that dietary saturated fat and mono-unsaturated fat were associated with healthy testosterone production in humans, while EFAs had no effect. So it appears that we need a little saturated fat for optimal hormonal health. However, most people get far too much saturated fat, which promotes insulin resistance and metabolic problems, and not enough EFAs, which are needed for healthy cells and immune function.The other important kind of fat that we should consciously include in our daily diet is mono-unsaturated fat, which we get from foods like olive oil. Recent data have shown that mono-unsaturated fats decrease the risk of certain cancers, and have an anti-inflammatory effect.Fatty acid recommendations.EFAs include the omega-3 and omega-6 fatty acids. Most people get an imbalance of these two by consuming too small an amount of omega-3 fats, which have anti-inflammatory properties, and relatively too large an amount of omega-6 fats, which tend to promote inflammation when out of balance. To get more omega-3s, eat more fish, including salmon, tuna, sardines, anchovies, mackerel, rainbow trout, and herring. Omega-6s are contained in common vegetable oils, like sunflower, safflower, and corn oils. Try to reduce your intake of these.Oils and cooking.
Olive oil is one of the best oils to cook with. For sauteing that exposes oil to high temperatures, you can also cook with high-oleic sunflower oil, avocado, canola, macadamia, or any oil that is high in mono-unsaturated fatty acids.Avoid cooking with oils made from corn and sesame. These oils contain more omega-6 fats, and less mono-unsaturated fats, so they have a higher potential for spoiling and turning to trans-fats, which are bad for the immune system. Try to avoid any intake of these oils when they are not absolutely fresh.Also, choose oils that are minimally processed. Most of the clear oils in supermarkets are stripped of some of their natural components to make them more suitable for sitting on store shelves for long periods of time without spoiling. Do not use these stripped oils. When you do cook, do not overheat the oil so that it smokes, which causes the formation of carcinogens and destroys the beneficial fatty acids.Avoid margarine, hydrogenated fats, or processed oils.
Do your best to avoid processed fats or oils, as they have negative effects on cellular health, overall metabolism, and your immune system. Look out for the words hydrogenated and partially-hydrogenated. These kinds of manipulated fats probably do increase the risk of cancer and heart disease. They also weaken healthy cellular immune metabolism. Lastly, they are also likely to promote high lipid levels and insulin resistance.Protein, food for the immune system.
Dairy protein fractions, such as caseine (contained in milk curd) and whey, are at the top of the list of proteins that optimally feed lean body mass growth. In dairy products, the amino acid balances, insulin-raising potential, and overall growth factor content add up to one thing: milk proteins were created to make mammals grow bigger. While there is a lot of hoopla related to which dairy protein fractions are best, there is more misinformation than reality in this area. Those with lactose intolerance should be careful in their selection of milk-based products. Aged cheeses and yogurt may be more tolerable for those who cannot digest lactose.Egg protein.
Next on the list are egg proteins. The important thing to remember is that whole egg is probably somewhat better than egg white for lean body mass growth and overall health effect, because the yolk is a rich nutrient source, and its protein content complements the protein in the egg white. Together they are a better source of protein.Meat protein.
While real food like meat often seems to take a back seat to protein powders because of a mindset created by slick advertising, professional athletes know the value of real food related to lean body mass growth. If you do not make real food and meat fundamentals in your diet, you will not grow lean body mass tissue as well. Fish, chicken, turkey, and beef are vitally important foods, not only because of their protein content, but because they contain numerous other nutritional components that are important for a healthy metabolism. The message is: eat real food, then supplement food with protein powder drinks if you need them.Lean red meat is a superior source for lean body mass growth and blood-building nutrients. These include creatine, carnitine, phenylalanine, conjugated linoleic acid (CLA), and heme- (blood) iron, the most absorbable form of iron. And meat, in general, is less likely to cause allergic reactions than eggs or dairy proteins, like casein and whey. The only caution about red meat is that the high amount of saturated fat most commercial red meat contains could promote metabolic problems. So be moderate about including it in your diet and choose leaner meats if you do.Important details on meat: cooking kills bacteria in meats. Stewed meat is better for digestion (chicken soup, beef stew). Roasting is okay. Try not to fry or barbecue with charcoal. Charred foods are associated with increased risk of gastrointestinal system cancers. Any cooking of meat or vegetable protein that causes the formation of a hard outer skin renders the protein that becomes the skin to be much less digestible because it cross-links the protein.Vegetarian diets
It is very difficult to gain lean muscle weight on a vegetarian diet. In fact, it is almost impossible for most people, especially when they are fighting infections that burn lean body.If you do choose a vegetarian diet, your best protein sources are beans, seeds and nuts. Digestion of nuts and seeds will be improved by soaking them overnight to reduce the enzymes they contain that inhibit digestion of proteins. If you can eat them without digestive problems, many nuts and seeds are ideal foods because they contain protein, healthy fat, and complex carbohydrates in a very good balance for overall health. They also make a great snack between meals. However, the amino acid balances in these proteins do not appear to be optimum for lean body mass growth for humans.Calcium and vitamin D—two important micronutrients
We know that calcium and vitamin D help to strengthen bone. Many of us chose to take calcium plus vitamin D supplements, but there are also foods that are rich in these nutrients. Calcium-rich foods include milk, cheese, spinach, fortified orange juice (be careful with the sugar, though!), fish, eggs, and beans. Vitamin D-rich foods include milk, most fish, and eggs. However, most of us do not consume the 1000 mg and 2000 IU needed per day for calcium and vitamin D, respectively, and need to take over-the-counter supplements.Miscellaneous nutrition tipsFor your food, shop mostly in the outer part of the grocery store where the fresh produce, meats, and milk products/eggs are. Avoid overly processed canned or packaged foods, except for frozen vegetables. Read the labels and avoid products with many preservatives and additives. Trans-fats and hydrogenated oils, high fructose corn syrup, and high sugar should be on your radar when reading labels.Try to eat several smaller balanced (protein + good carbs + good fats) meals or snacks instead of two to three large ones. Smaller meals/snacks are more easily digestible, keep blood sugar and insulin more constant through the day, and keep you from binge eating late at night.Eat more almonds, walnuts, pecans and pistachios (good cholesterol-lowering fats). Twice a day, snack on such nuts to get your good fats and fiber. If you wish, mix them with some dried fruit. Research has shown that people who eat nuts tend to have lower LDL cholesterol.Avoid junk and fast food. The best way to do this is to have enough food at home and to bring lunch to work. Cook a lot of food on weekends and freeze meals in small containers you can heat up later.Do not sabotage yourself by bringing sweets and junk into your home. Watch your cravings at night, when most people find it the most difficult to avoid overdrinking alcohol or eating ice cream, cookies, and comfort foods.Eat a large breakfast, a moderate lunch, and a small dinner. Skipping breakfast makes you more prone to overcompensate by eating more calories late in the day. Your body has spent several hours without food and is starved for nutrients in the morning. Do not feed it sugar and white flour products at this important time. Eggs, oatmeal (the type that has no added sugar, and you can add whey protein powder to it!), Greek-style yogurt with nuts and fiber supplements, low-fat cottage cheese with fruit, almond butter on multigrain (high-fiber) bread, and fruit are all good choices for breakfast.For lunch have some soup and a glass of water first and wait 10 minutes to trick your body into feeling full faster. Grilled chicken with vegetables, tuna salad over greens and nuts, a Greek salad with sliced steak, and any Mediterranean food choices are good.For dinner, fill yourself with stir-fried (use olive oil!) vegetables and lean meats. Two hours before bed, you can have half an almond butter sandwich or yogurt with fruit. You will not be hungry and desperate with this diet!Eat fruits and vegetables of all colors. Each has a different antioxidant profile. The produce section of the market is basically a fresh vitamin department and a medicine chest. Some foods like garlic, onions, and ginger have genuine therapeutic effects. Eating the widest variety of fresh produce on a daily basis assures you of getting all the ingredients that nature provides that can help keep your body strong enough to handle bacteria and viruses so that you stay healthy.Avoid sodas, sweet drinks, and fruit juices (fruit sounds healthy, but juice contains too much sugar and no fiber to slow down its absorption into the blood).  Consuming sugar daily can affect your metabolism, create insulin resistance, make you fat, and have all kinds of negative health consequences. The suggested pecking order of carbohydrate food sources that support your health without increasing insulin resistance follows. Best are vegetables in their many forms. Next are beans and peas. These deliver more calories than vegetables, but the carbohydrates release much more slowly than grains. Next are whole grains, which are calorie-dense but contain carbohydrates that, in general, release somewhat slowly. At the bottom, and the most likely to promote body fat problems, are carbohydrates from milled grains, like wheat and corn. Whole grains are marginally better than processed grains, but when they are milled into flour the difference is not that great. The very worst carbohydrate sources are sweets, like candies, which can deliver as many as 2,000 calories per pound. Try to eat from the first group of slow-release carbohydrate sources most of the time, and if you are relatively healthy, you can have small amounts of milled wheat products or sweets once in awhile.Drink lots of water. Six to eight glasses a day is a good goal. If you get thirsty, you are already dehydrated!Eat a high-protein, complex carbohydrate-rich meal after workouts. Examples: chicken salad with nuts, cottage cheese or yogurt and nuts/fruit, celery sticks and hummus (chickpea butter), etc.Manage your intake of caffeine (it reduces appetite but can increase anxiety). Do not have any caffeine after 4 p.m., since it can impair your sleep.Minimize hidden sugars like high fructose corn syrup. Read the labels of food you buy. Diet sodas tend to make your brain crave sweets in general, so they are not good substitutes for sugary drinks. Water, water, water!If you do not consume at least 20 grams of fiber a day, add to your intake supplements like Citrucell or Benefiber, purchased in any grocery store. Fiber improves insulin sensitivity, makes you feel full longer, keeps your gut healthy (friendly gut bacteria that produce vitamins love fiber), keeps you regular and reduces diarrhea, and can lower the chances of getting colon cancer.Eating healthy is eating smart, and it does not mean that you should starve yourself. Hopefully, this information has shed some light on healthy food sources and how they can affect health and the bodySo, take charge of your health and take care of your body. It is the only one you have.Healthy Eating Shopping List
1. ProduceSpinach and other green leafy vegetablesBroccoli and cabbageGreen beansAvocadosRaspberries and all berries. You can buy frozen ones and add to whey protein shakesWhole fruits (remember no juices).Sweet potatoes, carrotsHummusBeans and other legumes (you can buy canned or frozen ones)2. Nuts, Grains, OilMix of almonds and other nutsPeanut, almond, and cashew butters without hydrogenated oil   (the   healthy   nut   butters   show   oil   and   butter separated since the lack of hydrogenated oils prevents emulsification)Pumpkin and sunflower seedsWild rice (the darker the rice, the better)Whole grain breads and pastaHigh fiber crackersOatmeal (not the little packets; those are loaded with sugars)Olive oil3. DairyLow fat milk, cheeseYogurt (Greek style, no sugar added)Eggs (free range or Omega 3 enriched if possible)4. MeatLean meatsSalmon, sardines and tunaOccasional glass of red wine per day (optional)5. SupplementsWhey protein (I like the Isopure brand since it does not give me gut problems and it is very light)Vitamin DA multivitamin (Super Nutrition's Super Blend)Fish Oils NELSON VERGEL,  a chemical engineer from Venezuela,  created the Program for Wellness Restoration (PoWeR) and founded the Body Positive Wellness Center in Houston. Nelson has lectured extensively around the country and overseas, and with his research partner, Michael Mooney, co-authored the book Built to Survive. In 2011, he wrote and published Testosterone: A Man's Guide—Practical Tips for Boosting Physical, Mental and Sexual Vitality (available on amazon.com)
Bodybuilding Nutrition

Testosterone Replacement in Men Treated for Prostate Cancer

These two paragraphs were taken from an excellent review on Medscape entitled "Testosterone in Hypogonadal Men Treated for Prostate Cancer: Testosterone Replacement in Men Treated for Prostate Cancer" by D. Landau; T. Tsakok; S. Aylwin and S. Hughes.

http://www.medscape.com/viewarticle/757420_4
Testosterone replacement therapy after radical prostatectomy was the focus of Kaufman and Graydon's study in seven patients with hypogonadism over a maximum follow-up period of 12 years. They reported symptomatic improvement of hypogonadism, with no evidence of cancer recurrence. Agarwal and Oefelein administered TRT to a similar group of 10 patients and also reported that no PSA recurrences were associated with rises in mean serum testosterone from 197 to 591 ng/dl. In a study by Khera et al.,57 men received testosterone for an average of 36 months following radical prostatectomy – no increases in PSA were seen over a mean follow-up of 13 months. Of note is the larger study by Sathyamoorthy et al. in 133 postprostatectomy patients, 21 (16%) of whom had either Gleason score ≥ 8, positive margins or nodes. There were no significant PSA rises associated with increases in mean testosterone levels from 262 to 418 ng/dl over a 1 year follow-up. A prospective study of 22 patients by Nabulsi et al. [reported that one patient (4·5%) experienced biochemical recurrence after TRT postradical prostatectomy.Despite the intuitive concern that residual prostate tissue is more likely to result in residual microscopic disease susceptible to androgen stimulation, some studies evaluating the use of TRT after radiotherapy and brachytherapy have also produced encouraging data. Sarosdy[22]followed 31 men receiving testosterone after brachytherapy with a median 5 year follow-up, finding no incidence of cancer recurrence or progression. Morales et al. [looked at five men post external beam radiotherapy and noted marked symptomatic improvement, with no biochemical recurrence for up to 27 months. Davila et al. analysed PSA response after TRT in a split cohort of 20 patients after either prostatectomy or external beam radiation therapy. There were no biochemical recurrences and no differences between the two groups in PSA levels after testosterone replacement. Finally, Leibowitz et al  reported a retrospective study of a heterogeneously treated population of 96 patients. 60% of participants had not received definitive local therapy and consequently had both malignant and benign prostatic tissue in situ; notably, 11 men in the study group had metastatic disease in remission after ADT. After a mean treatment duration of 15 months, 41 men (43%) had PSA progression. This high rate of PSA progression can in part be explained by the relatively high proportion of patients with aggressive disease (25% had Gleason score ≥ 8). However, it is also possible that stimulation of residual benign prostatic tissue contributed to the raised PSA levels, which in most cases returned to baseline following cessation of testosterone replacement. Elevated baseline PSA before testosterone replacement was associated with a significantly increased risk of PSA progression, serving as a reminder that this therapy should be restricted to patients in overt biochemical remission.We have summarized a small number of mostly retrospective case series evaluating the safety of initiating TRT in postprostatectomy patients with negative margins and undetectable PSA levels. Overall, 42 of 381 (11%, range 0–43%) experienced biochemical recurrence, whilst the majority benefited from symptomatic improvement in their hypogonadism without adverse effects on PSA or tumour progression. It is likely that research in this field suffers from publication bias as well as the modest quality of most studies. Nevertheless, the data presented here are largely at odds with the longstanding taboo regarding the use of androgens in men with prostate cancer and again raises the question: is it of clinical consequence if a normal serum testosterone level is achieved in a prostate cancer survivor by natural or pharmacological means? Until more studies have been published on this subject, we should take a cautious and conservative approach.

The Science of Healthy Eating

By Nelson Vergelwww.TestosteroneWisdom.com
There is so much confusing andcontradictory information out there about healthy eating.  I will try to summarize what I have learnedas a bodybuilder who wants to stay healthy as I age.  The choices of foods that we can now can havea significant effect not only on our body shape and quality of life, butalso  mortality and on how well we age.
The components of whole food.
Foods are made up of many different components—some are "micro" or smallerquantity nutrients, like vitamins, and some are "macro" or larger quantitynutrients. The three macro groups that compose the majority of our diets arecarbohydrates, proteins, and fats. These three units are the basic materialsthat fuel our activities and metabolism and maintain body composition.Selecting the best sources and amounts of these three macronutrients may helpto minimize metabolic disorders (such as high cholesterol and blood sugar) andprevent loss of lean body mass and accumulation of body fat.
The best carbohydrates.
Carbohydrates provide our body's main source of quick energy. Aftercarbohydrates are digested and after some processing by the liver, they arereleased into the bloodstream as a sugar called glucose to be delivered to thecells.
Throughout the majority of the last million years of ourevolution, the human diet consisted of animal carcasses, some seeds, nuts, andfibrous vegetable and fruit carbohydrate sources that are generallynutrient-rich with lots of water, but are not calorie-dense like processedfoods of today. The majority of these carbohydrate sources are vegetables,leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends toslow down digestion, a majority of the carbohydrates in these foods areabsorbed relatively slowly, inducing less blood sugar (glucose) and insulinspikes than processed sweets that contain no fiber. Some people call these"slow carbs."
It was only after the advent of agriculture that human beings wereintroduced to higher intakes of grains as carbohydrate sources. Higher intakesof grains deliver lots of calories. Additionally, some grains deliver theirsugar energy relatively quickly, especially if the grain is milled (whichremoves the fiber that slows down sugar absorption), as are the grains inbreads and pasta. Unless you are very active and exercise enough to metabolizenutrients more rapidly, this quick glucose release into the bloodstream cancreate a dysfunctional hormonal environment that can ultimately promoteobesity, cardiovascular disease, and diabetes. This hormonal shift also has aprofound effect on lean body mass and fat metabolism, and possibly immunefunction. The key hormone involved in this problem is called insulin, producedby an organ called the pancreas.
Insulin and insulin resistance.
The hormone insulin is produced by the pancreas to control blood sugar andstore it in muscles for later use as glycogen. Insulin's main job in the bodyis to promote the delivery of sugar energy as glucose to cells. When a smallamount of glucose is delivered into the bloodstream, a small amount of insulinis produced by the pancreas to accompany it. When there is a large amount ofglucose, the pancreas works to produce a large amount of insulin to facilitateits delivery so that cells can take in as much glucose as possible. Extraglucose that cannot be taken in by the cells circulates in the bloodstream andcan be toxic to brain cells, so under normal circumstances, most of it is soonconverted into triglycerides (fat) in the liver to be stored for later use. Butwe have to be careful with high blood levels of triglycerides, since they arewhat feed fat cells.
The correct amount of carbohydrate sources will provide enoughsugar to give a healthy amount of glucose to the cells, but not too much atonce. Thus, levels of glucose and insulin in the bloodstream are not unusuallyelevated for any long period of time. The pancreas works, but it is notoverworked trying to keep up with an unusual demand for insulin.  However, in the U.S., muchof the diet consists not only of large amounts of high-calorie carbohydratesources, but also of carbohydrates from sweets and sodas, which are veryconcentrated sources of sugar. The net effect that intake of thesecalorie-dense carbohydrate foods creates is a bloodstream that is occasionallyflooded with large amounts of glucose, a pancreas that is overworked, and largeamounts of insulin and triglycerides circulating in the bloodstream. Note thatexcess insulin causes increased production of cholesterol.
Over time, these occasional glucose, triglyceride, and insulinfloods can cause a decrease in the sensitivity of the cells' response toinsulin, which reduces the cells' ability to take in glucose. Insensitivity toinsulin is called insulin resistance, and it is a serious consideration in metabolicproblems. Some HIV medications can worsen insulin resistance, so we need to beaware of nutritional considerations that can help. Ways to decrease insulinresistance are to exercise, follow a proper diet, and taking medications thatimprove insulin response. For instance, several studies have found that peopleconsuming an overall high-quality diet, rich in fiber and adequate in energyand protein, were less likely to gain fat. This is why it is best to select themajority of your carbohydrate intake from fiber-rich, slow-releasingcarbohydrate sources that do not contain an excessive amount of calories. Andthese good carbs should be accompanied by good sources of protein and fats.
Combining carbohydrates with protein, fiber, and fat.Protein, fiber, or fat will slow the absorption into the blood of glucose fromcarbohydrates, which helps to reduce the rise in blood sugar and insulinspikes. So, mixing carbohydrates with protein, fiber, and good fats is one wayto reduce their problematic effect on blood sugar and insulin. Ensure thatevery meal and snack you consume has a mix of these three macronutrients. Butwhat are the best fats, protein, and high-fiber carbohydrates sources outthere?
Fats and oils.
There are a number of different kinds of fats. There is motor oil, there isbutter, and there are essential fatty acids. The most important oil to keep aHonda running right is not the kind with essential fatty acids (EFAs), but ifyou want to help your body stay healthy and your immune system operating at itsbest, you had better consider getting these EFAs on a daily basis. They arecalled "essential" because your body cannot manufacture them, and must obtainthem from an outside source, like food or supplements. These oils are necessaryfor every critical function in your metabolism, including building lean bodymass and fighting infections.
The main point is that since we need EFAs and other fats forhealth, we should be getting them in our diets from fresh, high-qualitysources. A proper diet reduces the amount of starchy carbohydrates whilemaintaining a certain amount of healthy fats so that there is a differentmacronutrient balance than the old high-carbohydrate, high-protein, low-fatdiets contained. This means striving to get fatty acids from several sources,the least of which are the saturated fats in butter or animal fat. Understandthat saturated fats are not the demons we have been led to believe. When werealize that we evolved getting a certain amount of saturated fat from foods inthe wild, it is only logical that they would have a place in a healthy diet.One recent study showed that dietary saturated fat and mono-unsaturated fatwere associated with healthy testosterone production in humans, while EFAs hadno effect. So it appears that we need a little saturated fat for optimalhormonal health. However, most people get far too much saturated fat, whichpromotes insulin resistance and metabolic problems, and not enough EFAs, whichare needed for healthy cells and immune function.
The other important kind of fat that we should consciously includein our daily diet is mono-unsaturated fat, which we get from foods like oliveoil. Recent data have shown that mono-unsaturated fats decrease the risk ofcertain cancers, and have an anti-inflammatory effect.
Fatty acid recommendations.
EFAs include the omega-3 and omega-6 fatty acids. Most people get an imbalanceof these two by consuming too small an amount of omega-3 fats, which haveanti-inflammatory properties, and relatively too large an amount of omega-6fats, which tend to promote inflammation when out of balance. To get moreomega-3s, eat more fish, including salmon, tuna, sardines, anchovies, mackerel,rainbow trout, and herring. Omega-6s are contained in common vegetable oils,like sunflower, safflower, and corn oils. Try to reduce your intake of these.
Oils and cooking.
Olive oil is one of the best oils to cook with. You can also cook withhigh-oleic sunflower oil, avocado, canola, macadamia, or any oil that is highin mono-unsaturated fatty acids.
Avoid cooking with oils made from corn and sesame. These oilscontain more omega-6 fats, and less mono-unsaturated fats, so they have ahigher potential for spoiling and turning to trans-fats, which are bad for theimmune system. Try to avoid any intake of these oils when they are notabsolutely fresh.
Also, choose oils that are minimally processed. Most of the clearoils in supermarkets are stripped of some of their natural components to makethem more suitable for sitting on store shelves for long periods of timewithout spoiling. Do not use these stripped oils. When you do cook, do notoverheat the oil so that it smokes, which causes the formation of carcinogensand destroys the beneficial fatty acids.
Avoid margarine, hydrogenated fats, or processed oils.
Do your best to avoid processed fats or oils, as they have negative effects oncellular health, overall metabolism, and your immune system. Look out for thewords hydrogenated and partially-hydrogenated. These kinds of manipulated fatsprobably do increase the risk of cancer and heart disease. They also weakenhealthy cellular immune metabolism. Lastly, they are also likely to promotehigh lipid levels and insulin resistance.
Protein, food for the immune system.
Dairy protein fractions, such as caseine (contained in milk curd) and whey, areat the top of the list of proteins that optimally feed lean body mass growth.In dairy products, the amino acid balances, insulin-raising potential, andoverall growth factor content add up to one thing: milk proteins were createdto make mammals grow bigger. While there is a lot of hoopla related to whichdairy protein fractions are best, there is more misinformation than reality inthis area. Those with lactose intolerance should be careful in their selectionof milk-based products. Aged cheeses and yogurt may be more tolerable for thosewho cannot digest lactose.
Egg protein.
Next on the list are egg proteins. The important thing to remember is thatwhole egg is probably somewhat better than egg white for lean body mass growthand overall health effect, because the yolk is a rich nutrient source, and itsprotein content complements the protein in the egg white. Together they are abetter source of protein.
Meat protein.
While real food like meat often seems to take a back seat to protein powdersbecause of a mindset created by slick advertising, professional athletes knowthe value of real food related to lean body mass growth. If you do not makereal food and meat fundamentals in your diet, you will not grow lean body masstissue as well. Fish, chicken, turkey, and beef are vitally important foods,not only because of their protein content, but because they contain numerousother nutritional components that are important for a healthy metabolism. Themessage is: eat real food, then supplement food with protein powder drinks ifyou need them.Lean red meat is a superior source for lean body mass growth andblood-building nutrients. These include creatine, carnitine, phenylalanine,conjugated linoleic acid (CLA), and heme- (blood) iron, the most absorbableform of iron. And meat, in general, is less likely to cause allergic reactionsthan eggs or dairy proteins, like casein and whey. The only caution about redmeat is that the high amount of saturated fat most commercial red meat containscould promote metabolic problems. So be moderate about including it in yourdiet and choose leaner meats if you do.
Important details on meat: cooking kills bacteria in meats. Stewedmeat is better for digestion (chicken soup, beef stew). Roasting is okay. Trynot to fry or barbecue with charcoal. Charred foods are associated withincreased risk of gastrointestinal system cancers. Any cooking of meat orvegetable protein that causes the formation of a hard outer skin renders the proteinthat becomes the skin to be much less digestible because it cross-links theprotein.
Vegetarian diets
It is very difficult to gain lean muscle weight on a vegetarian diet. In fact,it is almost impossible for most people, especially when they are fightinginfections that burn lean body.  
If you do choose a vegetarian diet, your best protein sources arebeans, seeds and nuts. Digestion of nuts and seeds will be improved by soakingthem overnight to reduce the enzymes they contain that inhibit digestion ofproteins. If you can eat them without digestive problems, many nuts and seedsare ideal foods because they contain protein, healthy fat, and complexcarbohydrates in a very good balance for overall health. They also make a greatsnack between meals. However, the amino acid balances in these proteins do notappear to be optimum for lean body mass growth for humans. 
Calcium and vitamin D—two important micronutrients
We know that calcium and vitamin D help to strengthen bone. Many of us chose totake calcium plus vitamin D supplements, but there are also foods that are richin these nutrients. Calcium-rich foods include milk, cheese, spinach, fortifiedorange juice (be careful with the sugar, though!), fish, eggs, and beans.Vitamin D-rich foods include milk, most fish, and eggs. However, most of us donot consume the 1000 mg and 2000 IU needed per day for calcium and vitamin D,respectively, and need to take over-the-counter supplements.
Miscellaneous nutrition tips·        For your food, shopmostly in the outer part of the grocery store where the fresh produce, meats,and milk products/eggs are. Avoid overly processed canned or packaged foods,except for frozen vegetables. Read the labels and avoid products with manypreservatives and additives. Trans-fats and hydrogenated oils, high fructosecorn syrup, and high sugar should be on your radar when reading labels. ·        Try to eat several smallerbalanced (protein + good carbs + good fats) meals or snacks instead of two tothree large ones. Smaller meals/snacks are more easily digestible, keep bloodsugar and insulin more constant through the day, and keep you from binge eatinglate at night.·        Eat more almonds,walnuts, pecans and pistachios (good cholesterol-lowering fats). Twice a day,snack on such nuts to get your good fats and fiber. If you wish, mix them withsome dried fruit. Research has shown that people who eat nuts tend to have lowerLDL cholesterol.·        Avoid junk and fastfood. The best way to do this is to have enough food at home and to bring lunchto work. Cook a lot of food on weekends and freeze meals in small containersyou can heat up later.·        Do not sabotage yourselfby bringing sweets and junk into your home. Watch your cravings at night, whenmost people find it the most difficult to avoid overdrinking alcohol or eatingice cream, cookies, and comfort foods.·        Eat a large breakfast, amoderate lunch, and a small dinner. Skipping breakfast makes you more prone toovercompensate by eating more calories late in the day. Your body has spentseveral hours without food and is starved for nutrients in the morning. Do notfeed it sugar and white flour products at this important time. Eggs, oatmeal(the type that has no added sugar, and you can add whey protein powder to it!),Greek-style yogurt with nuts and fiber supplements, low-fat cottage cheese withfruit, almond butter on multigrain (high-fiber) bread, and fruit are all goodchoices for breakfast.·        For lunch have some soupand a glass of water first and wait 10 minutes to trick your body into feelingfull faster. Grilled chicken with vegetables, tuna salad over greens and nuts,a Greek salad with sliced steak, and any Mediterranean food choices are good.·        For dinner, fillyourself with stir-fried (use olive oil!) vegetables and lean meats. Two hoursbefore bed, you can have half an almond butter sandwich or yogurt with fruit.You will not be hungry and desperate with this diet!·        Eat fruits andvegetables of all colors. Each has a different antioxidant profile. The producesection of the market is basically a fresh vitamin department and a medicinechest. Some foods like garlic, onions, and ginger have genuine therapeuticeffects. Eating the widest variety of fresh produce on a daily basis assuresyou of getting all the ingredients that nature provides that can help keep yourbody strong enough to handle bacteria and viruses so that you stay healthy.·        Avoid sodas, sweetdrinks, and fruit juices (fruit sounds healthy, but juice contains too muchsugar and no fiber to slow down its absorption into the blood).  Consuming sugar daily canaffect your metabolism, create insulin resistance, make you fat, and have allkinds of negative health consequences. The suggested pecking order ofcarbohydrate food sources that support your health without increasing insulinresistance follows. Best are vegetables in their many forms. Next are beans andpeas. These deliver more calories than vegetables, but the carbohydratesrelease much more slowly than grains. Next are whole grains, which arecalorie-dense but contain carbohydrates that, in general, release somewhatslowly. At the bottom, and the most likely to promote body fat problems, arecarbohydrates from milled grains, like wheat and corn. Whole grains aremarginally better than processed grains, but when they are milled into flourthe difference is not that great. The very worst carbohydrate sources aresweets, like candies, which can deliver as many as 2,000 calories per pound.Try to eat from the first group of slow-release carbohydrate sources most ofthe time, and if you are relatively healthy, you can have small amounts ofmilled wheat products or sweets once in awhile.·        Drink lots of water. Sixto eight glasses a day is a good goal. If you get thirsty, you are alreadydehydrated!·        Eat a high-protein,complex carbohydrate-rich meal after workouts. Examples: chicken salad withnuts, cottage cheese or yogurt and nuts/fruit, celery sticks and hummus(chickpea butter), etc.·        Manage your intake ofcaffeine (it reduces appetite but can increase anxiety). Do not have anycaffeine after 4 p.m., since it can impair your sleep.·        Minimize hidden sugarslike high fructose corn syrup. Read the labels of food you buy. Diet sodas tendto make your brain crave sweets in general, so they are not good substitutesfor sugary drinks. Water, water, water!·        If you do not consume atleast 20 grams of fiber a day, add to your intake supplements like Citrucell orBenefiber, purchased in any grocery store. Fiber improves insulin sensitivity,makes you feel full longer, keeps your gut healthy (friendly gut bacteria thatproduce vitamins love fiber), keeps you regular and reduces diarrhea,and can lower the chances of getting colon cancer. ·        Eating healthy is eatingsmart, and it does not mean that you should starve yourself. Hopefully, thisinformation has shed some light on healthy food sources and how they can affecthealth and the bodySo, take charge of your health and take care of your body.It is the only one you have.
HealthyEating Shopping List
1.Produce·        Spinach and other green leafyvegetables·        Broccoli and cabbage·        Green beans·        Avocados·        Raspberries and all berries. You canbuy frozen ones and add to whey protein shakes·        Whole fruits (remember no juices).·        Sweet potatoes, carrots·        Hummus·        Beans and other legumes (you can buycanned or frozen ones)2.Nuts, Grains, Oil·        Mix of almonds and other nuts·        Peanut, almond, and cashew butterswithout hydrogenated oil   (the   healthy  nut   butters   show   oil  and   butter separated since the lack of hydrogenated oils preventsemulsification)·        Pumpkin and sunflower seeds·        Wild rice (the darker the rice, thebetter)·        Whole grain breads and pasta·        High fiber crackers ·        Oatmeal (not the little packets; thoseare loaded with sugars)·        Olive oil3.Dairy·        Low fat milk, cheese·        Yogurt (Greek style, no sugar added)·        Eggs (free range or Omega 3 enrichedif possible)4.Meat·        Lean meats·        Salmon, sardines and tuna·        Occasional glass of red wine per day(optional)5.Supplements·        Whey protein (I like the Isopurebrand since it does not give me gut problems and it is very light)·        Vitamin D·        A multivitamin (Super Nutrition'sSuper Blend)·        Fish Oils NELSON VERGEL,  achemical engineer from Venezuela, created the Program for Wellness Restoration (PoWeR) andfounded the Body Positive Wellness Center in Houston. Nelson haslectured extensively around the country and overseas, and with his researchpartner, Michael Mooney, co-authored the book Built to Survive. In 2011,he wrote and published Testosterone: A Man's Guide—Practical Tips for BoostingPhysical, Mental and Sexual Vitality (available on amazon.com)

BOOK AND FILM REVIEWS Published: February 2012. Testosterone: A man's guide: practical tips for boosting physical, mental and sexual vitality; by Nelson Vergel

BOOK AND FILM REVIEWSPublished: February 2012.Testosterone: A man's guide: practical tips for boosting physical, mental and sexual vitality; by Nelson VergelSimon Collins, HIV i-BaseThis is the second edition of a book by the US activist Nelson Vergel. It is a users guide to testosterone by an HIV positive man who has researched the subject over many years for his own care.The non-technical sections include helpful tips about what not to do as well as the best approaches. This looks at how to assess potential testosterone deficiency, including what to measure (free vs total), when and how, and the impact of age on target ranges including fluctuation in levels throughout the day. The information is in the context of supplementary approaches being dependent on working with your doctor, not only to ensure that an appropriate dose and formulation are used (oral supplementation being the least useful), but that routine monitoring guides the safety of this approach.Replacement therapy is discussed, usually recognising this as a lifelong treatment, as testosterone supplementation reduces the need and ability for the body to continue it own production. The risks from interrupting treatment and a period of testosterone depletion until the body adjusts include depression, weight loss, lack of motivation and reduced sex drive – often the symptoms that suggested treatment in the first place.The guide also discusses side effects from testosterone and how to manage these, including the experimental use of Human Chorionic Gonadotropin (HCG) to maintain normal testicular function and reverse shrinkage. It discusses alternative treatment for low sex drive and erectile dysfunction including a review of data (or lack of it) for non-approved products. It also includes the importance of lifestyle modifications including diet and exercise, the importance of adherence and on finding a doctor that will monitor and prescribe treatment.This is a users guide, written by an activist who has used many of the available approaches for over 16 years and he shares his experiences of different approaches. But the author professionally trained as a chemical engineer, and this informs his discussion on the chemistry behind a daunting range of formulations (including injections, topical creams, patches, implants, underarm products and sublingual and buccal preparations).Although titled 'a man's guide' the book includes information on testosterone use in women, including links for further reading, though for future editions this might be helpful if this was collated and compiled in a separate chapter.Nelson is also co-author of Built to Survive, a similar guide to using anabolic steroids, nutrition and exercise to develop and maintain muscle mass for HIV positive men.Nelson Vergel – Testosterone: a man's guide: practical tips for boosting physical, mental and sexual vitality; 2nd edition, 2011.IBSN: 978-0-9837739-1-7. £12.00, paperback; £6.41 Kindle.

BOOK REVIEW: Testosterone: A man's guide

Testosterone: A man's guide: practical tips for boosting physical, mental and sexual vitality; by Nelson VergelSimon Collins, HIV i-BaseThis is the second edition of a book by the US activist Nelson Vergel. It is a users guide to testosterone by an HIV positive man who has researched the subject over many years for his own care.The non-technical sections include helpful tips about what not to do as well as the best approaches. This looks at how to assess potential testosterone deficiency, including what to measure (free vs total), when and how, and the impact of age on target ranges including fluctuation in levels throughout the day. The information is in the context of supplementary approaches being dependent on working with your doctor, not only to ensure that an appropriate dose and formulation are used (oral supplementation being the least useful), but that routine monitoring guides the safety of this approach.Replacement therapy is discussed, usually recognising this as a lifelong treatment, as testosterone supplementation reduces the need and ability for the body to continue it own production. The risks from interrupting treatment and a period of testosterone depletion until the body adjusts include depression, weight loss, lack of motivation and reduced sex drive – often the symptoms that suggested treatment in the first place.The guide also discusses side effects from testosterone and how to manage these, including the experimental use of Human Chorionic Gonadotropin (HCG) to maintain normal testicular function and reverse shrinkage. It discusses alternative treatment for low sex drive and erectile dysfunction including a review of data (or lack of it) for non-approved products. It also includes the importance of lifestyle modifications including diet and exercise, the importance of adherence and on finding a doctor that will monitor and prescribe treatment.This is a users guide, written by an activist who has used many of the available approaches for over 16 years and he shares his experiences of different approaches. But the author professionally trained as a chemical engineer, and this informs his discussion on the chemistry behind a daunting range of formulations (including injections, topical creams, patches, implants, underarm products and sublingual and buccal preparations).Although titled 'a man's guide' the book includes information on testosterone use in women, including links for further reading, though for future editions this might be helpful if this was collated and compiled in a separate chapter.Nelson is also co-author of Built to Survive, a similar guide to using anabolic steroids, nutrition and exercise to develop and maintain muscle mass for HIV positive men.Nelson Vergel – Testosterone: a man's guide: practical tips for boosting physical, mental and sexual vitality; 2nd edition, 2011.