Recent data are showing that the covid-19 death rate among Italian men is much higher than among women: 80% of all deaths were in men, only 20% in women.
Interestingly, normal levels of estrogen seem to be immunoprotective, but high levels, as in pregnant women or men on Bipolar Androgen Therapy (BAT), reverses the protection.
The implications are:
• If you are on continuous ADT, stay on it. This is true even if ADT has been augmented with Zytiga and prednisone, or anti-androgens.
• If you are on intermittent ADT, this might be a good time to end your ADT vacation.
• Men using Bipolar Androgen Therapy on a clinical trial should discuss the timing with the trial investigator. Anyone taking supraphysiologic doses of testosterone should consider this as well.
• If you are taking adjuvant ADT with radiation, consider sticking with it a little longer.
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Tall_Allen
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Another variable however is that the rate of men who smoke in these countries is much higher than that of women. Since covid 19 affects the lungs, I'm sure that smoking has much to do with the higher incidence of death, wouldn't you say?
I'm not sure that Italian smoking rates are that different between men and women to explain the difference. According to this data from Italy, heavy smokers are 9.7% among males and 6% among females.
Taking this a step further, since most of the mortality is among the elderly, it is possible that the near-parity of female heavy smokers now may not reflect what was the case 40 or more years ago.
Maybe. It is also the case that women have a health advantage over men because the XX gives them a chance at a corrected back-up copy of the genes on the X chromosome, whereas if a man has an error in the one copy of the X he has, he is screwed.
Yeah, there's that. Most metrics females do better. Exception--autoimmune disease, which generally have a higher incidence in females. If we view that as an excessive immune response, it could also be a factor in the severity of infectious disease. Of course, just idle speculation on my part.
Good question - I wondered about that myself. Very high levels of estrogen increase the regulatory T cell response. Regulatory T cells are what shuts down the immune response to invasive antigens. It makes sense in pregnant women because it suppresses the immune response to the baby they are carrying. Your father may want to show the following to the trial investigator and ask for a response:
While testosterone has a role in inhibiting immunity, is there any prior observed association of the immune protective function associated with ADT having a certain degree of actual benefit in protecting older men from specific viral infections? The protective implications would seem to extend well beyond COVID-19.
Like fewer colds and flu? I haven't seen any studies on that. It would be very difficult to such a trial ethically - randomize men to ADT or no ADT and see who gets more colds?
Not asking for clinical studies, just any observed correlation that might appear in the scientific literature. There is no ethical problem in recording observations of men who have already been castrated... it's been done for centuries.
So you would have to compare the infection rate of men who have metastatic PC and are castrated vs men who have metastatic PC who are not castrated. Where would they find a database of men who have metastatic PC and are not castrated? Everyone who is diagnosed with metastatic PC is chemically or physically castrated. And if they raen't, it probably means they have significant comorbidities. You see the problem?
It shouldn't need to have anything to with PC, only with castration and observed protective effects. (Unless you are suggesting castration is only protective for men with PC?)
Castrated men have been around for millennia. Curious men have been recording observations for millennia. Sure, they missed observing some things, or observed some things and failed to record them, but I kinda think this one might have been noticed. (They did notice: Eunuchs Live Longer. What a bumper sticker!)
And it is only the past few decades where nearly EVERYONE with metastatic PC gets diagnosed and castrated. It was originally a treatment for severe symptoms of PC, not for PC itself. So prior decades had plenty of men both castrate and non-castrate with tumor burdens and comorbidites that were not extremely dissimilar in nature.
But I am confused by your logic here: since studies have not been done and would be hard to do, we can proceed to confidently assert a protective benefit in fact exists, without any studies?
That's not correct. Having cancer is debilitating and has negative effects on the immune system. You have to compare ADT vs no ADT in men who have metastatic PC. You could compare castrated to non-constrated men, none of whom have prostate cancer - but (a) where would you find a database like that ? and (b) you have to find out why they were castrated? Medical reason?
I don't know any database that reaches back before 1947 when ADT became SOC.
Since it is well established that ADT immuno-protective, and we've actually seen it for other diseases, you are free to believe that it won't happen for coronavirus-19, and that may be true, but it would fly against available evidence. The burden falls on those who would deny that effect in this one case.
You are wrong. I never suggested I believe that it won't happen for coronavirus-19. I suggested that I don't know and that you don't know. And I KNOW that you don't know. Everybody does.
The burden falls on those suggesting anything more than a possibility of protection. I am not denying the possibility exists. I deny that there is any compelling evidence or data that could provide a meaningful way to evaluate the probability of a benefit. Sure, the possibility exists. So what?
You are suggesting people buy a lottery ticket because the prize is big and because people who buy lottery tickets can and do win big prizes, but you cannot tell us the number of tickets being sold. You are suggesting that I am telling people they cannot win the lottery. No, I'm telling them they have no clue of the odds. If you know the odds or can estimate them, please share.
Even with lousy odds, we should be seeing ADT plugged on the news as a possible protection. Why aren't we? Can you give us even a short list of medical professionals suggesting it? (I admit, I have found it hard to get docs to prescribe treatments that have been definitively proven effective simply because they fall outside of the preferred standard of care.)
If you work under the impression that ADT is a cost-free ticket with no downside, then of course there would no reason to NOT buy a free lottery ticket. But I don't work under that impression, because it's not true.
This is silly. ADT isn't in the news as a protection for the same reason Neulasta isn't in the news as a possible protection. They are both protective for those who are taking it anyway. I never said there was no downside to ADT- we all know there is. I'm only saying it is immunoprotective.
Because it is only a replacement dose, it has no effect. Too little cortisol or too much cortisol (the natural version of prednisone) is immuno-suppressive.
Some guys get in trouble because they google prednisone and it tells them that it is immunosuppressive - that is true in higher doses. To my knowledge, taking it with Zytiga is the only use where only a replacement dose is involved.
Here's something - I'm not sure it's easy. Steroid effects are very complex, and highly controlled by negative feedback, receptor ligands and amplification, enzyme regulation, chaperone molecules, and interconversion.
I live and learn from guys like you Tall_Allen. I’ve learned or educated myself on my Cardiovascular AFIB issues, paroxysmal tagged. Yes, AFIB or staying NSR has been my goal since SCA May 2011.
Prednisone steroid drugs do affect my cardiovascular/muscular functions too. I’m consciously aware of that.
I will digest the ncbi.nlm.gov/pmc/article tonight. Can’t go to fitness gyms yet. So why not better educate me medically.
I never ever really cared about my health, medicines, new treatments before cardiac arrest almost 9 years ago. - - - May 12,2011 3days before our 35th wedding anniversary. Will celebrate anniversary #44 in 2.5 months. With advanced prostate cancer. Time to educate.
Me too. Read the 1st jacc.org article. AFIB patients, like me, (3.60%) highest of all the cancer types. Or a 2.3 fold increased odds.
The next to last sentence of that article kind of dis-heartening but it is what it is. ....'a higher mortality associated with AFIB/prostate cancer.
On a positive note, I could become a part of a Clinical EP AFIB-Cancer patient study.
Excellent question for me to ask, pin down my newest EP doc, Mar 31st (post- AFIB hospital experience follow-up visit). He, Dr V. I'll call him, directly visited me Feb 13th @ 20:30 eve after he had just given a presentation on "newest methods of cardiac ablation for permanently stopping AFIB electrical signal malfunctions in the right atria and pulmonary veins. A clinical trial that is supposed to be in use late this year or early next. Is not medical advances in super technology amazing!
Got this info fresh in my 68yo mind. Next re-read it tomorrow.
Thanks for the positive non-easy complex steroid link facts. Next up AFIB interaction or contraindications as they say, I think. I brought up my AFIB heart rhythm concerns way back in 2018 to my EP doctor #1. He said at that time my ADT meds, Lupron and Casodex would not have any issues causing Long Qtc rhythm glitches; reasoning I tend to have had a high HR, not low tending HR. Yes, I've got an ICD/Pacemaker to correct Low or High HR's within limits. I've also asked EP #4(yeh on # 4 EP doc) the same things now on Abiraterone and Pred. He says pretty much the same thing. Don't worry about ADT interference, yet.
Also There is beginning to be some discussion about whether the lung disease caused by this virus is in fact immune mediated. There is a small amount of evidence from China that there was no evidence of patients with significant immune suppression at greater risk of death. This is the opposite to what occurs in most viral infection so I am sceptical but you never know. If that is true then maybe ADT isn’t such a great idea. This is a fairly evidence Freezone but hopefully over the next few weeks to months crunching the rapidly increasing data will give us more accuracy.
It’s interesting that the US Government Top down is task forcing this Virus. I’ve never ever seen so many medical number data talking peoples in my life. It’s great to see medicine, technology and government actually doing something.
I think BAT may not involve any exogenous source of E2, but rather when T increases in men, then its increased aromatization into estrogens makes for increased levels, given that endogenous source of E2.
Higher serum levels of T and E2 would likewise occur in men on AAM (antiandrogen monotherapy), like those taking Casodex only.
The proposal that ADT increases immune response COULD suggest, if it is true as suggested from some of the early data, that decreased immune function patients do better, means that we poor souls on ADT could be at more risk because we have a more potent immune response.
My brother suggests I mingle as much as possible in an attempt to get the covid-19 virus now, while there are still available ventilators. I am uncertain as to his motive.
John. I need advice. This winter while in Florida I spent a lot of time in the pool
Many times a woman would swim over near me and ask "who did your boob job, they look fantastic". I need a good answer and I immediately thought of you.🍸🍸🤠
Thanks for the positive info! An encouraging idea during troubled times. Makes me want to move from away from intermediate (after 3 more months) to consistent ADT--at least for a year or so!
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