Mark Moyad & Stephen Auerbach, MD, chatting about testosterone [T] replacement after PCa, below [1]. (I know that some here are using T.)
Moyad has been around for a long while & many here will know of him. In the past I have questioned some of his opinions, but looking through the 59 papers he has published since 1995 - many of them opinion pieces with only his name - I have a more positive view. {Dr. Myers has said that he often disagreed with Moyad but always enjoyed their debates.}
From 1999 [2]:
"There has been a strong interest in this supplement {vitamin E} in the prostate cancer arena primarily because of a Finnish study that demonstrated a lower morbidity and mortality from this disease in men taking 50 mg of synthetic (alpha-tocopherol) vitamin E daily. In addition, observations from laboratory and clinical studies dealing with heart disease have found that gamma-tocopherol may also play a significant role in prevention; therefore, we decided to test the ability of this compound (versus synthetic vitamin E) to control the growth of a human prostate cancer cell line. Gamma-tocopherol was found to be superior to alpha-tocopherol in terms of cell inhibition in vitro. Both forms of vitamin E (and others) should be thoroughly evaluated in the future to provide the most effective chemoprevention information to the patient."
But subsequent interventions continued to use alpha tocopherol, even though the gamma form is more common in the American diet - if not the blood.
In 2002 [3], he wrote about the Selenium and Vitamin E Chemoprevention Trial (SELECT), which was kicking off:
"Is there sufficient evidence to support the use of these supplements in a large-scale prospective trial for patients who want to reduce the risk of prostate cancer? Results from numerous laboratory and observational studies support the use of these supplements, and data from recent prospective trials also add partial support. However, a closer analysis of the data reveals some interesting and unique associations. Selenium supplements provided a benefit only for those individuals who had lower levels of baseline plasma selenium. Other subjects, with normal or higher levels, did not benefit and may have an increased risk for prostate cancer."
Moyad was merely pointing out the obvious, but the SELECT team seem to have ignored those studies. In an American population, one needs to be below the bottom tenth of selenium intake to see benefit. Instead, selenium was given even to men who were already taking high doses. Why did they think this could cause no harm?
"The dose of vitamin E in the SELECT trial (400 IU/day) is 8 times higher than what has been suggested to be effective (50 IU/day) by the largest randomized prospective trial in which the incidence rate of prostate cancer was used as an endpoint. Recent research also suggests that dietary vitamin E may be associated with a lower risk of prostate cancer than the vitamin E supplement. Additionally, recent results from all past cardiovascular prospective, randomized trials suggest that vitamin E shows little benefit for cardiovascular disease risk, especially at the dose being used in the SELECT trial."
Again, supplementation occurred without regard to one's E status.
Moyad probably didn't know back then that supplementation with alpha tocopherol would drive down blood levels of gamma tocopherol - the isoform he had identified as being more protective against PCa.
Skipping forward to his most recent paper (2016) [4]:
"Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses in English using such search terms as “prostate cancer” and “androgen deprivation therapy”, “cardiovascular risk”, “lean body mass”, “exercise”, and “diet”. The initial searches produced 379 articles with dates 2005 or more recent. Articles published after 2004 were favored. This review utilizes the latest data to provide a status update on the effects of exercise and diet on patients with prostate cancer, focusing on ADT-associated side effects, and it discusses the evidence for such interventions."
The link is to the full text.
...
Going back to the video, there is a discussion of the dangers of T replacement.
Erythropoiesis - the making of red blood cells [RBCs] is affected by T levels. As T levels fall, so do RBCs. RBCs contain the hemoglobin that transport oxygen, so low T levels can cause anemia. Some argue that high levels of T will cause the opposite of anemia. Too great a concentration of RBCs might lead to a stroke. Well, that never happened when we were 21. In my case, when I go from castrate T to >1,000 ng/dL my RBCs quickly increase up to the middle of the normal range. The body is smarter than some anti-T experts say.
A 1983 study [5] used testosterone enanthate on normal men (i.e. presumably not hypogonadal):
"Mild but significant increases in white blood cell, red blood cell, hematocrit, and hemoglobin concentrations were noted. These effects correlated with the dose frequency schedules. Negligible changes in mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were observed. Despite the significant individual increases in blood parameters, all values remained within the normal population range and no clinical manifestations were observed."
{Note that hematocrit "is the volume percentage (vol%) of red blood cells in blood. It is normally 40% for men". (Wiki)
But RBCs/hematocrit should be monitored while using T replacement. Not every aging body responds according to spec. & no-one should risk having a stroke.
-Patrick
[1] youtube.com/watch?v=DvJqu1n...
[2] ncbi.nlm.nih.gov/pubmed/103...
[3] ncbi.nlm.nih.gov/pubmed/119...
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