Testosterone gel linked to increase in heart problems in frail men, study finds

Many men use a testosterone supplement to treat symptoms linked to testosterone deficiency in older age, such as poor libido and deteriorating muscle strength. However, such treatment appears to come with additional health risks for frail, elderly men who use the gel to increase their strength and mobility.

Researchers reported Wednesday that a study designed to assess the risks and benefits of testosterone replacement therapy in men ages 65 and older who had mobility problems was stopped early -- in December 2009 -- because of a much higher rate of cardiovascular problems in the men receiving testosterone compared with those receiving a placebo gel.

The study, led by researchers at Boston University and funded by the National Institute on Aging, included 209 men, half of whom used testosterone gel daily for six months. The average age of the men in the study was 74. All of the men in the study had limited mobility and a high prevalence of chronic disease. However, among the 106 men using testosterone gel, 23 had cardiovascular-related events compared with only five men in the 103-person placebo gel group. The study is published online in the New England Journal of Medicine.

It's difficult to know just what to make of this study, the authors acknowledged. There was a broad range of cardiovascular events, including heart attack, stroke, death from suspected heart attack, exacerbation of congestive heart failure, atrial fibrillation, swelling, chest pain and other milder symptoms. With such a diversity of events, it's hard to pinpoint how testosterone replacement therapy may be responsible. The doses of testosterone used in the trial may have been higher than in previous testosterone studies that have not found cardiovascular risks. Moreover, the trial was small and was stopped early.

The elderly men using testosterone did show increased strength in leg-press and chest-press strength and in stair climbing while carrying a load.

As for younger and healthier men who use testosterone gel, it's doubtful this study can be applied to them, the authors said. Previous studies of testosterone gel in other groups of men have not shown significant increases in cardiovascular risks. "Caution is also warranted in extrapolating these findings to other doses and formulations of testosterone or to other populations, particularly young men who have hypogonadism without cardiovascular disease or limitations in mobility," they wrote.

However, long-term studies on the risks and benefits of testosterone therapy in men of all ages are lacking, according to a recent story in the Los Angeles Times. Meanwhile, the availability of testosterone in gel form has led to a huge jump in prescriptions in the U.S.; 3.3 million prescriptions were filled in 2008 compared to 64,800 in 1999, according to one pharmaceutical data company.

As for older men in poorer health: "The authors note that physicians and patients, especially older men, should consider this study's findings on adverse effects along with other information on the risks and benefits of testosterone therapy," officials from the NIA said in a statement. Further research is needed to clarify the safety issues raised by the trial, the authors note.

Additional trials on the risks and benefits of testosterone therapy in men are ongoing, the NIA statement said. Those trials will continue although investigators and participants will be advised of the findings of the Boston University study.

-- Shari Roan

Photo credit: Stephen Sedam  /  Los Angeles Times

The Father's Day gift that keeps on giving

Without further ado, here's a Booster Shots tribute to dads and their families, courtesy of Dr. Marc Siegel, a practicing internist who writes the Unreal World column for the Health section, and Dr. David Samadi, a practicing urologist and the chief of robotics at Mt. Sinai Medical Center in New York.
 
* * *

Guys out there, give yourselves a present for Father’s Day -- go to the doctor. Do you want to be around to receive another godawful tie from your kids next year? Go to your doctor now to make sure you have the chance. Are you having problems peeing or difficulty getting aroused? Don’t argue, see your urologist. It could save your life.
 
Unfortunately, statistics show that you guys are just not doing it. The Agency for Healthcare Research and Quality has just released the results of a sobering survey showing that just 57% of American men see a doctor, nurse practitioner or physician’s assistant for routine care on a yearly basis. The number is much higher for women -- 74%.
 
Further, it appears that the men who need care the most are often the ones less likely to seek it. Three-quarters of men who said they were in excellent health sought routine care versus only half of men who reported being in fair to poor health. What better time than Father’s Day to make a resolution to change your ways? If not for yourself, do it for your family.
 
If you come to see your internist or family practitioner, we won’t attack you; we will simply check your blood pressure, your weight, your cholesterol, your glucose and your PSA (if you’re over 40). These are all crucial measurements to make sure you aren’t at risk for a heart attack, diabetes, stroke or prostate cancer.

High blood pressure is the most common chronic disease and the second-leading cause of death in the U.S., affecting one out of three adults, or 65 million people. More than 102 million adults have elevated cholesterol levels. You can learn to change your lifestyle, or if needed, we can give you medicine that will help you. 

Prostate cancer will be diagnosed in one in six men in the U.S., and it kills 30,000 men every year, the second-biggest cancer killer of men after skin cancer. We can screen you for prostate cancer and for colon cancer over age 50, which, when we catch it early, can be cured. We want you to be around next year.
 
What exactly is your prostate? It lives right below your bladder, and although it is just the size of a plum, it causes big problems. The prostate can grow and block the urinary stream, or it can develop a lethal form of cancer. Although recent studies have provided conflicting results regarding the PSA blood test, we continue to value its usefulness. We don’t believe in over-treatment, or that everyone with prostate cancer should be treated. But we do believe that knowledge is power, and a simple blood test can help us gain that knowledge.
 
Make yourself a Father’s Day resolution: Go to see your doctor so that your kids have a holiday to celebrate next year at this time.

And now for some helpful health links ...

- The risk factors for high blood pressure.

- The risk factors for a heart attack.

- How to manage cholesterol.

... and some statistics for U.S. men and cholesterol by age, from the National Center for Health Statistics:

- 11% of men age 20-34 have high cholesterol.

- 21.1% of men age 35-44 have high cholesterol.

- 22.9% of men age 45-54 have high cholesterol.

- 16.5% of men age 55-64 have high cholesterol.

As for information about prostate health, the Centers for Disease Control and Prevention offers a primer on informed decision-making, the National Cancer Institute explains cancer screening, and the Prostate Cancer Foundation offers a look at physiology. 

 -- Drs. Marc Siegel and David Samadi

Become a fan: We've set up a page dedicated to fitness, medical and health news at facebook.com/latimeshealth.

Photo: What better time than Father’s Day to make a resolution to change your ways? Credit: Al Schaben / Los Angeles Times

Study finds a link between lower IQ scores in men and suicide attempts

Having a lower IQ has been linked in studies with smoking and heart disease, but a new study shows there may also be an association for men between scoring low on IQ tests in early adulthood and suicide attempts.

Researchers examined data on 1.1 million Swedish men who had their IQs tested in early adulthood. In that group were 17,736 men who had been hospitalized at least once for a suicide attempt during a follow-up of about 24 years.

They found a link between lower IQ scores and a higher risk of attempted suicide -- the lower the IQ, the more likely the men were to try to kill themselves. Men in the lowest IQ group were almost nine times as likely to have a suicide attempt as those in the highest group. The association held even after the researchers adjusted for age and socioeconomic status.

Having a lower IQ might put someone at a disadvantage in several ways, according to the study authors: Lower IQ tends to be linked with a lower socioeconomic level, which can bring with it social and financial hardships. Lower IQ is also tied to less healthful habits such as binge drinking. And IQ may also be a factor in how people deal with life's stresses and traumas. Some studies have shown that more intelligent people may deal better with pressure and might be better problem solvers.

"Suicide, either attempted or actual, is a serious problem, particularly amongst young adults, but we have a relatively poor understanding of what leads a person to take such drastic action," said study co-author Elise Whitley of the University of Glasgow, in a news release. "If we can better understand the association between IQ and suicide, this will provide valuable insight into why some people make such a tragic decision. Such knowledge would help inform public health strategies and provide help and support for vulnerable groups."

The study was released this week in the British Medical Journal.

Men should exercise to improve sex life

Many men turn to a little pill if they are unhappy with their sexual functioning. But it might be worth giving exercise a try.

Men who exercised had significantly higher scores on a sexual-function questionnaire compared with men who were sedentary, according to a study released Monday at the annual meeting of the American Urological Assn.

The study evaluated 178 men, both whites and blacks, whose average age was 62. When researchers adjusted for factors that could affect sexual functioning -- such as age, body mass index, heart disease, diabetes, medications and depression -- the men who reported more exercise still had significantly higher sexual function scores.

Among all the men, however, the average sexual function score was only 53 points out of a possible 100. The study was conducted at the Durham VA Medical Center.

-- Shari Roan

Photo credit: Bryan McLellan  /  For The Times

Add 'behind the wheel' to places that BMI matters, especially for men

Extra padding in an automobile accident is not a good thing, not when that padding comes from fat.

Scientists at the Medical College of Wisconsin's Injury Research Center and elsewhere analyzed real-world data on almost 11,000 drivers involved in front-end crashes; they also crafted computer models and crash simulations. Their conclusion: In automobile accidents, obese men are much more likely to sustain serious upper body injuries than are normal-weight men.

Body shape and center of gravity are factors, but the researchers acknowledge that additional study is needed to put a fine point on the body mass index (BMI)-risk connection.

They conclude: "Our findings may have important implications for high-risk cohort identification (e.g., obese male drivers), traffic safety intervention, policymaking, and for motor vehicle design to protect more vulnerable body regions."

Here's the full driver-injury study, published in the March issue of PLoS Medicine.

And don't forget to click on "supporting information" for the crash-test dummy simulations.

On Southern California roads, we need as much safety-related information as we can get.

-- Tami Dennis

Photo: On the plus side, a high rate of speed is often unlikely.

Credit: Christine Cotter / Los Angeles Times

Live right and Americans could all live an extra 4 to 5 years

Sure, each of us would feel better if we would just put down that sugary midafternoon snack, lose the smokes, hit the gym and take those high blood pressure drugs the doctor prescribed.

But let's look at the impact of these health-improving measures as if we were, say, in one of those popular competitive reality shows. If we divided ourselves up into teams along ethnic and geographic lines--say, high-risk urban blacks, white middle Americans, Asians, Western Native Americans, low-income northern rural whites and low-income Southern rural blacks--who would win the great life-extension contest?

According to researchers from the Harvard School of Public Health, the low-income Southern black team has the most to gain by quitting smoking and bringing their weight, blood pressure and blood glucose levels into line with current recommendations. Men would gain an average of 6.7 years of life and women, 5.7 on average, with the greatest gains coming from controlling blood pressure and (for men, anyway) smoking cessation. African Americans from cities with high murder rates come in next with the most to gain by quitting smoking and lowering their blood pressure.

The article,which details the impact that smoking, high blood pressure, insulin resistance and excess weight have on different populations of Americans, appears in the journal Public Library of Science (PLoS) Medicine, released Monday. It finds that Asian American lifespans are the least affected by the big four health scourges. Average life expectancy in that community is currently 82 years for men and 87 for women, but with optimal health behavior, could reach 87 and 91, respectively.

(The PLoS study comes on the immediate heels of a set of studies in the American Journal of Public Health that finds within the ethnically diverse bloc of Asian Americans -- long considered the "model minority" in terms of health factors -- there are subgroups -- for instance, Laotian Hmong, Vietnamese, Cambodian -- that suffer unusually elevated risks of certain cancers, due generally to higher rates of smoking or lower rates of screening).

Have a look at the PLoS study's team tally here.

How did Middle America --- defined as all whites not living in the northern plains or the Dakotas, or in Appalachia or the Mississippi Valley -- do? Average life expectancies on that team now stand at 76 for men and about 81 for women. But if everyone on the team pitched in, Middle American men could be living, on average, to 81 and women to 85.

If only real life could be more like a reality show!

-- Melissa Healy  

Rodent of the Week: A new understanding of how prostate cancer treatment may backfire

The very therapy used to treat prostate cancer patients in the early stage of the disease actually promotes the second, more deadly wave of the disease, according to a new study.

Men with prostate cancer often take drugs to shut down the body’s production of testosterone, the hormone that feeds the initial tumors. But when those tumor cells die, they trigger an inflammatory response that draws in immune cells called B cells. Those B cells, in turn, secrete a molecule that paves the way for the growth of a second wave of deadlier prostate cancer cells that are resistant to the hormone therapy.

The researchers – from UC San Diego, Scripps Research Institute-Florida and the Engelhardt Institute of Molecular Biology in Moscow – pieced this together by studying the progression of prostate cancer in a variety of genetically modified mice. Here’s how they put it in their report, published in Thursday’s edition of the journal Nature:

“The inflammatory response elicited by the dying primary tumor contributes to the failure rather than the previously proposed success of anti-cancer therapy.” (emphasis added)

It sounds like bad news, but there may be a silver lining. Now that the mechanism is understood, the researchers say that any interference with this sequence of events ought to delay the onset of the dangerous secondary tumors.

In their experiments, such interventions reliably delayed those tumors by three to four weeks. Converting that from “mouse time” to “human time,” they calculated that equivalent interventions in people would slow the development of secondary prostate cancer tumors by 2.3 to 3.1 years.

— Karen Kaplan

Photo credit: Advanced Cell Technology Inc.

Looking for guidance on circumcision? You’re on your own

Circumcision. It’s a delicate procedure and a loaded word, filled with connotations of pain, religious significance and hotly debated health benefits.

Some commentary in the current issue of the Archives of Pediatrics and Adolescent Medicine shows that medical professionals are not quite ready to come down on one side or the other. “Recommendations for routine newborn circumcision will need to wait for well-designed studies that verify its cost-effectiveness for the individual and/or society,” the editorial said.

But another paper in the same issue pointed to three recent studies that found circumcision helped reduce HIV acquisition by up to 60%.

In this L.A. Times story, writer Marnell Jameson highlighted the dilemma for many parents looking to circumcise:

Those who strongly oppose infant circumcision believe the procedure violates a child's human rights. …

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Bottom line: In the delivery room or afterward, no one’s going to be providing some infallible rules on circumcising your child. Do your homework before you have to decide. Here’s a brief description from the American Urological Assn. and some very helpful information from KidsHealth. Should you choose not to make the cut, the American Academy of Pediatrics has a guide on caring for an uncircumcised penis.

-- Amina Khan

Photo credit: Annie Wells / Los Angeles Times

What's in Gold Bond? A powder by any other name …

Paris-based drug giant Sanofi-Aventis made waves today when it announced the $1.9 billion acquisition of Chattem Inc., humble maker of Selsun Blue shampoo and Gold Bond medicated powder. Business pundits wondered what a high-end international pharmaceutical company was doing buying the Chattanooga, Tenn., maker of hair products and powders for itchy heads and feet. But here at Booster Shots, we're wondering: What's so special about Gold Bond powder anyway?

Gold Bond uses menthol to cool the skin, and zinc-oxide as a skin protectant. It’s a pretty simple formula – essentially the same one used when the Rhode Island Medical Assn. developed it in 1898.
 
But aside from the menthol, it's not that special. Like other baby or body powders, Gold Bond is mostly made up of talc with a little bit of zinc oxide (and other herbal-sounding things, like acacia and eucalyptol) thrown in. Other brands, like Johnson & Johnson, also offer "medicated" versions of their own, with ingredients like aloe and vitamin E. 

Yet J&J is better known for its baby products, not its adult offerings. And Gold Bond has tried to stay ahead of imitators by releasing new products (most recently in its "ultimate" series.) So in spite of its simple ingredients -- menthol, zinc and talc -- Gold Bond has turned into a winning formula. Consumers, especially men, swear by the stuff, citing its effectiveness at beating back that old foe, “jock itch.”

And the product line, which includes lotions and sprays, is still growing: Along with Cortizone-10 and Balmex, it helped bring in nearly $142 million in net sales in Chattem's "medicated skin care" category. Gold Bond powder sales rose 8% in 2007 compared with 2006, according to SEC filings. Guess nothing says relief like a respectable brand name.

-- Amina Khan

Cancer deaths down, but statistics are sticky

Our hard work to live more healthfully seems to have paid off, with a new annual report showing that cancer death rates have been dropping since the 1990s. The risks are still higher for men than for women, but men showed the greater drop in deaths, falling 10% from 2002 to 2006 as opposed to 7.5% for women.

Consider also that in 2009, more than 713,000 women and 766,000 men are projected to be diagnosed with cancer, lead author Brenda K. Edwards of the National Cancer Institute said in an interview.

Each year, the report takes an in-depth look at one particular type of cancer to draw conclusions about the why, not just the how much, of cancer death rates. This year, the team looked at colorectal cancer. Aside from being the second most deadly cancer threat, it serves as a good model for studying the declining cancer rate.

Researchers found about half of the decline was due to better screening, Edwards said. (Last year, the report singled out the No. 1 killer, lung cancer, and the team was able to point to smoking controls in California for its comparatively better lung cancer rates.) 

Edwards also raised some concerns that overall numbers would mask certain issues – for example, that lung cancer for women is still on the rise, though it’s going up more slowly than before.

The report, published online in Cancer, is a joint effort of the institute, the American Cancer Society, the Centers for Disease Control and Prevention and the North American Assn. of Central Cancer Registries.

David Agus, director of the USC Center for Applied Molecular Medicine, said in an interview that better screening practices, technologies and healthier lifestyles have contributed to the decline, but he also delivered a reality check on the data.

“This is not acceptable. We need to be down like heart disease, stroke, infectious disease, where the rates are down 50%,” Agus noted. “In the cancer world we’re not much better at doing things than we were five decades ago.”

-- Amina Khan