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Identical twins go on vegan and meat-based diets for 12 weeks to see what’s ‘healthiest’- here’s what they found – Times Now

Posted: December 6, 2021 at 1:52 am

Credit: Instagam/@theturnertwiins 

The debate over whether a meat-based or vegan diet is healthy or not has been going on for years and is likely to linger on for decades.

The discourse has now evolved to on-ground and social media campaigns as each group tries to boast the benefits of their eating in innovative and sometimes scientific ways.

As the opinions, observations, and recommendations about vegan and meat-based food are highly subjective, it's not possible to come to one conclusion.

But now, a set of identical twins have come up with a more pragmatic approach in deciding what is best or 'healthieast'.

Hugo and Ross Turner participated in a study that involved one of them going on a plant-based diet while the other ate meat.

Hugo stopped eating meat and dairy for 12 weeks and Ross decided to stick to a diet that had meat, fish, and dairy.

The experiment, which was actually part of a study by Kings College London, saw the two consume the same amount of calories each day and carry out the same gym exercises.

I was on the vegan diet and it really does take a hit on your body," Hugo told BBC, admitting the switch to a plant-based diet wasn't easy.

He said he was eating a lot more fruits and nuts than he used to. This meant his sugar levels were satiated during the day and he had more energy. On the other hand, his meat-eating twin brother said he felt 'very energetic' on some days and low on other days. In other words, his energy levels werent consistent.

But Hugo's energy levels were pretty much the same throughout his diet.

Another notable difference was the change in their gut bacteria. Hugo said the diversity of his gut bacteria dropped but his brother's remained the same.

By the end of 12-weeks, Hugo saw drops in his total body weight and cholesterol level. But the two said there wasn't 'a huge difference if any'. Hugo dropped from 185 pounds to 181. His brother gained fat and his weight increased to 189 pounds.

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Identical twins go on vegan and meat-based diets for 12 weeks to see what's 'healthiest'- here's what they found - Times Now

How to live longer: The most ‘powerful’ way to protect yourself against ageing – Daily Express

Posted: December 6, 2021 at 1:52 am

A new study is underway examining the examining how diet can emulate the impact of medications on treating common chronic conditions. Senior author Professor Stephen Simpson said that we can reduce our dependency on medication by better controlling our diets. He said: Diet is a powerful medicine. However, presently drugs are administered without consideration of whether and how they might interact with our diet composition even when these drugs are designed to act in the same way. The study found that dietary composition had a stronger effect on these pathways than drugs.

The study found that these drugs could interfere with the positive impact of diet.

Both rapamycin and metformin reduced the cellular response to protein, while resveratrol dulled the effect of carbohydrates and fat.

Future research will be needed to see how much of this research will carry over to humans, although many of the pathways are unaltered.

The study focused largely on the interaction of the different nutrients at the cellular level, rather than constructing a diet that can be translated into human portions.

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Lead author Professor David Le Couteur believes the research can further out understand of what causes aging at the cellular level.

He said: We all know what we eat influences our health, but this study showed how food can dramatically influence many of the processes operating in our cells.

This gives us insights into how diet impacts health and ageing.

The research was published in Cell Metabolism, laying out findings about how diet and the different drugs influenced the liver.

Other lifestyle changes that can combat the effects of aging include mental and physical exercise.

Some behaviours can worsen the effects of aging.

These include drinking, lack of sleep, smoking and stress.

One study conducted by Yale also found that people with a positive perception of aging lived seven years longer.

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How to live longer: The most 'powerful' way to protect yourself against ageing - Daily Express

Unable to Fall Asleep at Night? Start Including Vitamins in Your Diet – India.com

Posted: December 6, 2021 at 1:52 am

Not being able to fall asleep at night is one of the most common issues. Insomnia can occur due to stress at the workplace and various other factors as well. However, insomnia can take place due to nutritional deficiency. It is important that you consume a well-balanced meal that also includes portions of vitamins, minerals, protein, carbs, and everything.Also Read - Skincare: 5 Vitamin Deficiency Signs That Should Not Go Unnoticed

A well-balanced diet keeps body weight intact, provides longevity, and keeps chronic diseases like heart disease, diabetes, and metabolic disorders at bay. However, vitamin deficiency can also be the reason for sleeplessness. Heres the list of vitamin deficiencies: Also Read - 5 Food That Can Help You Sleep Better and Avoid Insomnia

Vitamin C can be found in citrus fruits. It is a powerhouse of antioxidants known for removing inflammation, strengthening the immune system, bone, and teeth. By including oranges, berries, peppers, broccoli, lemon, you can improve your sleep cycle. Also Read - Sleep Deprivation: How Lack of Sleep Affects Your Health?

When the body does not receive enough vitamin B6, the body tends to stop producing sleep-inducing cells and thus, leading to insomnia. Therefore, to fall asleep peacefully, include bananas, peanuts, oats, pork, chicken, fish, and turkey.

Vitamin E helps in preventing sleep deprivation that often leads to memory loss and cognitive decline in the long run. You should include vitamin E food like almonds, sunflower oil and seeds, pumpkin, spinach, and red bell peppers.

Vitamin D helps in regulating mood and prevents inflammation. As per a study, vitamin D can lead to inducing sleep-regulating cells. You can include food like mushrooms, salmon, sardines, egg yolk, and other fortified foods.

The inability to fall asleep leads to insomnia. This also leads to feeling restlessness and irritability. Heres how sleeplessness can affect your overall health:

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Unable to Fall Asleep at Night? Start Including Vitamins in Your Diet - India.com

This Diet Can Increase Your Risk of Gastrointestinal Cancers, Says Science Eat This Not That – Eat This, Not That

Posted: December 6, 2021 at 1:52 am

You're probably already thinking about how your dietary choices affect your heart health and your blood pressure, but the impacts of the foods you eat on your overall health extend further than you may know. Your diet can impact your sleep schedule, your brain health, and even your sex drive. Now, new research finds that eating a diet high in fat and sugar over a long period of time can leave you at risk of developing gastrointestinal cancer.

In the study, published in the journal Nature Metabolism, researchers looked at 27,000 intestinal cells from mice, some of which were fed a high-fat, high-sugar diet meant to imitate the western diet, and others of which were fed a control diet. Using machine learning technology, researchers found that the stem cells in the intestines of the mice fed the high-fat, high-sugar diet divided more quickly, noting that this fast division can promote gastrointestinal (GI) cancer's development and growth. In short, the mice ate a typical western-style diet, the stem cells in their guts divided more quickly, which could put them in increased danger for certain cancers.

Related: Eating Habits to Avoid if You Want a Healthy Gut, Say Dietitians

For context, GI cancer, according to Yale Medicine, is a term that encompasses multiple cancers in the GI tract, including esophageal cancer, stomach cancer, colorectal cancer, pancreatic cancer, and liver cancer, among others. While this study was conducted on mice, its results offer the hope that changing your diet might help fight off these dangerous conditions.

Plus, cancers are not the only risk to your gastrointestinal health, and switching from a high-fat, high-sugar diet to a more gut-friendly one can help you protect this vital system, lowering your risk for a range of other symptoms and diseases.

"When we eat, we're not just feeding ourselveswe're feeding the trillions of microbes living inside of our guts, known as the gut microbiota," Colleen D. Webb, MS, RDN, a nutritionist specializing in gastrointestinal health, told Eat This, Not That! In an interview. "This 'forgotten organ' strongly influences GI health and plays a key role in disease development and progression, with its effects extending well beyond the gut. The best diets for a healthy gut microbiota are ones that are full of whole or minimally processed plants, including fruits, vegetables, whole grains, legumes, nuts, and seeds."

For more on eating your way to a healthy gut, consider getting familiar with these Popular Foods That Improve Your Gut Health, Says Science.

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This Diet Can Increase Your Risk of Gastrointestinal Cancers, Says Science Eat This Not That - Eat This, Not That

Are you a mushroom lover? 5 varieties that you must add to your diet – Times Now

Posted: December 6, 2021 at 1:52 am

5 mushroom varieties that you must add to your diet  |  Photo Credit: iStock Images

New Delhi:Mushrooms are popularly consumed foods that are neither fruit nor vegetable. These are a type of fungus that currently has over 10000 known varieties. Due to their fleshy texture and chewy consistency, mushrooms are also a popular meat substitute for vegetarians and vegans,

Mushrooms are rich in fibre, antioxidants, vitamin D, B vitamins, copper, phosphorous, potassium, and selenium. These bell-shaped foods are low in calories and come with various health benefits. From heart health to cognitive function, the consumption of mushrooms can help enhance health significantly. Furthermore, the presence of polysaccharides inculcates prebiotic properties in mushrooms making them good for gut health.

Here are some varieties of mushrooms that can be found in India:

Button mushrooms: This is the most commonly found variety of mushroom and also go by the names table mushroom, white mushroom, etc. Its botanical name is Agaricus bisporus. Some common health benefits of button mushrooms include improved cognitive health, improved heart health, and more. Button mushrooms are small with short stems and a smooth cap.

Shiitake mushrooms: With caps resembling an umbrella, Shiitake mushrooms are brown with short stems and are popularly consumed in parts of East Asia. Its botanical name is Lentinula edodes. These varieties have a cholesterol-lowering compound known as eritadenine. Apart from having anti-inflammatory properties, shiitake mushrooms can also boost immunity.

Maitake mushrooms: This variety is also known as the dancing mushroom or hen of the woods and the cluster of its caps resembles a flower. Its botanical name is Grifola frondosa. Maitake mushrooms are healthy due to their low calorie, fat, and cholesterol content.

Enoki mushrooms: Only a few mushroom varieties are safe to be eaten raw and enoki mushrooms are one of them. Enoki mushrooms are also known as velvet shank and have a small cap with a long, thin stem.Its botanical name is Flammulina velutipes. This delicious variety can be eaten cooked or raw and can help boost immunity, enhance heart and brain health.

Oyster mushrooms: Also known as hiratake mushrooms, these edible fungi have very short or no stem and caps shaped like an oyster. Its botanical name is Pleurotus ostreatus. The most common variety of oyster mushrooms is the pearl oyster and some other varieties may include golden oyster, pink oyster, and phoenix oyster. This variety can help regulate blood sugar levels, boost immunity, and improve gut health.

Disclaimer: Tips and suggestions mentioned in the article are for general information purpose only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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Are you a mushroom lover? 5 varieties that you must add to your diet - Times Now

Creating a low-carb diet of local and imported energy – Valley Courier

Posted: December 6, 2021 at 1:52 am

The phrase locavore has been around for almost two decades. It was invented to describe someone who eats locally originated food.

Some years ago, at Telluride Mountainfilm, those providing lunch proudly proclaimed all the ingredients had been sourced from within 100 miles. The spring salad was excellent, but the menu was shy of citrus and sparing of coffee and tea.

Now, in energy, we have a similar movement, a new emphasis and pride on locally originated renewable energy. But, like locally grown food in the San Juans, its hard to grow all of your own energy.

Consider Holy Cross Energy, which is seeking to blaze a trail toward 100% renewables by the decades end. How will they achieve this? Its as ambitious a goal as I know of in Colorado or beyond, devoid caveats or asterisks.

The portfolio being created by Holy Cross is a mix of local, mostly solar, and imports, mostly wind. Aside from a few blustery days, mountain valleys are not windy. For that, Holy Cross will secure electricity from turbines 120 miles southeast of Denver, near a town along Interstate 70 called Arriba.

Mountain valleys, though, do have strong solar. There, you see Holy Cross plunging ahead. A milestone will be celebrated on Dec. 8 with a snipping of ribbon at the 5-megawatt Pitkin County Solar Array. Another project is underway near Glenwood Springs, adjacent to the Colorado Mountain College campus. More such solar projects are likely.

A recently completed study by the Carbondale-based Clean Energy Economy for the Region found the solar potential of Eagle, Garfield and Pitkin counties was 25 times greater than what now exists. Much of this potential is in the Xcel Energy service territory downvalley from Glenwood Springs.

For much of the past century, the energy hopes of this area around Rifle were often focused on oil shale development. So far, it has defied success of commercial extraction at scale. The late Randy Udall used to say that pig manure (well, yes, he used a different word) had more energy than kerogen, the substance of oil shale. Anvil Points was long the central focus of oil shale extraction. Its a fetching image to now imagine solar panels lining the base of those cliffs.

This solar-generated electricity isnt necessarily the cheapest available. Electricity, like corn, can be produced most cheaply at scale and in the best places. The study about solar in the mountain valleys makes the argument that cost alone should not be the sole criterion. It points to future job generation as demand for fossil fuel declines. It also points to another benefit of local generation.

That local benefit is illustrated by the 2018 Lake Christine Fire. Centered in the El Jebel area, the fire nearly severed transmission into Aspen during the Fourth of July weekend. Local generation from the new solar farm in Pitkin County coupled with batteries can allow, at least temporarily, continued operation of home refrigerators and oxygen concentrators. The concept here is that of a microgrid, the ability to at least temporarily create self-sufficient islands in our electrical grid.

Colorado together has strong renewable resources. A solar developer of several mammoth projects near Pueblo says the solar resource there ranks eight or nine on a scale of 10. The elevation of the San Luis Valley may make the solar potential there even higher. Wind in southeastern Colorado, at the heart of the Dust Bowl-country ravaged landscape in the 1930s, may be as good as anywhere in the country.

Still, even greater geographic diversification will be needed to achieve the deep, deep integration of renewable generation. Think of Vail Resorts with its corporate strategy. A bad snow year in Colorado? Well, it has properties in New England, and then some in Europe and in Australia.

Most goals for 100% renewables including those of Holy Cross are similarly premised on sharing of electricity across broader geographic areas through wholesale market structures. A new Colorado law requires electrical utilities to figure out how to participate in such an organization, called a regional transmission organization, by 2030. It might be a cloudy day in Colorado, but not in Arizona. And the wind is always blowing somewhere.

Other Colorado power providers, including the Fort Collins-based Platte River Power Authority, and Durango-based La Plata Energy similarly hopes to a mix of local generation and access to broader markets.

Can local resources be knitted with large-scale resources from elsewhere to meet the 2030 carbon-free goals? Plenty of smart and hard-working people are trying.

Allen Best publishes Big Pivots, an e-journal devoted to energy and other transitions provoked by climate change. See more atBigPivots.com.

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Creating a low-carb diet of local and imported energy - Valley Courier

High estrogen in men after injectable testosterone therapy …

Posted: December 6, 2021 at 1:49 am

Testosterone replacement improves quality of life and is aromatized in men in adipose tissues to estrogen. Hyperestrogenism is believed to be harmful to male sexuality. This is a description of our experience of screening 34,016 men in the Low T Centers, of which approximately 50% were converted to treatment. Men were treated with injectable testosterone, and we have available data from 2009 to 2014. The data were extracted from our electronic health record (AdvancedMD) of 35 Low T Centers across the United States. In all, 7,215 (20.2%) out of the 34,016 patients had high estradiol levels defined as 42.6 pg/ml. Estradiol was measured using electro-chemiluminescence immunoassay. Of the patients who had high estradiol levels, the age distribution was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years; 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years. The difference between extreme age groups (<25 and 65) was statistically significant using a chi-square test (p = .013). The correlation coefficient of serum estradiol to age was .53, SD = 8.21. It was observed that practitioners used aromatase inhibitor and selective estrogen receptor modulator to treat symptoms of hyperestrogenism, irrespective of blood estradiol levels. Gynecomastia was rarely documented as a reason for the prescription. Our finding was that high estradiol levels were not associated with higher rates of low libido but established higher rates of documented low libido with those with normal or lower estradiol levels. The difference was statistically significant (p < .05).

Keywords: age; aromatase inhibitor/SERM; estrogen; gynecomastia; testosterone therapy.

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High estrogen in men after injectable testosterone therapy ...

Testosterone Therapy: Review of Clinical Applications …

Posted: December 6, 2021 at 1:49 am

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Testosterone Therapy: Review of Clinical Applications ...

Testosterone Injections: Are They Right for You?

Posted: December 6, 2021 at 1:49 am

Testosterone

Testosterone is a male steroid hormone that does a lot more for men than just promote a healthy sex drive. The hormone affects several other factors in your health, including body fat, muscle mass, bone density, red blood cell count, and mood.

Normal testosterone levels are between 300 and 1,000 ng/dL. If a blood test shows that your levels are far below the norm, your doctor may suggest testosterone injections. These are a form treatment called testosterone replacement therapy.

Testosterone injections are most often given by your doctor. The injection site is typically in the gluteal muscles in the buttocks. However, your doctor may allow you to self-administer the injections. In that case, the injection site would be in your thigh muscles.

Men naturally start losing some of their testosterone when they hit their 30s or 40s. A more rapid decline in testosterone levels may indicate a problem called low testosterone (low T). Common symptoms of low T include:

Some men may also have changes in the size of their penis and testicles. Others may have breast swelling.

Some men may want to diagnose themselves with low T. The problem with self-diagnosis is that many of the symptoms of low T are normal parts of aging, so using them for diagnosis isnt reliable. A doctor-ordered testosterone level test is the only way to find out if your testosterone levels are too low.

When you see your doctor, they will take a thorough health history and do a physical exam. In addition to a blood test to measure your testosterone levels, youll also likely have a test that measures your red blood cell count. Testosterone injections can increase your red blood cell count, so this test is done to make sure you arent at risk of a dangerous increase in these cells.

If your exam and tests reveal that you have low T, your doctor may suggest testosterone injections.

The purpose of testosterone injections is to help regulate male hormone levels to help address problems related to low T. For men with low T, the benefits of these injections can include:

Men generally have less body fat than women. This is partly related to testosterone, which regulates fat distribution and muscle maintenance in your body. With low T, youll likely notice an increase in body fat, especially around your midsection.

Your hormones also help regulate muscle growth. So, with low T, you may feel like youre losing muscle size or strength. However, this only occurs if your low T is prolonged and severe.

Testosterone shots can help regulate fat distribution, but you shouldnt expect significant weight changes from hormone therapy alone. As for muscle maintenance, testosterone therapy has been found to help increase muscle mass, but not strength.

Low sperm count is a common side effect of low T. This problem can make it difficult if you and your partner are trying to get pregnant. However, if low T is to blame for problems with conception, dont count on testosterone injections to help. Testosterone therapy can itself lead to reduced sperm counts, especially at high doses.

According to GoodRx.com, the cost of 1 mL (200 mg/mL) of Depo-Testosterone is about $30. The same amount of testosterone cypionate, the generic version of that drug, runs about $12$26. The Depo-Testosterone label states that shots should be given every two to four weeks. Considering that dosage varies by patient, the cost could run anywhere from less than $24 per month to more than $120 per month.

These estimates only cover the drug itself, and not all possible costs of treatment. For instance, if you receive the injections from your doctor, theres a cost for the office visits. This is in addition to the cost of office visits for monitoring, as your doctor will likely monitor your condition carefully to check for side effects and to make sure the injections are working properly. If you give yourself the injections, you may also need to buy needles and syringes.

Testosterone therapy doesnt cure the cause of low T, it just raises testosterone levels up to a normal range. Therefore, injections could be a lifelong treatment if you continue to need them.

Some insurance companies cover portions of the costs, but youll want to check your coverage in advance. If you have questions about the costs, talk to your doctor.

Testosterone shots can help many men with low T. Still, this doesnt mean that these powerful injections are safe for all men. Be sure to tell your doctor about all health conditions you have before starting testosterone therapy.

You will likely need extra monitoring from your doctor if you have heart disease, sleep apnea, or a high red blood cell count. And you should not use testosterone injections at all if you have breast cancer or prostate cancer.

Testosterone shots may also increase your risk of certain health problems, such as:

Testosterone injections can be helpful, but only if you actually have low T. If youre wondering if these injections might be right for you, talk to your doctor. They can test you for low T. If they diagnose you, you can discuss whether these injections would be a good choice for you.

If you dont end up having low T but still feel like your hormone levels might be off, keep in mind that good nutrition, regular exercise, and avoiding smoking could help you feel better. If those dont help, be sure to talk to your doctor.

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Testosterone Injections: Are They Right for You?

Masculinizing hormone therapy – Wikipedia

Posted: December 6, 2021 at 1:49 am

Masculinizing hormone therapy, also known as transmasculine hormone therapy, or female-to-male (or FTM) hormone therapy, is a form of hormone therapy and gender affirming therapy which is used to change the secondary sexual characteristics of transgender people from feminine or androgynous to masculine. It is a common type of transgender hormone therapy (another being feminizing hormone therapy), and is predominantly used to treat transgender men and other transmasculine individuals. Some intersex people also receive this form of therapy, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of therapy is to cause the development of the secondary sex characteristics of the desired sex, such as voice deepening and a masculine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments to reverse. The medications used for FTM therapy include, mainly, androgens (namely testosterone) and GnRH analogues.

While the therapy cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different sex can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as their gender. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of the therapy, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Several contraindications to androgen therapy exist.[1] An absolute medical contraindication is pregnancy.

Relative medical contraindications are:

Hormone therapy for transmasculine individuals has not been adequately studied. Two recent studies indicate the potential for elevated risk of cardiovascular events. Nota, et al (2019) found that transgender men taking testosterone had an increased risk of cardiovascular events compared to cisgender women, with 11 vs. 3 cardiovascular events per 100,000 person-years, though the risk was less than that of cisgender men. Researchers were not able to control for smoking status or stressors.[2]Another recent study (Alzahrani, 2019) found elevated risk of heart attacks among self-identified transgender menwhich persisted even after adjusting for age, diabetes mellitus, chronic kidney disease, smoking, hypertension, hypercholesterolemia, and exercisethough the study did not include data about whether the subjects were undergoing hormone therapy and did not control for stressors. The study found that transgender men have a >4-fold and 2-fold increased odds of having a myocardial infarction when compared with cisgender women and cisgender men, respectively.[3] Since testosterone for transgender men is intended to be used over an individual's entire lifespan, the full range of risks of such lengthy testosterone administration is not yet known.

Testosterone is metabolized by the cytochrome P450 enzyme system (specifically CYP3A isoforms) in the liver. There are certain drugs that increase or decrease the activity of cytochrome P450 enzymes and may cause increased or decreased levels of testosterone:

Testosterone can also alter the effects of other drugs:

Because of these interactions, it is advised that trans men make their healthcare providers aware of their hormone therapy when this is relevant to their treatment for other medical issues.

Medications used in hormone therapy for transgender men include androgens and anabolic steroids like testosterone (by injection and other routes) to produce masculinization, suppress estrogen and progesterone levels, and prevent/reverse feminization; GnRH agonists and antagonists to suppress estrogen and progesterone levels; progestins like medroxyprogesterone acetate to suppress menses; and 5-reductase inhibitors to prevent/reverse scalp hair loss.

The elimination half-life of testosterone in the blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinization.

'Depot' drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two primarily used forms in the United States are the testosterone esters testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Delatestryl or Xyosted) which are almost interchangeable. Testosterone enanthate is purported to be slightly better with respect to even testosterone release, but this is probably more of a concern for bodybuilders who use the drugs at higher doses (2501000mg/week) than the replacement doses used by transgender men (50100mg/week). These testosterone esters are mixed with different oils, so some individuals may tolerate one better than the other. Testosterone enanthate costs more than testosterone cypionate and is more typically the one prescribed for hypogonadal males in the US. Testosterone cypionate is more popular in the US than elsewhere (especially amongst bodybuilders). Other formulations exist but are more difficult to come by in the US. A formulation of injected testosterone available in Europe and the US, testosterone undecanoate (Nebido, Aveed)[13][14] provides significantly improved testosterone delivery with far less variation outside the eugonadal range than other formulations with injections required only four times yearly. However, each quarterly dose requires an injection of 4mL of oil which may require multiple simultaneous injections. Testosterone undecanoate is also much more expensive as it is still under patent protection. Testosterone propionate is another testosterone ester that is widely available, including in the US, Canada, and Europe, but it is very short-acting compared to the other testosterone esters and must be administered once every 2 or 3days, and for this reason, is rarely used.

The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate). 100mg weekly gives a much lower peak level of testosterone than does 200mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections.

Injectable forms of testosterone can cause a lung problem called pulmonary oil microembolism (POME). Symptoms of POME include cough, shortness of breath, tightening of the throat, chest pain, sweating, dizziness, and fainting.[15][16] A postmarketing analysis by the manufacturer of Aveed (testosterone undeconate injection) found that POME occurred at a rate of less than 1% per injection per year for Aveed.[17]

Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels (blood levels drawn just before your next shot). A trough level of 500ng/dL is sought. (Normal range for a cisgender male is 290 to 900ng/dL).

Both testosterone patches, creams and gels are available. Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection. Both can cause local skin irritation (more so with the patches).

Patches slowly diffuse testosterone through the skin and are replaced daily. The cost varies, as with all medication, from country to country, it is about $150/month in the US, and about 60 in Germany.

Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim. They are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day. The cost varies, as with all medication, from country to country, from as little as $50/month to about $280/month.

Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient's skin. This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk.

Implants, as subcutaneous pellets, can be used to deliver testosterone (brand name Testopel). 6 to 12 pellets are inserted under the skin every three months. This must be done in a physician's office, but is a relatively minor procedure done under local anesthetic. Pellets cost about $60 each, so the cost is greater than injected testosterone when the cost of the physician visit and procedure are included. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.

Oral testosterone is provided exclusively as testosterone undecanoate. It is available in Europe and Canada, but not in the US. Once absorbed from the gastrointestinal tract, testosterone is shunted (at very high blood levels) to the liver where it can cause liver damage (albeit very rarely) and worsens some of the adverse effects of testosterone, like lower HDL cholesterol. In addition, the first-pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. Because of the short terminal half-life of testosterone, oral testosterone undecanoate must be administered two to four times per day, preferably with food (which improves its absorption).

In 2003, the FDA approved a buccal form of testosterone (Striant). Sublingual testosterone can also be made by some compounding pharmacies. Cost for Striant is greater than other formulations (US$180210/month). Testosterone is absorbed through the oral mucosa and avoids the first-pass metabolism in the liver which is the cause of many of the adverse effects of oral testosterone undecanoate. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks. The lozenge is 'mucoadhesive' and must be applied twice daily.

Synthetic androgens/anabolic steroids (AAS), like nandrolone (as an ester like nandrolone decanoate or nandrolone phenylpropionate), are agonists of the androgen receptor (AR) similarly to testosterone but are not usually used in HRT for transgender men or for androgen replacement therapy (ART) in cisgender men. However, they can be used in place of testosterone with similar effects, and can have certain advantages like less or no local potentiation in so-called androgenic tissues that express 5-reductase like the skin and hair follicles (which results in a reduced rate of skin and hair-related side effects like excessive body hair growth and scalp hair loss), although this can also be disadvantageous in certain aspects of masculinization like facial hair growth and normal body hair growth). Although many AAS are not potentiated in androgenic tissues, they have similar effects to testosterone in other tissues like bone, muscle, fat, and the voice box. Also, many AAS, like nandrolone esters, are aromatized into estrogens to a greatly reduced extent relative to testosterone or not at all, and for this reason, are associated with reduced or no estrogenic effects (e.g., gynecomastia). AAS that are 17-alkylated like methyltestosterone, oxandrolone, and stanozolol are orally active but carry a high risk of liver damage, whereas AAS that are not 17-alkylated, like nandrolone esters, must be administered by intramuscular injection (via which they act as long-lasting depots similarly to testosterone esters) but have no more risk of liver damage than does testosterone.

For the sake of clarification, the term "anabolicandrogenic steroid" is essentially synonymous with "androgen" (or with "anabolic steroid"), and that natural androgens like testosterone are also AAS. These drugs all share the same core mechanism of action of acting as agonists of the AR and have similar effects, although their potency, pharmacokinetics, oral activity, ratio of anabolic to androgenic effects (due to differing capacities to be locally metabolized and potentiated by 5-reductase), capacity for aromatization (i.e., conversion into an estrogen), and potential for liver damage may all differ.

Dihydrotestosterone (DHT) (referred to as androstanolone or stanolone when used medically) can also be used in place of testosterone as an androgen. The availability of DHT is limited; it is not available in the United States or Canada, for instance, but it is available in certain European countries, including the United Kingdom, France, Spain, Belgium, Italy, and Luxembourg.[18] DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.[19] Relative to testosterone, and similarly to many synthetic AAS, DHT has the potential advantages of not being locally potentiated in so-called androgenic tissues that express 5-reductase (as DHT is already 5-reduced) and of not being aromatized into an estrogen (it is not a substrate for aromatase).

In all people, the hypothalamus releases gonadotropin-releasing hormone (GnRH) to stimulate the pituitary to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH analogues, such as leuprorelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH analogues work by initially overstimulating the pituitary gland then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The Harry Benjamin International Gender Dysphoria Association Standards of Care permits treatment from Tanner stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. The high cost of GnRH analogues is often a significant factor.

Antiestrogens (or so-called "estrogen blockers") like aromatase inhibitors (AIs) (e.g., anastrozole) or selective estrogen receptor modulators (SERMs) (e.g., tamoxifen) can be used to reduce the effects of high levels of endogenous estrogen (e.g., breast development, feminine fat distribution) in transgender men. In addition, in those who have not yet undergone or completed epiphyseal closure (which occurs during adolescence and is mediated by estrogen), antiestrogens can prevent hip widening as well as increase final height (estrogen limits height by causing the epiphyses to fuse).

5-Reductase inhibitors like finasteride and dutasteride can be used to slow or prevent scalp hair loss and excessive body hair growth in transgender men taking testosterone.[20] However, they may also slow or reduce certain aspects of masculinization, such as facial hair growth, normal male-pattern body hair growth, and possibly clitoral enlargement.[20][21] A potential solution is to start taking a 5-reductase inhibitor after these desired aspects of masculinization have been well-established.[20]

Progestogens can be used to control menstruation in transgender men. Depot medroxyprogesterone acetate (DMPA) may be injected every three months just as it is used for contraception. Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy.

In those who have not yet started or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.

The main effects of HRT of the FTM type are as follows:[22]

Many transgender men are unable to pass as cisgender men without hormones. The most commonly cited reason for this is that their voice may reveal them.

Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:

Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should be evaluated for age appropriate causes of abnormal uterine bleeding as per cisgender female guidelines.[23]

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident.

While a high level of testosterone is often associated[how?] with an increase in aggression, this is not a noticeable effect in most trans men. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen.

Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Studies are limited and small scale, however, based on self reporting over a short period of time (7 months). In a study by Motta et al, trans men also reported better anger control.[26] Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression.[citation needed]

During HRT, especially in the early stages of treatment, blood tests should be consistently done to assess hormone levels and liver function.

Gianna Israel and colleagues have suggested that for pre-oophorectomy trans men, therapeutic testosterone levels should optimally fall within the normal male range, whereas estrogen levels should optimally fall within the normal female range. Before oophorectomy, it is difficult and frequently impractical to fully suppress estrogen levels into the normal male range, especially with exogenous testosterone aromatizing into estrogen, hence why the female ranges are referenced instead. In post-oophorectomy trans men, Israel and colleagues recommend that both testosterone and estrogen levels fall exactly within the normal male ranges. See the table below for all of the precise values they suggest.[31]

The optimal ranges listed for testosterone only apply to individuals taking bioidentical hormones in the form of testosterone (including esters) and do not apply to those taking synthetic AAS (e.g., nandrolone) or dihydrotestosterone.

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Masculinizing hormone therapy - Wikipedia


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