Bisher AKIL, MD

Archive for the ‘General Health’ Category

Coronavirus: An Update

In General Health, Infections worthy of news on March 1, 2020 at 3:53 pm

Introduction: Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China, and has caused serious illness and death. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving.

How deadly is it? Epidemiologists are still trying to determine exactly how deadly covid-19. About 2 percent of reported cases have been fatal, but many experts say the death rate could be lower. That’s because early in an outbreak, mild illnesses may not be reported. If only people with severe illness — who are more likely to die — seek care, the virus will appear much more deadly than it really is because of all the uncounted people with milder symptoms.

How is it spread?: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages .Covid-19 spreads similar to other coronaviruses that cause cold-like symptoms, experts have said. There have been reports of people transmitting the virus before they show symptoms, but most experts think this is probably not a major driver of new infections. What is concerning, however, is that symptoms can be mild, and the disease can clearly spread before people realize they’re sick. A report in the New England Journal of Medicine suggested covid-19 reaches peak infectiousness shortly after people start to feel sick, spreading in the manner of the flu. A study published in JAMA chronicled the case of a 20-year-old Wuhan woman who appeared to infect five relatives, even though she never showed signs of illness.

What are the symptoms? : Symptoms are primarily respiratory. Coughing and shortness of breath are common, according to the CDC. Fever is also possible. The severity of the symptoms depends highly on the patient’s age and immune system.  For the elderly and those with underlying heart disease, diabetes or other conditions, coronavirus can cause pneumonia and lead to organ failure and death. But for most people, cases have been mild, requiring little to no medical intervention.

Do we have a test?: Yes,. A kit is available from the CDC, and today the FDA licensed other tests from private laboratories.

Is there a treatment?: There is no licensed medication for the treatment of this virus. . Gilead pharmaceutical has the antiviral drug remdesivir as a possible coronavirus treatment. It is now in clinical trials in several countries, including China. It has been used at least once in the US on compassionate basis.

How do I prepare? There are some basic precautions you can take, which are the same as what you should be doing every day to stave off other respiratory diseases: Wash your hands regularly. Cover your nose and mouth when you sneeze. And when you’re sick, stay home from work or school and drink lots of fluids.. The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises not to touch your eyes, nose and mouth and to clean objects and surfaces you touch often.   Here is a video from WHO to show to proper hand wash:

https://www.youtube.com/watch?v=3PmVJQUCm4E

Should I wear a mask?: If you’re not already sick and you’re not a health-care worker, the short answer is no. The main point of the mask is to keep someone who is infected with the virus from spreading it to others . CDC does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases. Common surgical masks block the droplets coming out of a sick person from getting into the air, but they are not tight enough to prevent what’s already in the air from getting in. There are specialized masks — known as N95 masks because they filter out 95 percent of airborne particles. The masks are difficult to use without training. They must be fitted and tested to work properly.

When will it end? Unknown; it could follow a seasonal pattern (appears in cold weather and disappears with warm weather), and to return next season. However, there is evidence that it persists in Southern hemisphere countries that already have warm weather.

What about a vaccine?: several agencies and pharmaceutical companies are working on developing a vaccine; it is not likely that vaccine will be available this year and it not likely to be used in treatment.

 

<<Disclaimer: This summary is  compiled from information available through medical journals (New England Journal of Medicine, The Lancet, JAMA and others),government and public health sites (CDC, DHHS and FDA) and media outlets (New York Times, Washington Post and others) . Many of the information we know now, will likely to change as we know more- BA>>

Will This Make Me an Addict?

In General Health, Uncategorized on November 22, 2019 at 4:24 pm

The risk of addiction after a short course of opioids for acute pain is poorly understood. To quantify the risk of ongoing opioid use after a single prescription in the emergency department (ED), researchers prospectively enrolled adult opioid-naive patients with new-onset acute pain who were prescribed an opioid and discharged from the ED. Follow-up was performed at 6 months via telephone call, chart review, and review of a statewide prescription database. Among 484 patients enrolled at two EDs, average age was 46 years and the median pain duration was 2 days. Most patients (88%) were low risk for opioid misuse based on the Opioid Risk Tool. Oxycodone-acetaminophen was the most common opioid prescription (77%). Overall, 102 patients (21%) filled at least one additional opioid prescription within 6 months (the primary outcome). “Persistent opioid use,” defined as at least six prescriptions during the 6-month follow up, occurred in five patients (1%). Of patients with persistent opioid use, prescription frequency decreased over the 6-month follow up period.

Citation:  Friedman BW et al. Opioid use during the six months after an emergency department visit for acute pain: A prospective cohort study. Ann Emerg Med 2019 Nov 1; [e-pub]. (https://doi.org/10.1016/j.annemergmed.2019.08.446)

 

Summary appeared in NEJM- Journal Watch

Comments: This question comes up quite often; patients may even endure pain for fear of  potential addiction; here is a good, but not great, answer; still 1% met the authors’ definition of persistent opioid use. Patients’ awareness and physician watchful attention are needed to make this practice lower- BA

Hold the Popcorn!

In General Health, Kids & teens on November 22, 2019 at 4:07 pm

Although electronic cigarettes (e-cigarettes) were initially marketed as a potential smoking-cessation aid and a safer alternative to smoking, the long-term health effect of e-cigarette use (“vaping”) is unknown. Vaping e-liquids expose the user to several potentially harmful chemicals, including diacetyl, a flavoring compound known to cause bronchiolitis obliterans (inflammatory obstruction of the lung’s tiniest airways, called bronchioles. The bronchioles become damaged and inflamed by chemical particles or respiratory infections) with inhalational exposure (“popcorn worker’s lung”- described from a number of workers in factories making microwave popcorn developed “popcorn lung” after inhaling the flavoring chemical diacetyl, which is also used in e-liquids ). Here is a case reported by Canadian physicians,  of a 17-year-old male youth who presented with intractable cough, progressive dyspnea (difficult or labored breathing)  and malaise after vaping flavored e-liquids and tetrahydrocannabinol(one of at least 113 cannabinoids identified in cannabis. THC is the principal psychoactive constituent of cannabis) intensively.  He required intubation (a procedure by which a tube is inserted through the mouth down into the trachea – the large airway from the mouth to the lungs), invasive mechanical ventilation and venovenous extracorporeal membrane oxygenation (ECMO) for refractory hypercapnia (a condition of abnormally elevated carbon dioxide (CO2) levels in the blood. Carbon dioxide is a gaseous product of the body’s metabolism and is normally expelled through the lungs). The patient’s condition improved with high dose corticosteroids. He was weaned off ECMO and mechanical ventilation, and discharged home after 47 days in hospital. Several months after hospital discharge, his exercise tolerance remained limited and pulmonary function tests showed persistent, fixed airflow obstruction with gas trapping. The patient’s clinical picture was suggestive of possible bronchiolitis thought to be secondary to inhalation of flavoring agents in the e-liquids, although the exact mechanism of injury and causative agent are unknown. They concluded that this  case of severe acute bronchiolitis, causing near-fatal hypercapnic respiratory failure and chronic airflow obstruction in a previously healthy Canadian youth, may represent vaping-associated bronchiolitis obliterans. This novel pattern of pulmonary disease associated with vaping appears distinct from the type of alveolar injury predominantly reported in the recent outbreak of cases of vaping associated pulmonary illness in the United States, underscoring the need for further research into all potentially toxic components of e-liquids and tighter regulation of e-cigarettes.

Source:  Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele and Karen J. Bosma CMAJ November 20, 2019 cmaj.191402; DOI: https://doi.org/10.1503/cmaj.191402

Summary reported in NEJM_ Journal Watch

Comments:  Yet another one!_BA

Testosterone Therapy and Blood Clots

In General Health on November 20, 2019 at 9:34 pm

Results from a study published in JAMA Internal Medicine on November 11,2019 was designed  assess whether short-term testosterone therapy exposure is associated with increased short-term risk of venous thromboembolism (VTE or blood clots in veins) in men with and without evidence of hypogonadism.

This case-crossover study analyzed data on 39 622 men from January 1, 2011, to December 31, 2017, with 12 months of follow-up. Men with VTE cases who were free of cancer at baseline and had 12 months of continuous enrollment before the VTE event were identified by International Classification of Diseases codes. Men in the case period were matched with themselves in the control period. Case periods of 6 months, 3 months, and 1 month before the VTE events were defined, with equivalent control periods (6 months, 3 months, and 1 month) in the 6 months before the case period. A total of 39 622 men (mean [SD] age, 57.4 [14.2] years) were enrolled in the study, and 3110 men (7.8%) had evidence of hypogonadism. In age-adjusted models, testosterone therapy use in all case periods was associated with a higher risk of VTE in men with (odds ratio [OR], 2.32; 95% CI, 1.97-2.74) and without (OR, 2.02; 95% CI, 1.47-2.77) hypogonadism. Among men without hypogonadism, the point estimate for testosterone therapy and VTE risk in the 3-month case period was higher for men younger than 65 years (OR, 2.99; 95% CI, 1.91-4.68) than for older men (OR, 1.68; 95% CI, 0.90-3.14), although this interaction was not statistically significant (P = .14).Conclusions   Testosterone therapy was associated with an increase in short-term risk for VTE among men with and without hypogonadism, with some evidence that the association was more pronounced among younger men. These findings suggest that caution should be used when prescribing testosterone therapy.

 

Source:

JAMA Intern Med. Published online November 11, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5135
Comment: this a retrospective study done by reviewing ,medical record; the cohort is a mix bag in causes, ages and no mentioning of treatment doses; these caveats should be considered when looking at this possibly important finding- need better studies- BA

HIV Treatment & Weight Gain

In General Health, HIV on November 14, 2019 at 5:44 pm

Following initiation of antiretroviral therapy (ART), many people with HIV gain weight as part of their “return to health.” However, certain antiretroviral medications, including integrase inhibitors, are associated with greater weight gain than others. Now, a manufacturer-sponsored pooled analysis of eight of the sponsor’s trials sheds light on risk factors for this weight gain.

Among 5680 people enrolled in randomized trials of initial ART between 2003 and 2015, median weight increase by week 96 was 2.0 kg. Risk factors for greater weight gain included lower baseline CD4 cell count, higher baseline HIV RNA, black race, and female sex. Participants taking integrase inhibitors (INSTIs) gained more weight than those receiving nonnucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors. Among INSTIs, weight gain was greater with bictegravir and dolutegravir than with elvitegravir/cobicistat (4.24, 4.07, and 2.72 kg, respectively). Among NNRTIs, weight gain was greater with rilpivirine than with efavirenz (3.01 vs. 1.7 kg). Among nucleoside reverse transcriptase inhibitors, weight gain was greater with tenofovir alafenamide than with abacavir, tenofovir disoproxil fumarate, or zidovudine (4.25, 3.08, 2.07, and 0.39 kg, respectively). Extreme weight gain (≥10% increase) occurred in 13% of participants in the first 48 weeks and had risk factors similar to those for weight gain overall.

Appeared in NEJM Journal Watch- edited

Citation: Sax PE et al. Weight gain following initiation of antiretroviral therapy: Risk factors in randomized comparative clinical trials. Clin Infect Dis 2019 Oct 14; [e-pub]. (https://doi.org/10.1093/cid/ciz999)

 

Comments: HIV infection is often associated with weight loss, particularly if left untreated after the initial infection and that has been thought to be through a mechanism that involves TNF-alpha; now with earlier detection and treatment we see less of wasting; however , newer medications have been reported to be associated with undesirable weight gain; treators have remarked on this and discussed it in meetings; this is the first study to look prospectively at this phenomenon.  Specific integrase inhibitors and tenofovir alafenamide were associated with greater increases than other ART drugs. Unfortunately, the two most effective integrase inhibitors are associated with higher weight gain than the less robust one-


Eat Meat – really?

In General Health on November 6, 2019 at 12:07 am

Current dietary guidelines implicate unprocessed red meat and processed meat in conferring adverse cardiovascular (CV) and cancer outcomes. However, these guidelines all have one or more limitations (conflict of interest for the authors; observational studies and not clinical trials [RCT]; other factors affecting outcome)

In this new guideline, an independent panel (Sponsoring Organization: Nutritional Recommendations (NutriRECS) international consortium) addresses each of these limitations, using findings from five comprehensive meta-analyses:  One meta-analysis included all randomized, controlled trial (RCT) evidence, three others included data from all observational studies with >1000 participants, and one concerned participants’ values and preferences about meat consumption. The panel’s evaluation produced the following summary results:

  1. Meta-analysis of the 12 RCTs showed no significant difference between patients who consumed higher versus lower quantities of red meat during longer than 10 years of follow-up for the outcomes of all-cause mortality, CV-related mortality, CV disease, or cancer-related mortality, including colorectal cancer.
  2. The observational studies showed that, for every 100 people who reduced processed or unprocessed meat intake by 3 servings per week, roughly 1 person avoided death and 1 person avoided a diagnosis of diabetes during 11 years of follow-up.

A panel suggests that adults may continue to consume unprocessed red meat and processed meat without incurring excess health risks.

Citation(s):

Johnston BC et al. Unprocessed red meat and processed meat consumption: Dietary guideline recommendations from the Nutritional Recommendations (NutriRECS) Consortium. Ann Intern Med 2019 Oct 1; [e-pub]. (https://doi.org/10.7326/M19-1621)

Appeared in NEJM Journal Watch: October 24,2019

Comments: These recommendations are actually weak and panel stated they are based on “low-certainty evidence”. Until there is better RCTs with less inherent biases(s), take these meats with a grain of salt-BA

Six teaspoon of added sugar, no more!

In General Health, Heart, Kids & teens on August 23, 2016 at 8:00 pm

The American Heart Association now recommends that children limit their added sugar intake to 25 g daily or less, the equivalent of 6 teaspoons of sugar, or 100 calories. On average, children currently consume about 80 g daily.

Some definitions are needed here:

Sugar: Although commonly used more broadly, the US Federal Drug Administration defines the term sugar as a sweet ,crystalline substance, obtained chiefly from the juice of the sugarcane and the sugar beet.

Total Sugars: The term total sugars is used conventionally to describe the monosaccharides: glucose, galactose, and fructose, as well as the disaccharides sucrose, lactose, maltose, and trehalose (sunflower seeds, shiitake/mushroom, oyster). Total sugars include all sugars in a food or beverage from any source, including those naturally occurring (such as fructose in fruit and lactose in milk) and those added to foods.

Naturally occurring Sugars include those that are an innate component of foods (eg, fructose in fruits and vegetables and lactose in milk and other dairy products).

Extrinsic and Intrinsic Sugars terms originated from the UK Department of Health.  Intrinsic sugars are defined as sugars that are present within the cell walls of plants (eg, naturally occurring sugars)  and are always accompanied by other nutrients. Extrinsic sugars are those not located within the cellular structure of a food and are found in fruit juice, honey, and syrups and added to processed foods. The term non- milk extrinsic sugars is used to differentiate lactose- containing extrinsic sugars from all  others  because the metabolic response for the 2 types of sugars differs  substantially.

Free Sugars a term used by the World Health Organization that refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook, and consumer (eg, added sugars) plus sugars naturally present in honey, syrups, and fruit juices (eg, non-milk extrinsic sugars).

The Risk:

  1. Excess weight gain and obesity
  2. Elevated blood pressure and uric acid levels
  3. Dyslipidemia
  4. Nonalcoholic fatty liver disease and
  5. Insulin resistance and diabetes mellitus.

Data source: They  used publicly available data from the most recent cycles of the National health and Nutrition Examination Survey ( NHANES)  (2009–2012) to estimate current levels of added sugars intake. These estimates may be conservatively low because it is well established that self-reported dietary assessments under report. Their analysis demonstrates that US children 2 to 19 years of age consume an average of 80 g added sugar daily . Absolute intake is higher among boys than girls (87 versus 73 g), but there were no differences when intake was assessed in relation to total energy intake (16.1% for both). Added sugars intake increases with age . Intake of free sugars, the combination of added sugars and sugars that occur naturally in honey, syrups, and juices, is 91 g and 18.5% total energy. Foods and beverages each contribute half of the added sugars in children’s diets, 40 g each. The top contributors to added sugars intake include soda, fruit- flavored and sports drinks, and cakes and cookies. Previous research has suggested that most added sugars are consumed at home rather than away from home.

Sobering findings: 

  1. Children consuming 3.5% to 6.8% of calories as sucrose (the lowest consumption group) had lower triglycerides and higher High density lipoprotein(HDL) than higher consumers.
  2. Children consuming no sugar-sweetened- beverages (SSBs) such as sodas,  compared with those consuming an average of 8 oz/d had lower C-reactive protein, smaller waist circumference, and higher HDL cholesterol.
  3. Each additional Sugar- sweetened beverages (SSB) equivalent (≈1 cup or 8 oz) consumed by children daily was associated with a 5% increase in Homeostatic model assessment and insulin resistance (HOMA-IR – , a method used to quantify insulin resistance and beta-cell function) 16-mm increase in systolic blood pressure, a 0.47-cm increase in waist circumference, a 0.90-percentile increase in BMI for age, and a 0.48-mg/dL decrease in HDL concentrations. The low consumers in this analysis consumed a mean of 0.1 oz of SSBs per day.
  4. Adolescents who consumed >10% of their total energy as added sugars had lower HDL levels, higher triglycerides, and higher low-density lipoprotein cholesterol levels than those who consumed less. Overweight or obese adolescents had higher insulin resistance (as assessed with HOMA-IR).

They concluded,  the available evidence found that associations with increased cardio-vascular disease (CVD) risk factors are present at levels far below US children’s current added sugars consumption levels. Current evidence supports the associations of added sugars with increased energy intake, increased adiposity (severe or morbid overweight), increased central adiposity, and increased dyslipidemia (elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein level that contributes to the development of atherosclerosis) , all of which are demonstrated CVD risk factors. Importantly, the introduction of added sugars during infancy appears to be particularly harmful and should be avoided. Although added sugars can mostly likely be safely consumed in low amounts as part of a healthy diet, little research has been done to establish a threshold between adverse effects an health, making this an important future research topic.

Summary appeared in JWatch, August 23 2016

Citation: published ahead of print

http://dx.doi.org/10.1161/CIR.0000000000000439

Comments: This is my review of the paper. The conclusions are: Children and adolescents should limit their intake of sugar-sweetened beverages (like sodas) to one 8-oz serving per week, or less, and for those under 2 years of age, added sugars should be avoided entirely_BA

 


Potatoes are bad food; really?

In General Health on June 15, 2016 at 1:30 am

In 2015, and on the basis of an Institute of Medicine report requested by Congress, the restriction on white potatoes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), was lifted;   The rationale for removing these limitations on potatoes included their high potassium content and appropriate potassium intake is associated with diminished risk for hypertension,  furthermore , there was insufficient evidence of their health effects. On the international front, the World Health Organization does not include potatoes as vegetables. Although potassium supplementation may be beneficial for chronic disease prevention, in particular prevention of hypertension, a six week feeding trial of 164 pre-hypertensive and hypertensive people found that diets rich in protein or monounsaturated fat reduced blood pressure compared with diets rich in carbohydrates. Because potatoes are high in both glycemic carbohydrates and potassium, their effect on risk of hypertension is unclear.

To assess the relation between potato intake and hypertension, researchers pooled data from three prospective cohort studies,  Nurses’ Health Study (NHS; n=121 700 women, aged 30-55 at the time of cohort inception in 1976), the Nurses’ Health Study II (NHS II; n=116 430 women, aged 25-42 at cohort inception in 1989), and the Health Professionals Follow-up Study (HPFS; n=51 529 men, aged 40-75 at cohort inception in 1986), and adjusted for many potential confounding variables (e.g., age, ethnicity, body-mass index, smoking status, physical activity, medications). A diagnosis of hypertension by a health professional was self reported on the baseline and biennial questionnaires.

Of >187,000 participants without hypertension at baseline, 78,000 participants reported receiving diagnoses of hypertension during follow-up. Participants who consumed ≥1 serving daily of baked, boiled, or mashed potatoes or French fries had excess risk for hypertension compared with those who consumed ≤1 serving monthly (multivariate hazard ratio, 1.12). Similar results were obtained for consumption of baked, boiled, or mashed potatoes alone and consumption of French fries alone (≥4 servings weekly vs. ≤1 serving monthly). However, potato chip consumption alone was not associated with increased risk.

Citation(s):Borgi L et al. Potato intake and incidence of hypertension: Results from three prospective US cohort studies. BMJ 2016 May 17; 353:i2351. (http://dx.doi.org/10.1136/bmj.i2351)

Appeared in NEJM Journal Watch 6/9/2016.
Comments: We generally eat potatoes with salt; could that play a role? However, potatoes chips (lots of salt!) was not associated with increased risk _ There is a lot of explaining to be done_ I am not stopping my potatoes, yet! but I am certainly cutting back_ that’s one person’s opinion_BA

 


Not all statins are equal

In General Health, Heart on September 13, 2013 at 7:57 pm

Because statins lower the incidence of adverse cardiovascular and cerebrovascular events — even in low-risk patients — they are used broadly. Statins’ reported adverse effects include myalgias (muscle pain) , myopathy(muscle disease), rhabdomyolysis (muscle damage / breakdown), transaminitis (elevated liver enzymes) , and diabetes mellitus. In a meta-analysis of 135 randomized trials (247,000 participants) that involved seven statins (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin [Crestor], simvastatin, and pitavastatin [Livalo]), investigators evaluated adverse effects associated with statins overall and individually. The overall rate of statin discontinuation owing to adverse effects was low (6%) for all statins combined. Statins as a class caused no more medication discontinuations, myalgias, creatinine kinase elevations, myopathy, rhabdomyolysis, or cancer than placebo. However, statins significantly increased relative risk for transaminase elevations (by 50%; baseline incidence, 1%) and diabetes (by 9%) compared with placebo. Simvastatin( Zocor)  and pravastatin(Pravachol)  were associated with best overall tolerability and lowest discontinuation rates. Compared with controls, atorvastatin( Lipitor) and rosuvastatin (Crestor)  were associated with the highest discontinuation rate because of adverse events; whereas atorvastatin (lipitor) and fluvastatin( LesCol)  were associated with higher risks for transaminase elevations (odds ratios, 2.6 and 5.2, respectively). Higher doses of all statins were associated with higher risk for transaminase elevations. Although low doses of simvastatin (Zocor) appeared to be safest, daily doses >40 mg significantly raised risk for creatinine kinase elevation (OR, 4.1) and transaminase elevation (OR, 2.8).

Appeared in NEJM Journal Watch

Source: Naci H et al. Comparative tolerability and harms of individual statins: A study-level network meta-analysis of 246 955 participants from 135 randomized, controlled trials. Circ Cardiovasc Qual Outcomes 2013 Jul; 6:390. –

Comments: Useful analysis; choosing the safest statin is exceedingly important, particularly when we have significant side effects such as diabetes and elevated liver enzymes, and muscle problems. Unfortunately, we are often obligated to use other than the safest statins to achieve the desired effect on lipids, leading to the choice of the lesser of the two evils; this is certainly a discussion to have with the PCP _BA


Dude, you need Estrogen.

In General Health on September 13, 2013 at 7:32 pm
Androgen deficiency reduces muscle mass and strength in men; estrogen deficiency is associated with increase in fat mass; and deficiencies in both impair sexual function, according to an industry-supported study in the New England Journal of Medicine. Some 200 healthy men aged 20 to 50 years first received goserelin acetate for suppression of estradiol and testosterone. They were then randomized to various doses (0-10 g) of daily 1% testosterone gel for 16 weeks. Another cohort of 200 men were similarly treated and also given anastrozole daily to inhibit the aromatization of testosterone to estrogen, leading to an estrogen-deficient state.In the first cohort, patients who received low doses of testosterone saw increases in body fat percentages and reductions in lean mass. In the second cohort, the percentage of body fat increased in all groups as aromatization was blocked. In both cohorts, sexual desire declined and erectile dysfunction worsened with lower doses of testosterone.Source: Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men; N Engl J Med 2013; 369:1011-1022September 12, 2013DOI: 10.1056/NEJMoa1206168Comments: We should measure both hormones, firstly because they are related chemically, and now they appear to have separate functions.BTW Goserelin acetate (Zoladex) is an injectable gonadotropin releasing hormone superagonist (GnRH agonist), also known as a luteinizing hormone releasing hormone (LHRH) agonist.  Goserelin acetate is used to suppress production of the sex hormones (testosterone and estrogen), particularly in the treatment of breast and prostate cancer.(from Wikipedia)