Declining Testosterone in Older Men

—A diminished serum testosterone level in older men is associated with increased mortality. It is probably a marker of general health, not an independent risk factor.

By Sanjai Sinha, MD, FACP, Assistant Professor, Department of Medicine, Weill Cornell Medical College, New York, NY
Reviewed By Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY

Serum testosterone concentration peaks during adolescence and early adulthood. Males tend to have a 1% to 2% reduction per year in testosterone beginning in their 30s. A more precipitous decline may indicate a higher probability of mortality. Observational studies have associated low serum testosterone and late-onset hypogonadism with cardiovascular risk factors, diabetes, and hyperlipidemia. While these intermediary outcomes are clearly related to earlier death, the effects of testosterone decline on longevity is less clear.

A recent study of more than 4000 men concluded that low testosterone predicts cardiovascular mortality but is not associated with death from other causes. In another study, low testosterone levels were associated with increased mortality over 8 years of follow-up in a retrospective analysis of male veterans who attended a hospital clinic. Two population-based studies of comparatively healthy men with longer follow-up (15 to 16 years) did not find an association of testosterone with survival.7,8 The men in these studies, however, were considerably younger (mean age, early 50s), so the survival effects of testosterone insufficiency were less impactful. Finally, a prospective trial of 794 men concluded that men in the lowest quartile of testosterone levels had a 40% increased relative risk of death compared to those with higher levels, independent of age, adiposity, and lifestyle.9 This finding held up even after adjusting for the presence of diabetes, metabolic syndrome, and cardiovascular disease (CVD).

A recent meta-analysis examined studies like these to determine if pooled results might clarify our understanding of the relationship between testosterone levels and survival. Searching data sources from 1966 to 2010, Araujo and colleagues evaluated English-language observational studies that reported the association between endogenous testosterone and all-cause or CVD mortality.10 Of 45 studies selected for full-text review, 21 were chosen for systematic review, with 12 eligible for meta-analysis. Eleven of these reported on all-cause mortality (16,184 patients) and 7 reported on cardiovascular mortality (11,831 patients). A secondary objective was to assess whether clinical, demographic, or study-related factors influenced or modified study results. Examples of these factors included baseline testosterone level, smoking status, body mass index, age, length of follow-up, and type of testosterone assay.

The mean follow-up period of the studies was 9.7 years. Average patient age was 61 years, and average testosterone level was 467 ng/dL. The authors found that a 2.18 standard deviation decrease in total testosterone was associated with a 35% increased risk of all-cause mortality and a 25% increased risk of CVD mortality.

The validity of these summary estimates is limited because of significant between-study heterogeneity, however. Factors contributing to the relative risk heterogeneity included mean age of the population (P = .02), baseline total testosterone level (P = .018), number of years of follow-up (P = .010), and whether blood samples were collected in the morning (P = .03). Larger relative risks were observed in studies that included older (RR = 1.54; 95% CI, 1.28-1.85) versus younger (RR = 1.12; 95% CI, 0.92-1.36) men, patients with lower (RR = 1.55; 95% CI, 1.28-1.88) versus higher (RR 1.09; 95% CI, 0.88-1.36) testosterone levels, patients who were followed for no more than 9.6 years (RR = 1.63; 95% CI, 1.32-2.02) versus more than 9.6 years (RR = 1.13; 95% CI, 0.95-1.36) and in those that did not obtain morning blood samples (RR = 1.61, 95% CI, 1.28-2.03) versus those that did (RR = 1.15; 95% CI, 0.94-1.41).

The studies included generally healthy men, but there was still significant heterogeneity in the association between endogenous testosterone and all-cause mortality across the studies. Based on these findings, it appears that low total testosterone is a marker for all-cause mortality rather than a risk factor itself. The summary estimate may reflect the contribution of underlying health conditions to mortality, rather than the random effects of testosterone. And while low testosterone levels may indicate a higher probability of medical problems, a low level also may be the result of these medical problems. This distinction is very difficult to elucidate. Another limitation of this meta-analysis is that all eligible studies were observational, which makes selection bias an issue. This meta-analysis suggests that testosterone levels in middle-aged and elderly men are likely markers of general health. Whether testosterone treatment affects mortality is currently under investigation

Understanding Nutrition and Exercise

longevity medicine

is best defined as the practice of prevention
of degenerative disease through the use of
optimum nutrition, exercise, identifying relevant genetic biomarkers through blood analysis, pain control, use of
supplements and hormone replenishment, to
achieve an end goal of extinguishing or at least
positively modulating the symptoms and signs of
aging.
The first step demands a comprehensive
evaluation in order to determine an individual’s
metabolism, genetic issues, endocrine function and
overall physiology. The patient’s work up includes
many diagnostic tests, guided by need and budget.
We realize that not everyone can afford everything
recommended but we will work with you. Some
tests will need to be done outside the office at an
imaging center. Laboratory studies can now be done

independent of a doctor referral. We will guide you.
After the initial diagnostic phase, the corrective
phase begins. Specific attention is given to each of
the above categories. An easy to use dietary plan
is created. Advice regarding dietary supplements
is put into place, hormone replenishment is
undertaken, sleep is managed, stress and mood are managed, and a realistic exercise program
is implemented. Ongoing supervision of the
program is necessary because corrective measures
will be modified as the patient progresses.
This approach leads to a greater quality of life
(return on investment) when you simply feel, look
and perform better. The interventions if done
properly, lead to reduced disease and a lesser need
for hospitals. Your exuberance about life becomes
infectious. Friends will want to know “what are
you doing?”
Simple results, but very important to this type
of program include mood elevation, improved
sleep, better control of blood sugar and blood
pressure, and improved wound healing. Some
diseases that are affected positively include
cancer incidence, vascular disease, osteoporosis,
Alzheimer’s disease and a cadre of others. The
results likely will result in less use
for prescription drugs. These drug molecules,
while they have utility, are seen by the body as
toxins. The body struggles to rid itself of them.
Specifically relevant to hormone modulation,
there is a focused effort to reduce insulin
and cortisol levels, both of which promote
degenerative disease. Endocrine balance is
essential to this goal. It’s all about the risk/benefit ratio.
Truthfully, what this amounts to is better
decisions by you to live a life of high quality that
will remain with you into the later years.
Don’t give up on your goals and dreams just
because you are over a certain age. The optimum
age to begin is during your 40’s, but it’s never
too late to start. Boost energy and sexuality,
reduce body fat, increase lean muscle, improve
cholesterol, strengthen the immune system, lift
your mood, manage stress and improve cognitive
function. This is what Longevity Medicine is all
about.
Take Charge of Your Destiny Now!

Download the full Nutrition Book Here

Shopping List

Produce- Vegetables and Fruits
-Blackberries, raspberries, blueberries, peaches, plums, cherries,
apples, pears, oranges, grapefruits, tangerines
Fresh (organic if possible) low glycemic vegetables: broccoli,
cauliflower, spinach, kale, collard greens, celery, carrots, lettuce,
radish, onions, garlic, asparagus, green beans, zucchini, peppers,
sweet potatoes, tomatoes, cucumbers, sprouted beans
-Dried apricots–unsulfured
-Dried goji berries (to mix in with nuts and seeds for a trail mix)

Protein
-Jay Robb Whey Protein–Vanilla–24 oz canister
-Organic skim or 1% milk, unsweetened soy or Almond Breeze–
Unsweetened Almond Milk
-Omega 3 Eggs
-Hummus
-Greek Yogurt (2%) 8 oz size
-Cottage Cheese
-Tofu, fresh turkey, chicken, grass fed beef
-Natural Turkey Sausage, no nitrates

Healthy Fats
-Olive oil
-Canola oil
-Flaxseeds either grind them yourself in a coffee grinder or
buy them already ground. Refrigerate
-Unsweetened wheat germ
-Fresh Ground almond or cashew butter
-Unsalted nuts: cashews, walnuts, almonds, pistachios,
pecans, sunflower seeds, pumpkin seeds slivered almonds
-Grains and Legumes
-Ezekiel Sprouted Grain Bread (frozen food section)
-Quinoa (cooks like rice but has more protein)
-Rolled Oats or Steel Cut Oats
-Beans: Edamame, sprouted mung beans, garbanzos, black
beans, pinto beans
-Barley, Cracked Wheat (Bulgur wheat—tabouleh)
-Spelt Crackers, Mary’s Gone Crackers

Miscellaneous

Alternative sweeteners such as agave, coconut sugar, honey, stevia

Nutrition
1. Keep the Glycemic Index of all below 50. Make sure
that each meal includes a lean protein, a low glycemic
carbohydrate and a healthy fat.
2. Avoid white rice, potatoes, bread, pasta or alcohol. Eat sweet
potato, brown rice, quinoa, beans and bulgur wheat.
3. Eat 3 meals and snacks every day. Do not go longer than 4
hours without eating. Have 3-5 vegetables per day and 2-3
fruits. No fruit juice!
4. Always have a fat or protein with a carbohydrate. This will
slow the rate of the glycation of the carbohydrate and the
rate or absorption.
5. Add all seeds and nuts (except peanuts) daily, sprinkle a
tablespoon of ground flaxseeds on yogurt, vegetables,
protein shakes or oatmeal.
6. Drink at least 80 to 100 oz of water a day. Drink an additional
8-16 oz of water for every 20 minutes of exercise. Electrolytes ARE important in water !!!
7. No fruit after 6pm. If hungry after dinner, have a lean source
of protein (egg white omelet, chicken breast, tuna, etc) or a
protein drink.
8. Try adding plain, low-fat yogurt to your routine. Try it with
berries and a few chopped nuts or ground flaxseeds. You
might also enjoy it with a chopped apple, nuts, flaxseeds and
cinnamon.
9. Eat a good protein meal or shake within 30 minutes after
your workout.
10. Keeping a log of your nutritional intake for the two weeks can be helpful if you have that kinda brain.

Breakfast:
1. Egg Omelet (1 whole egg with 2-3 egg whites) with
vegetables cooked with olive oil. Serve with grapefruit.
2. Cottage Cheese with sliced pear and almonds.
3. Greek Yogurt with berries and flaxseeds/nuts.
4. Raw Oatmeal with a scoop of vanilla protein powder, nuts,
ground flaxseeds. Stir in boiling water until creamy. Top
with fresh berries.

Snacks:
1. 1-2 tablespoons of any nuts except peanuts.
2. Fruit with nuts.
3. Lean source of protein (turkey, chicken, tuna in bag, hard
boiled eggs, veggie burgers with 12-14 grams of protein.
4. Hummus and vegetables.
5. Almond butter and apple or Ezejuak Sprouted Grain Bread.
Lunch and Dinner:
Lean source of protein (turkey, chicken, tuna, fish, tofu, soy
based protein, egg whites, veggie burgers with 12-14 grams of
protein), 1-2 vegetables and unlimited salad (buy cabbage already shredded).

Snack Ideas

Sweet and Creamy Snacks
• Greek Yogurt with half chopped apple, lots of cinnamon
1 Tbsp toasted slivered almonds (tastes like apple pie and
ice cream)
• Low fat whipped cottage cheese with cinnamon and
stevia (tastes like cheesecake)
• Greek yogurt with a tsp of instant expresso coffee
granules and stevia (decaf or regular)
• Greek yogurt with a tsp of Hersey’s Cocoa Powder,
unsweetened, and stevia. You can put it in the freezer for
15-20 min and it is the consistency of gelato
• Protein drink–in a blender, use skim milk, unsweetened
soy milk, unsweetened chocolate almond or oat milk or water.
Add a scoop of protein powder, 8-10 ice cubes, a tbsp of
ground flaxseeds and blend until thick and creamy
• More varieties of protein shakes: Add frozen berries or
frozen peaches. Use cold coffee instead of milk. Use
unsweetened cocoa powder, add stevia if necessary (use your imagination)

Fruit Snacks:
• Apple slices with a Tbsp of almond butter
• Sliced pear and low fat cottage cheese with slivered
almonds
• Dried unsulfured apricots with almonds
• Winter fruit salad–sliced oranges, apples and strawberries
tossed with lemon juice and stevia and a tbsp of
shredded natural coconut
• Dried goji berries combined with mixed nuts
• Fruit cobbler–heat low glycemic fruit in a little water with
cinnamon, nutmeg, and stevia, until fruit is tender. Mix in
rolled oats, ground flaxseed and nuts of choice. Put into a
baking dish, bake at 350° until golden brown. Let it cool
and sprinkle with vanilla protein powder or top with a
scoop of plain yogurt
• Cooked fruit with cottage cheese–simmer fruit of choice
in small amount of water. Reduce liquid as it cooks. Spoon
onto a scoop of low fat cottage cheese
• Pear slices topped with soft goat cheese

Salty and Crunchy Snacks:
• Spicy popped pumpkin seeds–put pumpkin seeds into
a bowl and sprinkle on them cayenne pepper, cumin,
paprika or any spice of your liking. Toss the seeds until
lightly coated. Put on a cookie sheet that has been coated
with olive oil. Bake at 375° for 8 minutes
• Zucchini chips–on a baking sheet coated with 2 Tbsp
of olive oil, put thinly sliced zucchini. Bake at 400° until
crispy and brown. Top with sea salt
• Seapoint Farms Dry Roasted Edamame–try with wasabe
• Toasted tamari almonds–raw almonds tossed in tamari
sauce. Bake in a toaster oven at 350° until brown
• Spelt seeded cracker with low fat cheese
Veggie Snacks:
• Celery with almond butter
• Vegetables for dip, raw or blanched. To blanch a vegetable
such as broccoli, cauli_ ower, green beans: drop into
boiling water for 1 minute until color brightens, remove
and drain immediately. You can rinse under cold water to
stop the cooking so they will be crispy
• Dip veggies in a mix of toasted sesame seeds and ground
sea salt (unless you have high blood pressure!)
• Sliced vegetables, hummus, guacamole dips should be
made with low fat yogurt rather than sour cream

A snack can be:
• Protein only
• Fat only
• Carbohydrate with fat
• Carbohydrate with protein
• Carbohydrate with protein and fat
After dinner a snack should be protein only!

• Whole radish topped with soft goat cheese
• Roasted cauliflower–toss florets in a mixing bowl with
a Tbsp of olive oil and a little sea salt. Bake at 400° on
baking sheet for 30-40 minutes
• Roasted asparagus–sprinkle with Italian herbs, olive oil
and Parmesan cheese, wrap in foil packs and bake in
toaster over at 350° for 10-12 minutes
• Grilled vegetables (zucchini, peppers, eggplant, onions,
asparagus) brush with olive oil, sprinkle with salt, pepper
and Italian herbs. Grill on hot grill and then drizzle with
balsamic vinegar
• Steam fresh green beans until they are bright green (just
a couple of minutes) and toss with grated orange rind
(zest), then sprinkle toasted slivered almonds on top
• Quinoa–sauté diced onion in olive oil in a sauce pan for
a few minutes. After it is soft and clear, stir in one cup of
dry quinoa, stirring for a couple minutes until it is slightly
brown. Add 2 cups of low sodium chicken broth. Cover
and cook for 15 minutes until all the liquid is absorbed.
In the last 5 minutes you can choose to add any fresh
or frozen chopped vegetable that you may have. Try it
with chopped cilantro sprinkled on top and/or slivered
almonds

Mustard Vinaigrette Salad Dressing
3 Tbsp water
½ packet of stevia
5 tsp of olive oil
2 Tbsp of balsamic vinegar
1½ tsp of stone ground mustard
½ tsp ground pepper
Shake in a small jar

THESE ARE ALL JUST SUGGESTIONS, NOT RIGID ORDERS…use your brain to guide you once you get the idea ……it’s all about adjusting your view of it…..Food…this instead of that (they’re right next to each other in the store like red grapes instead of white grapes)…always choose the one with more color…

IV Vitamins

Our clinic prides itself in being on the cutting edge of proactive retention of good health in the aging body. One of the interventions which we and others find useful in attaining this goal is administering IV Vitamins into the circulatory system through a small cannula.
 
IV (or parenteral) vitamins including magnesium, calcium, B vitamins, and vitamin C have been found to be effective against acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergies, rhinitis, cardiovascular disease and other disorders.
If you have any of these conditions or simply want to experience an elixir which lifts the spirits, calms the mind and gives a sense of well-being, you may find this intervention useful.
Magnesium is a muscle relaxant and a vasodilator. It is ubiquitously found in the human body in a certain ratio with calcium. Vitamin C is the primary healing agent for minor and more profound injuries and the B vitamins calm the nervous system without creating sedation. These are the primary ingredients utilized in this procedure. It is brief and results are generally immediate and long lasting. Ask us about getting your first treatment today.

Vitamin B12 is an essential nutrient necessary for proper metabolism and energy production. It plays an integral part in DNA synthesis and supports cell replication. The compound has an important role in the conversion of harmful homocysteine into beneficial methionine, an essential amino acid. Homocysteine is an amino acid (a building block or protein) that is produced in the human body. High homocysteine levels in the blood can damage the lining of the arteries. In addition, high homocysteine levels may make blood clot more easily than it should. This can increase the risk of blood vessel blockages. Vitamin B12 converts this harmful amino acid into a beneficial amino acid called Methionine which helps with energy production and is necessary for normal brain and nervous system function.

Vitamin B6 is involved in the process of making serotonin and norepinephrine, chemicals that transmit signals in the brain. Vitamin B6 is involved in the formation of myelin, a protein layer that forms around nerve cells. Vitamin B6 deficiency in adults may cause health problems affecting the nerves, skin, mucous membranes and circulatory system. Deficiency can occur in people with kidney failure complication, alcoholism, liver scarring, overactive thyroid, problems absorbing nutrients and heart failure. 

Vitamin B5 is used for alleviation of conditions like asthma, hair loss, allergies, stress and anxiety, respiratory disorders and heart problems.

Vitamin B1 sometimes called thiamine is called the anti-stress vitamin because it is believed to strengthen the immune system. It plays an important role in maintaining a healthy nervous system and improving the cardiovascular functioning of the body. We need vitamin B1 so that our body can use carbohydrates as energy. B1 is essential for glucose metabolism along with all the B vitamins are needed to keep the brain and nervous system functioning optimally as well as a for healthy as well as for healthy hair, skin and eyes and liver.

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Orthopedic Pain Management

Aching joints, muscular pain, arthritis, post-traumatic pain, headaches?? Find answers here...

Orthopedic or musculoskeletal medicine is the area of medicine directed towards chronic  painful, mostly traumatic but sometimes metabolically induced conditions. This Includes the treatment of myofascial, spinal, joint, disc injuries and torn ligaments or tendon insertions. Frequently these conditions are accompanied by chronic painful muscle spasms or headaches, leg and arm pains. 

In our practice we try to address these things non-surgically, but have access to the finest specialists in the Bay Area if surgical or other interventional diagnostic techniques are required. 
Our approach is primarilybased in injection therapies for torn tissue (reinforcing injections), muscle injections in order to reduce spasticity (local anesthetic orBotox), vitamin/supplement use, dietary interventions, hormonal replenishment and exercise. Our armamentarium of
specialists include leading figures in the world of pain elucidation and treatment. 

My background in this kind of medicine came from a long-standing affiliation with a major spine surgical center in the Bay Area. I've already seen the good, the bad and the ugly. 

My services are available to you. Let me help you to decide whether you need a surgeon and if you do, to help you in the selection process. 
 

STEM CELLS….THE ULTIMATE HEALING INTERVENTION

Talk about a Brave New World !!!

In this very moment the world of healing medicine has exploded, bringing to the forefront a whole new panoply of types of illnesses and conditions that can be treated, even cured, with STEM CELLS…

This is a REVOLUTION in medicine which will change the way that so many diseases are currently being treated, with way better outcomes.

Current research is ongoing at MANY large university centers and as well, at independently funded research centers.

Here’s the great news: the stem cells are taken from your own bone marrow, from the fat of the body, or can be created in a lab from any one of the living cells in your body, yes, from ANY LIVING CELL in your body.

Now

This revolution began with the Nobel Prize granted to two researchers in 2007.  Since then, scientists/researchers/physicians are working night and day in this exciting field of research.

One of the Nobels, Shinye Yamanaka, was a professor in Kyoto at the university there, but has since been recruited by the Gladstone Institute in San Francisco, an affiliate of UCSF, where his research is ongoing.  He was a professor of Orthopedic Surgery exploring this intervention for his spinal cord injury patients. He is having success.

Others are exploring and treating:

• Joint injuries

• Multiple sclerosis

• Stroke victims

• Cardiac issues including restoring the heart muscle where it has been damaged by heart attack

• Parkinson’s disease

Many community physicians are now treating with stem cells..

When you inject stem cells it actually heals the tissue.  Cortisone disinflames temporarily but ultimately damages the tissue if done too often. Thank you for your time and interest.  Looking forward…….ACTUAL HEALING of damaged tissues!

Frances Dee Filgas, M.D..