Can Testosterone Treatment Turn Back the Clock? Testosterone supplementation may improve sexual function in older men

March 8th, 2016

It’s no secret that the privilege of aging comes with inevitable declines in health. As men age, they also see a decline in testosterone levels. New research tries to determine whether testosterone treatments can give men back some of their lost vitality.


A team of researchers from the University of Pennsylvania School of Medicine conducted seven Testosterone Trials (TTrials), which were designed to see if testosterone therapy could relieve the symptoms of withdrawal from the hormone.

To conduct the study, the team enrolled 790 men, ages 65 and older, at 12 sites across America. All of the participants had lower testosterone levels than young healthy men, low sexual function, difficulty walking or low vitality.

The men were randomly selected to receive either a testosterone gel or placebo gel, which was applied daily for a year. The trial was double blind, meaning neither the researchers nor participants knew who was taking which gel. Researchers measured testosterone levels periodically for a year and monitored prostate and cardiovascular problems.

The research team found that among the men with low sexual function, testosterone treatment modestly improved sexual activity, sexual desire and erectile function compared to the placebo. Among men in all three trials, walking speed and distance also improved with the testosterone treatment.

Though testosterone treatment didn’t significantly affect fatigue symptoms, men in all three groups who received the testosterone reported slight improvements in mood, energy and depressive symptoms.

The study was led by Dr. Peter J. Snyder from the University of Pennsylvania School of Medicine.

“The results of the TTrials show for the first time that testosterone treatment of older men who have unequivocally low testosterone levels does have some benefit,” Dr. Snyder said in the press release. “However, decisions about testosterone treatment for these men will also depend on the results of the other four trials.”

According to the study, researchers found few adverse effects from testosterone treatment. The authors emphasized that larger and longer studies are needed to assess the risk of testosterone treatment in older men.

Researchers said that older men seeking testosterone treatment should consult with a physician.

The results for the first three elements—sexual function, walking and vitality—were reported February 18 in theNew England Journal of Medicine. Results for other outcomes, including cardiovascular, bone density, cognition, and anemia, will be reported in future papers.

The study was funded in part by The National Institute on Aging-The National Institute of Health.

The authors disclosed several potential conflicts of interest, including that Dr. Snyder reported receiving consulting fees from Watson Laboratories. Co-author Dr. Bhasin received fees to serve on advisory boards from Eli Lily and Sanofi, consulting fees from AbbVie and grant support from Regeneron Pharmaceuticals, Eli Lily, AbbVie and Novartis.

Apps for Managing ED

March 8th, 2016

Health-related apps have exploded on the internet, for both operating systems. It was only a matter of time before those that help to diagnose, manage, or treat ED came into being. There are several on the market today for those who have found that their performance on many different occasions was less than stellar. Some of these apps can give some discreet insight into what might be going on. Apple has an app called “Fire Up Your Sex Drive.” It does seem to make exorbitant claims for itself. The apps purveyor’s claim that not only does it address ED, but kicks one’s libido into high gear. After just 20 days, your sexuality should be advanced by over 80%, developer’s claim. They also say that using this app is the equivalent of taking Viagra. It works by sending out high-frequency alpha waves which will supposedly synchronize to the user’s own brain waves. After slapping down $2.99, a user has to listen to the app for six minutes, once a day. This is thought to stimulate the endocrine system into producing more testosterone, ramping up the sex drive and helping to reverse ED. Trouble is, most men with ED have it because of a physical problem, such as clogged penile arteries. In this case, alpha waves would do little to reverse it. Unfortunately, there is no evidence that this in fact cures the condition.


Another out of Bangalore, India is called, “Dr. Vasan’s CurED” app. Here, the user answers a series of questions to see if they in fact do have ED. If so, it also determines how severe it is. The app utilizes two professional metrics, the International Index of Erectile Function and Sexual Health Inventory for Men. If the patient receives a poor result, it can even help him contact a doctor. Lastly, there is the Erectile Dysfunction Self-Test. Available on the Google Play store, this app gives a four part, professional screening. Created by an Austrian couple where he is a psychotherapist and she a couple’s and sex therapist, the app gives a fairly accurate assessment and tips to improve the situation. Some of these apps may be helpful. But nothing can replace the experience of seeing a physician or urologist in the flesh and receiving a proper examination. These experts can help determine what is causing ED and how best to cure it. Contact a doctor or urologist near you should you be experiencing ED.

#ThatsNotLove: Helping teens spot signs of relationship abuse

March 3rd, 2016

By Kelly Wallace, CNN

Looking back, Mattis Collier, now 20 and a junior at the University of South Carolina, can see all the warning signs.

“It was a very quick relationship. I didn’t know him very well … but the jealousy, the rage, all of that stuff came pretty soon after,” said Collier about her ex-boyfriend, whom she started dating early in high school.

There was so much isolation, she says, remembering how he went through her phone one time, deleting all of her male friends in her contacts and on Facebook, and how he told her she couldn’t talk to guys or go to parties.

Reluctant to get too specific, she says the relationship was abusive in multiple ways. Ultimately, she cut off communication with him after she started college.

“I was very blind to the situation, and you know, when it’s your first love and all of that, you really think that that kind of thing is, ‘Oh it won’t happen again,’ or ‘He was just so mad,’ or ‘I lied to him so I deserved that,’ but it progressively got worse.”

Yeardley Love was beaten to death by her ex-boyfriend in 2010.

This summer, Collier’s father wore a “One Love” baseball cap to support the One Love Foundation – an organization created in honor of Yeardley Love, the University of Virginia lacrosse player who was beaten to death by her ex-boyfriend just three weeks before she would have graduated in May 2010.

Collier’s father encouraged her to check out the foundation. “I think that was his way of saying, ‘I’m wearing this hat in honor of a girl that was not as lucky as you.’”

So one night she went up to her room and looked up every news article and video she could find about One Love, and made a decision to create a campus organization called Team One Love at her college this past fall. “I was like, ‘OK, if I don’t do this for anyone else, I’m going to do it for myself.’”

Mattis Collier's sign says, "I will never let you go even when you want to. #ThatsNotLove"

There are now 40 active Team One Loves on college campuses across the country and nearly 6,000 Team One Love members. The goal is for the students to take the lead in educating and empowering their peers about the signs and dangers of relationship abuse. It’s all part of a #ThatsNotLove campaign that One Love Foundation officially launched back in October.

‘Every kid has a stake in solving this problem’


But this goes way beyond a campaign. The One Love Foundation hopes #ThatsNotLove starts a movement.

“I think the idea behind #ThatsNotLove is how can we think of a lot of different, creative ways to emphasize the same core message, which is that there is a difference between relationships that are about love and relationships that are about control, that you can see in some of the earliest phases of a relationship behaviors that are healthy and unhealthy,” said Katie Hood, chief executive officer of the One Love Foundation.

“We’re trying to sort of make this very clear, that every kid has a stake in solving this problem. Every kid has a stake in working for change and thereby make it easier for people to do so,” she said.

To drill that point home and get to teens and college students where they are — on social media — One Love worked with an outside agency to create “couplets,” eight digital shorts featuring animated emojis, which in a very clear-cut way indicate how intensity, obsession, isolation, disrespect, blame, control, anger and put-downs are most definitely not love.

Since the couplets were launched this month in honor of Teen Dating Violence Awareness and Protection Month, they have been viewed nearly 5 million times and counting, according to One Love.

“They demonstrate exactly what we’re trying to say with ‘That’s not love,’ but they do it a lighthearted way,” said Sharon Love, Yeardley’s mother and the founder of the One Love Foundation. “They’re not threatening. They’re very simple but they bring the point home directly.”

Added Lexie Love Hodges, Yeardley’s sister: “They can capture a whole relationship in five seconds.” People don’t always recognize relationship abuse when they read an article about it or listen to someone talk about it, she said, but here they can see the behavior demonstrated in a way they might click with.

“The topic of relationship violence is so heavy. I think that’s why it’s not talked about often and I think that the couplets … make it more approachable for friends to bring it up in a different way,” she said.

In addition to the digital shorts, two public service announcements also titled “That’s Not Love” have been released, and have been viewed more than 5 million times on Facebook and YouTube since October.

‘We were so clueless’


Relationship abuse is an issue that was never discussed in her household, Sharon Love said during a phone interview from her home in Baltimore.

“We were so clueless,” she said, adding that she and her family knew nothing about it and didn’t feel like it was a topic they needed to be concerned about either. “We didn’t realize there were signs, and we’re trying to turn that upside down. … The signs are somewhat obvious but they’re masked as love. You can think that they’re madly in love with you when they’re really just trying to control you.”

Love said she also had no idea about the statistics — how one in three women and one in four men will experience some form of physical violence in a relationship in their lifetime, according to the National Coalition Against Domestic Violence, and how young women 16 to 24 experience the highest rate of domestic partner violence — nearly three times the national average.

“I feel like what we thought of domestic violence was of someone that was married with children, that was stuck in a situation, that was dependent on the abuser and couldn’t get out,” said Love, saying what came to mind was Farrah Fawcett’s portrayal in the movie about domestic violence, “The Burning Bed.”

“That was like stuck in my head. That’s what relationship violence is,” she said.

It didn’t ever occur to her that relationship abuse could impact young people, let alone that young women in Yeardley’s age group were at the highest risk.

On May 3, 2010, when Yeardley was just 22 and weeks away from her college graduation, Sharon Love awoke to police officers at her front door. Life as she and her family knew it was completely over.

“It was incomprehensible to me that someone I knew, someone that Yeardley cared for, had taken her life,” she wrote last year in a letter posted on the One Love Foundation website. (Yeardley Love’s ex-boyfriend George Huguely was convicted of murder and is currently behind bars.)

The MADD for relationship abuse?


Determined to raise awareness among teens and help them recognize the warning signs of abusive relationships, Sharon Love started the foundation in the hopes of doing for relationship abuse what Mothers Against Drunk Driving has done for drinking and driving.

“They changed a whole mentality, with generations now thinking it’s appalling to drink and drive. My generation didn’t think anything of it,” she said. “So we’re hoping that relationship violence will be appalling behavior and something that you speak up against right away.”

The foundation created a film called “Escalation,” which showcases a fictional relationship between two students, Paige and Chase, that starts to turn very wrong, very quickly. In the film, Chase wants to be with Paige all the time, gets jealous when she spends time with men, begins to isolate her from her friends and grows increasingly more angry and violent as she starts to pull away. The film has a tragic ending and concludes with photos of young women who in real life were killed by their abusive partners.

I watched the film last year as it was being rolled out on college campuses around the country. It left me shaken and so upset. I watched it again before writing this piece and feel exactly the same way.

So far, the film — along with a 45-minute workshop led by student facilitators — has been shown nearly 700 times at colleges and high schools across the country, with nearly 35,000 students participating. According to Hood of One Love, nearly 90% of students who participated in workshops said they thought it should be required viewing at their school, and 97% said they would recommend it to a friend even if it wasn’t required.

‘Rocketed’ to understanding


The goal, an ambitious one, is to have 100% of students on every campus in the U.S. see the film and participate in a workshop, said Hood.

“Because movement is our goal, we just want as many eyeballs to see it as possible,” she said. “We now think that if ultimately we want to change the social climate on campuses, so that people can speak up when they see things, then it can’t just be a pocket of kids that see it. It has to be many, many more.”

I wondered why One Love wouldn’t just release the film on YouTube and allow teens across the country and around the world to see it. Hood said there are two reasons. First, it could be triggering for someone who is an abusive relationship, she said, and you would want to make sure there were resources available or you could communicate to that person what resources are available when they watched it. And second, she said, while the film is powerful, the workshops are more powerful.

“You walk in, you think this has nothing to do with you. And in 38 minutes, which is the length of the film … you’re sort of rocketed to not only understanding the issue, being more aware of it, you recognize that you’ve seen it before,” said Hood. “You have a connection to it.”

Because ultimately, that’s part of the sad reality of relationship abuse. We all most likely know someone who has experienced this.

“It doesn’t discriminate. It’s not just poor people. It’s not just people without fathers or mothers or guidance. It’s everybody. It’s your sorority sister. It’s your friend. It’s your sibling. It’s your child,” said Mattis Collier, who hopes to be able to work with One Love after her graduation in December and then go to law school to work on the issue of domestic violence in college athletics.

“And I think it’s very important for people to realize that you need to talk about it and you need to explain it while you’re younger. It’s not just bruises that are giveaways for an abusive relationship. … It’s how someone talks to you. It’s how someone treats you. It’s how someone talks about you to others.”

Showing people they have a role to play


Collier wishes the “Escalation” workshop were required at her high school and college. Right now, just over 40 schools require it with a subset of students, including athletic teams, fraternities and sororities, and freshmen, according to One Love.

“I wish that this was a required seminar for high school, for college students, because the lack of knowledge and education awareness in our country is astounding,” said Collier.

As One Love looks to the future, it hopes not only to increase the number of schools where “Escalation” workshops are held and also increase the number of schools where they are required, but also to deepen the engagement of students, with more Team One Loves — more students like Collier facilitating workshops, training students to be workshop facilitators and holding “That’s Not Love” events where they write words on sheets to match what love is and what it is not.

“It may sound crazy to have these ambitious goals about starting a movement and getting to 100% of the kids on college campuses,” said Hood, “but it’s sort of pretty simple what we’re trying to do. We’re trying to just wake people up to their personal connection and get them to develop their voice and understanding that they have a role to play.”

What drives Sharon Love and the rest of her family is trying to prevent what happened to Yeardley from happening to any other young person in a relationship.

“I feel pretty confident already that we are saving lives,” she said. “We’ve gotten so many letters from so many people that have gotten out of a bad situation, and really just one of those letters makes it all worthwhile.”

What do you think is the best way to try to prevent relationship abuse among teenagers? Share your thoughts with Kelly Wallace on Twitter @kellywallacetv or CNN Health on Twitter or Facebook.

‘Female Viagra’ gets mixed reviews

March 3rd, 2016

By Elizabeth Cohen, CNN Senior Medical Correspondent

A new review of the “little pink pill” for women with low sexual desire says the drug doesn’t work very well — but some doctors and patients who’ve been using the treatment disagree. The drug, Addyi, or flibanserin, has been on the market since October.

“The data presented in this review suggests that the meaningful change caused by flibanserin is minimal,” according to the team of Dutch researchers.

The researchers looked at eight studies on Addyi that together included nearly 6,000 women. They said for women using the drug, the number of additional “satisfying sexual events” averaged out to about 0.5 per month.

The agency asked Sprout Pharmaceuticals, which makes Addyi, to do more studies on the interaction between Addyi and alcohol.

An editorial accompanying the article, published in JAMA Internal Medicine, questioned the FDA’s approval of the drug. “The FDA approved a marginally effective drug for a non-life-threatening condition in the face of substantial — and unnecessary — uncertainty about its dangers,” wrote Dr. Steven Woloshin and Dr. Lisa Schwartz at the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice.

The researchers said the drug had significant known side effects, such as dizziness, sleepiness, and nausea.

The FDA approved Addyi last August with a “black box warning” to highlight the risks of severe low blood pressure and fainting when patients drink alcohol, take certain drugs, or have liver problems.

 Some doctors and patients who’ve been using Addyi say the drug has been helpful. There are no other FDA-approved treatments for women suffering from low sexual desire.

Dr. Lauren Streicher, medical director of the Center for Sexual Medicine at Northwestern Memorial Hospital in Chicago, said the results cited in the Dutch study are averages, and while Addyi doesn’t work for everyone, many of her patients have benefited from it.

She says she’s written Addyi prescriptions for about 10 women, and three or four have emailed her back to say it’s worked. “They say, ‘Oh my God, this has changed my life. Things are wonderful,’” Streicher said.

Jodi Cole, a 33-year-old stay-at-home mother from Porter, Oklahoma, said before she started taking Addyi, she didn’t want to have sex with her husband, Matt. “I love my husband and I believe God created emotional and sexual intimacy as key components of marriage. So we had sex, usually a couple of times a week. And while I was willing, part of me dreaded it. Every time,” Cole wrote in an email to CNN.

Cole said she started taking Addyi in November, and within six weeks felt a difference. “I was amazed,” she wrote. “I actually enjoyed being intimate and for the first time in a long time felt that connection with Matt.”

She said for her it wasn’t about increasing the quantity of sex she was having, but rather the quality. “What (Addyi) does is give just enough support so I can think about that part of our relationship with anticipation of pleasure rather than anxiety,” she wrote. She understands Addyi can have side effects, but said women should be able to choose to take it just as men choose to take Viagra despite its side effects.

“I should be able to choose whether the side effects are worth the benefit,” she wrote.

The controversy over Addyi


Seldom has one pill raised such controversy among medical professionals.

Doctors who treat women with low libidos tore apart the JAMA study. Streicher, an associate professor of clinical obstetrics and gynecology at the Northwestern University Feinberg School of Medicine, said the study drew “erroneous conclusions.”

The International Society for the Study of Women’s Sexual Health went even further, calling the study “a great disservice to the millions of pre-menopausal women suffering from (hypoactive sexual desire disorder).”

The doctors had several problems with the study’s methodology, including that three of the eight studies the Dutch researchers analyzed were not published. When studies are published, they go through a peer review process to assess whether the study methodology is sound.

One of those studies used a dosage of the drug that was half as high as what the FDA approved.

Dr. Loes Jasper, one of the authors of the Dutch analysis, said she and her colleagues removed the results from that study and still found that Addyi’s affects were minimal.

She said she and her colleagues included the results of the unpublished studies because sometimes negative studies of a drug don’t get published.

“We included all published and unpublished studies to capture a complete overview of the benefits and risks of flibanserin, without bias,” Jaspers wrote in an email to CNN.

According to the FDA, which looked at three clinical trials of Addyi that included about 2,400 women, about 10% more patients treated with Addyi reported meaningful improvements in satisfying sexual events, sexual desire, or reduced distress compared to women taking a placebo.

In their editorial, Woloshine and Schwartz said Sprout and others put pressure on FDA to approve the drug.

“While it is unclear how strongly politics influenced the decision, it is clear that the science was weak,” they wrote. “We all need a drug approval process that delivers good decisions based on adequate evidence.”

Bacteria swabbing trend for newborns medically in doubt

February 29th, 2016

‘re getting ready to give birth. Should the mother get an epidural? Is saving umbilical cord blood worth it? They may even ponder eating the placenta.

Now add to the list whether to follow a trend known as “vaginal seeding.” The practice involves swabbing the vagina of women who are going to have a cesarean delivery and then wiping the fluids on the baby. The hope is to give the baby the bacteria it would have been exposed to during vaginal delivery and help kickstart a healthy gut microbiome.

Although few doctors in the United States seem to be offering this simple procedure, a growing number of women are inquiring about it.

“It’s certainly happening more frequently (whereas) maybe like five or 10 years ago, I don’t think anybody really asked about this,” said Dr. Leonardo Pereira, chief of maternal-fetal medicine at Oregon Health & Science University.

Interest in the practice seems to be percolating overseas as well. “(By) taking a straw poll amongst colleagues at our hospital and other hospitals (in the United Kingdom), it seems in the last year or two almost all of the obstetricians and neonatologists here have encountered women asking for this to be done,” said Dr. Aubrey J. Cunnington, a pediatrician at Imperial College London.

large body of research points to an association between C-section delivery and increased risk of asthma, obesity and other health conditions. On the other hand, there has been an “absolute explosion of research on the role of the microbiota in health and disease,” Cunnington said.

However, experts say it is far too soon to say whether the vaginal microbiome gives babies a healthier start, and if so, whether seeding has the same beneficial effect as a vaginal delivery. Of greater concern is whether the practice could expose babies to some disease-causing bacteria in the bypassed birth canal.

In spite of the growing interest in vaginal seeding, there is a lack of data on its safety and benefits, and a lack of guidance for women and their doctors, Cunnington said. He and his colleagues in the United Kingdom and Australia took a close look at the issues surrounding the practice in an article that was published on Tuesday in the British Medical Journal.

“I think it would be helpful to have some guidelines on this, [but] it’s very hard to make guidelines when you have almost no evidence,” said Cunnington, who delivered babies before he started specializing in pediatric infectious disease. “Hopefully (the article) will help the medical profession to feel they have a little support,” whether they decide to practice vaginal seeding or not, he said.

Seeding a bad infection?


The main qualm doctors have with vaginal seeding is that it could infect babies with dangerous bugs at the same time it is bestowing them with potentially healthy bacteria. Topping the list of pathogens of concern are group B streptococcus, chlamydia and gonorrhea.

The Centers for Disease Control and Prevention recommends testing all pregnant women for these bacteria, as well as a number of other pathogens. About a quarter of all women harbor group B streptococcus, and while they may not experience symptoms, the bacteria could cause pneumoniaand meningitis in their newborns.

All women should get screened, even those planning to have a C-section, in case they end up having an unexpected vaginal delivery, Pereira said. If they are infected, women can receive antibiotics during labor to prevent passing the infection to their baby. However, some women decline screening, even those who are interested in vaginal seeding, Pereira said. “(In those cases) there’s a concern of taking group b strep from the birth canal and wiping it all over the baby,” he added. In addition to bacterial infections, experts worry vaginal seeding could infect babies with herpes virus if the mother has genital herpes.

While it is true that vaginal seeding probably only exposes babies to the same pathogens they would have gotten had they been delivered vaginally, these pathogens could have been avoided by C-section delivery. “If they had [a C-section] because it was the way they had to be delivered for the safety of the baby or the mother, why would you want to impose on them an increased risk of infection if it’s not going to benefit them?” Cunnington said.

What doctors should tell mothers


While doctors might not be doing a lot of vaginal seeding themselves, some mothers are taking the matter into their own hands. In one report, a woman in Brooklyn planned to insert a piece of gauze in her vagina before her C-section operation that her husband would wipe on their newborn shortly after delivery. Although there are no guidelines for how to perform vaginal seeding, the studies of the practice generally insert the gauze one hour before delivery and then wipe the fluids around the baby’s mouth, face and body.

It is important to tell these mothers that seeding might not have any benefit and might be increasing the risk of infection, Cunnington said. If they still want to do it, “They just need to be very aware that if their baby is unwell and they go to see a doctor, they should tell them they have performed vaginal seeding because it may change the doctor’s assessment,” he said. For example, a doctor may otherwise have ruled out the likelihood of a group B strep infection knowing that the baby was delivered via C-section.

Even though there is little evidence so far, it is also too soon to close the book on vaginal seeding. A small study recently provided the first evidence the practice might be able to give babies gut microbiomes that more closely resemble those of vaginally delivered infants.

However, “even if you can show their gut is colonized preferentially with labtobacillus or other organisms if you do that swab, you don’t really know if that really has any clinical health benefits, or if in a year from now that really matters,” Pereira said. More studies are needed, following babies who received vaginal seeding for years, to answer that question.

“It’s a fascinating area of research and it holds a lot of promise,” said David Hackney, assistant professor and medical director of labor and delivery at University Hospitals Case Medical Center.

“If someone said to me 10 to 15 years down the road this would be a routine thing we’ll be doing, that would be great and I don’t even know that I’d be surprised. But you can also imagine that in 10 to 15 years, we’ll look back and say what is that crazy thing we were doing,” Hackney said.

Giving babies healthier microbiomes

Until we have more answers about vaginal seeding, the potential for passing along healthy bacteria from the birth canal — while treating women to avoid passing along disease-causing bugs — could be just one more reason to encourage vaginal deliveries, Hackney said. C-sections are known toincrease the risk of complications for both mother and baby, and increase the recovery time for the mothers.

And while vaginal seeding might not be ready for prime time just yet, there are other well-studied practices that could help ensure babies start life with a healthy microbiome. Breastfeeding and skin-to-skin contact between mother and baby are known to “help newborns be colonized with healthy bacteria pretty quickly,” Pereira said.