Men's Health Lecture by Nelson Vergel


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Author and lecturer Nelson Vergel speaks about erectile dysfunction, testosterone replacement, nutrition, supplementation and exercise techniques for best health and performance.

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  • Low testosterone, or male hypogonadism, is associated with a number of signs and symptoms in the adult male. Loss of libido and erectile dysfunction are two hallmark symptoms of hypogonadism. 1,2 Mood and behavioral symptoms, namely depression, irritability, and loss of motivation, may also occur with low testosterone levels. Lethargy, or loss of energy, is also commonly seen in these men. 1 A deficiency of endogenous testosterone also has a deleterious effect on bone mass and is a risk factor for osteoporosis. Progressive decrease in muscle mass and muscle strength are also associated with low testosterone levels. 1,2 Some regression of secondary sexual characteristics, such as reduced ancillary and pubic hair, is observed, but voice, penis length, and prostate size remain unchanged. 2 Because hypogonadism is characterized by testicular dysfunction, production of sperm is impaired, resulting in oligospermia or even azoospermia, and many times hypogonadism is diagnosed as a result of fertility tests. 1,2 1.Tenover JL. Male hormone replacement therapy including "andropause." Endocrinol Metab Clin North Am. 1998;27:969-987. 2. Petak SM, Hypogonadism Task Force. AACE Clinical Practice Guidelines for the Evaluation and Treatment of Hypogonadism in Adult Male Patients. 1998. Available at: http://www/ hypogonadism.html. Accessed June 23, 2000.
  • Men's Health Lecture by Nelson Vergel

    1. 1.  Latest Advances in Men’s Health  Nelson Vergel Copyright © 2011 by Nelson Vergel
    2. 2. This information (and any accompanying printedmaterial) is not intended to replace the attention oradvice of a physician or other health care professional.Anyone who wishes to embark on any dietary, drug,exercise, or other lifestyle change intended to preventor treat a specific disease or condition should firstconsult with and seek clearance from a qualified healthcare professional.
    3. 3. Copies of these slides (plus a few more)are available free online at on the “Lectures” page
    4. 4. ObjectivesTo Review:– The most common causes of erectile dysfunction (ED) and its treatment options– Best ways to diagnose and treat testosterone deficiency– Best ways to increase lean body mass and decrease fat– Supplements backed by data– Nutrition and Exercise tipsQuestions and answers
    5. 5. ED Incidence20-30 million American men suffer EDAge dependent– 2% men age <40 years– 25% men age 65– 75% men >75 yearsNot a necessary occurrence of theaging process
    6. 6. An Erection Requires a Coordinated Interaction of Multiple Organ Systems Psychological Hormonal Vascular Neurologic
    7. 7. Cause of EDPsychogenic Causes:– Anxiety– Depression– Fatigue– Guilt– Stress– Marital Discord– Excessive alcohol consumption– Crystal Meth
    8. 8. Causes of EDOrganic Causes– Cardiovascular disease– Diabetes mellitus– Surgery on colon, bladder, prostate– Neurologic causes (lumbar disc, MS, CVA)– Hormonal deficiency
    9. 9. Causes of ED Risk Factors Massachusetts Male Aging Study¹Treated heart disease 39%Treated diabetes 28%Treated hypertension 15% ¹Feldman Ha, J Urol 1994; 151:54-61
    10. 10. Causes of EDMedication: Most common cause of ED in men >50 Many men are polymedicated Also have co-morbid conditions
    11. 11. Causes of EDMedications (cont.) Anti-hypertensive drugs – All capable – Common: thiazides and beta blockers – Uncommon: calcium channel blockers, alpha-adrenergic blockers, and ACE inhibitors
    12. 12. Causes of EDMedications (cont.) CNS drugs: – Antidepressants, tricyclics, SSRIs – Tranquilizers – Sedatives – Analgesics H1 and H2 receptor blockers
    13. 13. Treatment OptionsOral medications – PhosphodiesteraseType 5 Inhibitors (PDE-5): Viagra,Levitra, CialisUrethral suppositories (MUSE)Injection therapy - Caverject, Trimix,BimixVacuum constriction deviceSurgerySex therapy
    14. 14. Nonpharmacologic Treatment OptionsLifestyle changes: Reduce fat and cholesterol in diet Decrease or limit alcohol consumption Eliminate tobacco use and substance abuse Weight loss if appropriate Regular exercise
    15. 15. Medication Side Effects (PDE Inhibitors)Side effects: Headache Flushing Dyspepsia Nasal congestion Visual disturbances Back ache (Cialis)
    16. 16. Drugs Drug Onset of Duration Action of Activity Viagra 60 minutes 4-5 hours Levitra 30 minutes 4-5 hours Cialis* 15 minutes 36 hours* No food effect
    17. 17. Medication (PDE Inhibitors)Contraindications: Organic Nitrites: – Oral – Sublingual Severe cardiac disease – Obtain stress testing Careful with Norvir since it boosts PDE blood levels
    18. 18. Penile Injection TherapyCaverject, Edex, Tri/Bi-MixMechanism of action: smooth musclevasodilatorMonotherapy (protaglandin E1) or combinationof 2 or 3 agents (Papaverine+ Phentolamine +Alprostadil )Administration: 10, 20, 40ugInject directly into corporeal bodies of the penisResults: 70%-90%Dropout rates: 25%-60%Side effects: pain (36%), priapism (4%), fibrosis
    19. 19. Trimix (Papaverine+ Phentolamine + alprostadil)Available by prescription from compounding pharmacies
    20. 20. Signs and Symptoms of Low Testosterone  Loss of muscle mass and strength  Loss of libido and erectile dysfunction  Depression  Lethargy (fatigue, lack of focus)  Bone loss  Some regression of secondary sexual characteristics (body hair loss, etc)  Low or no sperm countTenover JL. Endocrinol Metab Clin North Am. 1998;27:969-987Petak SM, et al. AACE Clinical Practice Guidelines. Available at:
    21. 21. Hypothalamus
    22. 22. Testosterone and Aging
    23. 23. Testosterone Deficiency(Hypogonadism)• Normal levels in blood: Men... Total test. 300-1100 ng/dL, Free test. 5 - 21 ng/dL Women... Total test. 10-50 ng/dL Free test. 0.10-0.85 ng/dL• Symptoms of testosterone deficiency: Fatigue, low or lack of sex drive, poor appetite, loss of muscle mass & strength, depression
    24. 24. Testosterone Fractions in the Blood Free T 2% Albumin-bound T 38%T = testosterone SHBG-bound TOnly 2% is free 60%testosteroneand 98% is bound
    25. 25. (binds testosterone)
    26. 26. FinasterideAnastrozoleTamoxifen
    27. 27. The HPT Axis
    28. 28. TestosteroneReplacement Benefits Mental focus Stamina and Bone Strength Sexual function Lean Body Mass
    29. 29. Testosterone Options Gels BuccalInjections Gels Armpit lotion Axiron Pellets Patch New: Fortesta (2 % gel)
    30. 30. To Be Potentially Approved by the FDA in the Next 12-24 Months First FDA approved for womenTo be called Aveed in the US
    31. 31. Side Effect: Gynecomastia (breast enlargement in men)Treatment: Estrogen Blocker Medications or surgery (in worst cases)
    32. 32. Side Effect: Increased number of red blood cells (polycythemia) Watch out for hematocrit over 52 !Solution: Donate bloodor therapeutic phlebotomy (4-5 units every 3-4 months)
    33. 33. Side Effect: Testicular Shrinkage (atrophy)Treatment:Human Chorionic Gonadotropin(hCG)
    34. 34. Side Effect : Increased prostate size (benign prostatic hypertrophy)Prevention:Digital Rectal Exam (DRE)Prostatic Specific Antigen (PSA) blood test
    35. 35. Side Effect: AcneTreatment: Bezoyl Peroxide, salicilic acid lotions, soaps,showering after exercising, 20 min of sun a day, Zinc supplements
    36. 36. For More
    37. 37. COMPREHENSIVE APPROACH TO WELLNESS Stress ReductionMedications Nutrition Exercise
    38. 38. Protecting Your Heart
    39. 39. How To Minimize Heart Disease Do not smoke! Exercise and low animal fat/sugar diet Lose weight if you are overweight Manage stress and keep blood pressure in check Decrease triglycerides with Omega 3 fatty acids (cold water fish oils), low sugar intake, exercise. Improve HDL with Niacin 300-500 mg 3 x day. Start with lower dose to minimize “flushing” and take an aspirin 20 min before (Niaspan is the prescription grade) Soluble Fiber (oats, fiber supplemengts, etc) If everything else fails, use prescription lipid lowering agents (statins, fibrates, etc) A baby aspirin a day (81 mg) Keep healthy blood levels of testosterone and thyroid hormones.
    40. 40. Insulin Resistance: A Silent Health Threat Pre diabetesKeeping a healthy weight, exercising, low glycemic load diet, certain supplementsand medications can decrease Insulin resistance and glucose intolerance
    41. 41. Visceral Fat and Health
    42. 42. Potential Interventions for DecreasingAbdominal Fat (visceral adipose tissue-VAT)Diet- Lower carbohydrate diets, Mediterranean dietExercise- cardiovascular and resistance training- Somepilot data with good resultsAnti-diabetic drugs: Metformin (Glucophage)- conflictingand inconclusive dataTestosterone gel- subcutaneous fat loss onlyAnabolic steroids- Oxandrin, nandrolone?- limited VATdataHuman Growth HormoneHuman Growth Hormone Releasing Hormone- Sermorelinand Tesamorelin- Approved for the treatment of HIVrelated visceral fat accumulationSurgery- Liposuction of visceral fat very difficult and risky
    43. 43. How to Increase Lean Body MassHigher protein intake (whey, egg white proteinsupplements, lean meats, nuts, fish, eggs, etc)and more frequent snacking with right balance.More in nutrition sectionResistance exercise. More in exercise sectionTestosterone Replacement if neededGrowth Hormone replacementMedical use of oxandrolone and nandroloneCreatine SupplementationHealthy sleep habits
    44. 44. Supplements- Snake Oil?
    45. 45. Supplements- What Works?Niacin 1000-3000 mg/day– Increases good cholesterol (HDL). Caution with “flushing”. Take a baby aspirin 20 min before taking niacinSelenium– Glutathione production (anti-oxidant.) A study showed people who took 200 mcg/day had better immune functionCalcium Carbonate- 500-2000 mg/d– Bone protection, diarrhea controlVitamin D- Bone protection and other emergingbenefits (2000-4000 IU/d)SAMe (S-Adenosyl-L-Methionine) – energy,depression, liver detox
    46. 46. Supplements -Any data?Whey Protein 20-100 grams/day– Popular with bodybuilders. HIV study found compensatory response. People ate less food and no increased LBM was foundCreatine 5-15 grams/day– Muscle voluminizer, strength enhancer. Caution with diarrhea and kidney overload.Omega 3 oils (fish oils) 3000- 6000 mg/day– Decreases cholesterol/triglycerides, anti-inflammatory, mood stabilizer?L-Carnitine 1000-3000 mg/day– Helps use fat for energy, cell protection, lowers lipids, anti- catabolic, heart muscle protection, N-Acetyl Carnitine may restore nerve damage in neuropathyB Vitamins (100 mg each/day)- whole body processes,possible prevention of mitochondrial toxicity
    47. 47. Great Web Site to Find OutWhat Supplements to Trust
    48. 48. What Your Plate Should Look Like….
    49. 49. The ZONE &Modified Atkins South Beach Diets
    50. 50. Low- Fat vs Mediterranean vs Low-Carbohydrate Diets- Effect on Weight Loss
    51. 51. More Nutritional Tips • Shop the perimeter of the store • Do not skip breakfast (keep an eye on sugar and refined flower products!) • Try to eat several smaller meals or snacks instead of 2-3 large ones • Eat more almonds, walnuts, pecans and pistachios (good cholesterol lowering fats) • Eat fruits and vegetables of all colors • Avoid sweet drinks and fruits juices. Eat the fruit! • Eat a high protein, complex carbohydrate- rich meal after work outs • Get a slow cooker • Cook for the week and freeze
    52. 52. Nutritional Considerations• Reduce saturated (animal) fats, fried foods and hydrogenated oils• Eat omega-3 fish oil-rich foods- salmon, tuna, sardines or flax seed oil (alternative)• Use good fats: olive oil, nuts, avocados, flaxseed• Minimize sugar, fructose (sweets, sodas, foods with high fructose corn syrup )• Eat adequate amounts (0.7-1 gm/lb/day) of protein (fish, eggs, cottage cheese, lean meats, chicken, whey, yogurt, nuts, etc)
    53. 53. Best Protein SourcesBuilding block of muscle mass and food for theimmune systemDairy proteins - best is cottage cheese (casein),whey, yogurt… made to make mammals growbigger . Be careful with milk allergies/lactoseintoleranceWhole eggs are better than egg whiteFish - cold water fish like salmon and tunaLean beefChicken (no skin)Natural almond butter (no added hydrogenated oilsand fillers)Beans, rice - vegetarian diet requires goodknowledge of protein sources
    54. 54. Good Carbohydrates Bad Carbohydrates Provide energy and nutrientsBad carbs can worsen insulin resistance andtriglyceridesBad: Avoid/reduce high glycemic, high caloriecarbs – refined flour, especially milled grains,sugar, high fructose corn syrupGood: Eat more fiber, nutrient, and fluid-rich,low calorie, low glycemic carbs like: oatmeal,multi-grain breads, vegetables, fruits, roots,greens, wild rice and beans
    55. 55. Fat is not a Four Letter WordFats are needed for energy, immunefunction, vitamin absorption, andhormonesGood Fats - monounsaturated- Olive OilEssential Fatty Acids- polyunsaturatedOmega 3’s- cold water fish (salmon)Omega 6’s- high oleic sunflower oil, walnuts, almonds, pecans, avocadoOmega 3’s and 6’s- Flaxseed mealBad Fats -processed/hydrogenatedoils,margarine, artificial creamers, anyman-made oil, burned oils, rancid oils, lard
    56. 56. Grocery Shopping ListAlmonds and other nutsBeans and other legumesSpinach and other green leafy vegetablesLow fat dairy, yogurtHummusWhey proteinOatmealEggsLean meatsWhole grain breads and pastaPeanut, almond , cashew buttersOlive oil and avocadosRaspberries and all berries. Fruits (avoid fruit juices)One or two glasses of red wine per day (optional)Flaxseed , pumpkin and sunflower seedsSweet potatoes and wild riceGreen tea (optional)
    57. 57. Exercise, the Best Therapy for Most Health Problems
    58. 58. Exercise: The Best MedicineBenefits: ↓ total and abdominal fat improves insulin sensitivity improves glucose tolerance increases HDL cholesterol ↓ triglycerides and LDL increases muscle mass improves endurance improves strength improves bone density improves mood
    60. 60. Aerobic (Cardiovascular) ExerciseStart with a brisk walk every day if tiredConcentrate in low impact or no impactexercises (e.g. Elliptical Trainers)Do what you enjoy (bicycling, rollerskating, etc)Good for burning fat, triglycerides, bloodsugar, but it may decrease muscle mass20 - 30 minutes 3-4 times a week isenough for many people
    61. 61. Resistance ExerciseExercise using weighs, machines, your ownbodyWarm up by doing a light setLift maximum weight for muscular failure(exhaustion) at 8-12 repetitionsOne body part per weekOne hour sessions 3-4 times a weekThree sets per body partIf no access to a gym, start with crunches,push ups, and squats at home
    62. 62. Resistance Exercise Principles Safety First - Stop if if hurts! High Intensity - Momentary muscular failure to stimulate growth Recovery = Rest, nutrition, and time 2 - 3 warmup, 2- 3 heavy sets per exercise 45 to 60 minutes per session, 3 - 4 sessions per week. DO NOT OVERTRAIN!
    63. 63. Resistance Exercise Principles (continued)Major muscle group first when energy ishighestDo compound exercises first whileenergy is up. They affect the mosttissue/mass for quickest growth(squats, bench press)Secondary/ancillary muscles followImportant: Full range of motion -recruits/builds the most muscle mass
    64. 64. Resistance Exercise Principles (continued)Warm up sets: 50 - 60 % of theheavy weight you can lift 6-12timesHeavier sets: Weight you arecapable of lifting 6 - 12 times tomomentary muscular failureWhen strength increases so youcan do 12 reps, increase weight 5– 10 lbs so you can only lift about6-8 reps to momentary muscular
    65. 65. Best Exercise Sites with videos, etc www.MyFit.caIpod exercise routine downloads:
    66. 66. Final WordsThere are several life style modifications in your controlto stay healthy and in shape as you age to preventlean body mass and bone loss, sexual dysfunction, andheart disease.You do not have to accept sexual dysfunction as areality of aging. There are several treatment options!Find out your free testosterone and thyroid function ifyou have fatigue, sexual dysfunction, etc. Supplementif needed. Readjust the dose if you do not achieveoptimum levels.
    67. 67. Final WordsDo not waste your money and risk liver or medicationinteraction problems with unproven supplements. Supportthe New York buyers’ club.Combat loss of lean mass and increased fat withresistance and cardiovascular exercise 3 to 4 times a weekfor an hourDiet: Avoid sweets, hydrogenated oils, high fructose cornsyrup, animal fats and consume more fruits, vegetables,fish, lean meats, yogurt and nuts.An informed man helps his doctor to give him the best care
    68. 68. For More InformationMore details in ”Testosterone- A Man’s Guide” on Vergel –