Author Interviews, Endocrinology / 22.01.2016

MedicalResearch.com Interview with: Marita Teng, MD Associate Professor of Otolaryngology Head and Neck Institute Icahn School of Medicine at Mount Sinai MedicalResearch.com Editor's note: January is Thyroid Awareness Month. In recognition, Dr. Teng discusses the thyroid gland's important role in the production of  hormones that help the body regulate its metabolism.  Dr. Teng also discusses the recognition of thyroid nodules and cancer. MedicalResearch: What does the thyroid gland do?  Why is it important for health? Dr. Teng: The thyroid gland produces thyroid hormone, which is carried through the circulation to the other organs in the body.  Thyroid hormone is responsible for the body’s metabolism, and therefore maintains functions such as keeping the body warm, and properly use the energy we derive from food. MedicalResearch: What is are some signs or symptoms of an underactive or overactive thyroid? Dr. Teng: Thyroid overactivity (hyperactivity) results in heat intolerance, weight loss, rapid heartbeat, nervousness, increased appetite, difficulty sleeping, skin thinning, and hair loss, among other symptoms.  Thyroid underactivity (hypothyroidism) causes fatigue, weight gain, cold sensitivity, slowed heart rate, depression, memory impairment, and weakness, among other symptoms.  It should be noted that these symptoms are all nonspecific and can certainly be caused by other medical conditions as well. (more…)
Author Interviews, Endocrinology, OBGYNE, Pediatrics / 19.01.2016

More on Obgyne on MedicalResearch.com MedicalResearch.com Interview with: Sandra Schulte (candidate Medicine) University Hospital Bonn Dept. Ped. Endocrinology and Diabetology MedicalResearch: What is the background for this study? What are the main  findings? Response: Low birth weight, unfavourable intrauterine conditions and post-natal catch-up-growth are associated with impaired growth, accelerated pubertal maturation and metabolic disturbances later in life. However, normally, study designs cannot rule out the influence of different genetic backgrounds and familiar environments between their subjects and control groups. Therefore, we recruited a very special study cohort, solely composed of monozygotic twins. These twins had significant differences in birthweight, due to twin-to-twin-transfusion-syndrome (TTTS). Because of irregular placental anastomoses, one twin, the recipient, receives more blood becoming hypertensive and polyuric, leading to polyhydramnios and ultimately congestive heart failure and hydrops fetalis. In contrast, the donor twin becomes hypovolemic, hypotensive and oliguric, leading to oligohydramnios and growth restriction. We followed 30 pairs of these twins regularly from birth up to this current follow-up at a mean age of 14.6 years, to examine the impact of a lower birthweight on auxologic development and pubertal maturation later in life. (more…)
Author Interviews, Brigham & Women's - Harvard, Colon Cancer, Dermatology, Nature, Testosterone / 14.01.2016

More on Colon Cancer on MedicalResearch.com MedicalResearch.com Interview with: Dr. Nana Keum, PhD Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Keum: Male pattern baldness, the most common type of hair loss in men, is positively associated with androgens as well as IGF-1 and insulin, all of which are implicated in pathogenesis of colorectal neoplasia.  Therefore, it is biologically plausible that male pattern baldness, as a marker of underlying aberration in the regulation of the aforementioned hormones, may be associated with colorectal neoplasia.  In our study that examined the relationship between five male hair pattern at age 45 years (no-baldness, frontal-only-baldness, frontal-plus-mild-vertex-baldness, frontal-plus-moderate-vertex-baldness, and frontal-plus-severe-vertex-baldness) and the risk of colorectal adenoma and cancer, we found that frontal-only-baldness and frontal-plus-mild-vertex-baldness were associated with approximately 30% increased risk of colon cancer relative to no-baldness.  Frontal-only-baldness was also positively associated with colorectal adenoma. (more…)
Author Interviews, Depression, Hormone Therapy, JAMA, Menopause / 08.01.2016

MedicalResearch.com Interview with: Eleni Petridou, MD, MPH, PhD Marios K. Georgakis, MD Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens, Greece Medical Research: What is the background for this study? Response: Previous epidemiologic studies have shown that women during their reproductive life are more vulnerable (by a factor of two) to depression than men; this has been particularly evident during peaks of intense fluctuations of ovarian hormones, like the premenstrual, perimenopausal and postpartum periods. Endogenous (natural) female sex hormones, however, have been shown in various experimental studies to possess neuroprotective and anti-depressive properties. Production of these hormones is diminished after menopause; therefore, age at menopause can be used as a proxy of the lifetime exposure to endogenous hormones. Our research hypothesis was whether longer exposure to endogenous sex hormones has a cumulative anti-depressive action, i.e., whether later age at menopause decreases the risk for postmenopausal depression. (more…)
Author Interviews, Blood Clots, Endocrinology, Hormone Therapy, Pharmacology / 07.01.2016

MedicalResearch.com Interview with: Ida Martinelli MD, PhD A Bianchi Bonomi Hemophilia and Thrombosis Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy  Medical Research: What is the background for this study? What are the main findings? Dr. Martinelli: Hormonal therapies are associated with an increased risk of venous thromboembolism. Patients with acute deep-vein thrombosis or pulmonary embolism require anticoagulation, but women of childbearing potential require also an adequate contraception, as oral anticoagulants cross the placenta potentially leading to embryopathy or fetal bleeding. This study was aimed to evaluate the safety of hormonal therapies together with anticoagulant therapies in terms of recurrent venous thrombosis and uterine bleeding. We demonstrated for the first time that women who take oral anticoagulants can safely use hormonal therapies, as their risk of recurrent venous thromboembolism or uterine bleeding is not increased. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Surgical Research, Testosterone / 04.01.2016

MedicalResearch.com Interview with: Quoc-Dien Trinh MD Assistant Professor, Harvard Medical School Brigham and Williams Hospital  Medical Research: What is the background for this study? What are the main findings? Dr. Trinh: Among elderly Medicare beneficiaries with metastatic prostate cancer, surgical castration is associated with lower risks of any fractures, peripheral arterial disease, and cardiac-related complications compared to medical castration using GnRH agonists. (more…)
Author Interviews, Dermatology, Endocrinology, UCSF / 27.12.2015

MedicalResearch.com Interview with: Kanade Shinkai, MD PhD Associate Professor of Clinical Dermatology Director, Residency Program Endowed Chair in Dermatology Medical Student Education UCSF Department of Dermatology San Francisco, CA 94115  Medical Research: What is the background for this study? What are the main findings? Dr. Shinkai: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in the United States that has important skin manifestations including acne, hair loss, hirsutism, and acanthosis nigricans. We performed a retrospective cross-sectional study of women referred to a multidisciplinary PCOS clinic at UCSF to determine whether skin findings and systemic associations differ between women who meet diagnostic criteria for PCOS versus those suspected of having PCOS but do not meet diagnostic criteria. We found that women with PCOS commonly have skin findings, however, present across a broad spectrum of cutaneous manifestations. Comparing the skin findings in women who meet diagnostic criteria for PCOS with women who are suspected of having PCOS suggests that it can be very difficult to distinguish a patient with PCOS based on skin findings alone.  Hirsutism and acanthosis nigricans are the most helpful findings to suggest PCOS and require a comprehensive skin examination to diagnose; acne and androgenic alopecia are common findings but do not differentiate. The finding of hirsutism and acanthosis were associated with important systemic abnormalities including elevated free testosterone levels, insulin resistance, obesity, and dyslipidemia. This is the first study to perform systematic comprehensive skin exams on women with PCOS and link the skin findings to key systemic associations that have significant implications for the treatment and prognosis of women with the disease. (more…)
Author Interviews, Endocrinology, Kidney Disease, Transplantation, Vitamin K / 21.12.2015

MedicalResearch.com Interview with: Josep M Cruzado, MD Head, Nephrology Department Hospital Universitari de Bellvitge  Medical Research: What is the background for this study? What are the main findings? Dr. Cruzado: Tertiary hyperparathyroidism is frequent after renal transplantation. Inappropriately high parathyroid hormone levels are associated with hypercalcemia, hyperphosphatemia, both allograft and vascular calcification and bone mineral density loss. Cinacalcet is highly effective to control hypercalcemia in this setting although there were no studies comparing cinacalcet with subtotal parathyroidectomy. Main findings are that subtotal parathyroidectomy is superior to cinacalcet in normalizing hypercalcemia amb iPTH, increased bone mineral density at femoral neck and is more cost effective (the cost of subtotal parathyroidectomy is equal to 14 months of cinacalcet and this drug should be maintained overtime). (more…)
Author Interviews, Brigham & Women's - Harvard, JCEM, Thyroid, Thyroid Disease / 14.12.2015

MedicalResearch.com Interview with: Dr. Erik K. Alexander, MD FACP Chief, Thyroid Section, Division of Endocrinology Brigham & Women's Hospital Associate Professor of Medicine, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Alexander: Thyroid nodular disease has become an increasingly common medical illness, with prevalence reported to range between 26-67% in the adult.  Though advancing age is known to influence the formation of thyroid nodules, their precise relationship remains unclear.  Furthermore, it is uncertain whether age influences the risk that any thyroid nodule may prove cancerous.  Thus we conducted a study to determine the impact of patient age on nodule formation, the number of thyroid nodules, and risk of thyroid malignancy. Medical Research:  What are the main findings? Dr. Alexander: Our study is a prospective cohort analysis of consecutive adults who presented for evaluation of nodular disease from 1995-2011 at Brigham and Women’s Hospital, Boston, MA.  6,391 patients underwent thyroid ultrasound and fine needle aspiration that resulted in 12,115 thyroid nodules ≥1 cm.  Patients were stratified into six age groups and compared using sonographic, cytologic, and histologic endpoints. We found that the prevalence of thyroid nodular disease increases with advancing age.  The mean number of nodules at presentation increased from 1.5 in the youngest cohort (ages 20–30) to 2.2 in the oldest cohort (>70 years).  In contrast, the risk for malignancy in a newly identified nodule declined with advancing age.  Thyroid cancer incidence per patient was 22.9% in the youngest cohort, but 12.6% in the oldest cohort.  Despite a lower likelihood of malignancy, identified cancers in older patients demonstrated a more aggressive cancer subtype.  While nearly all malignancies in younger patients were well-differentiated, older patients were more likely to have higher risk papillary thyroid cancer variants, poorly differentiated cancer, or anaplastic carcinoma. (more…)
Alzheimer's - Dementia, Author Interviews, Journal Clinical Oncology, Prostate Cancer, Testosterone, University of Pennsylvania / 10.12.2015

MedicalResearch.com Interview with: Kevin T. Nead, MD, MPhil Dept. of Radiation Oncology Perelman School of Medicine University of Pennsylvania MedicalResearch: What is the background for this study? What are the main findings? Dr. Nead: There are a growing number of studies suggesting that the use of  Androgen Deprivation Therapy (ADT)  may be associated with cognitive changes and some of these changes overlap with characteristic features of Alzheimer’s disease. In addition, low testosterone levels have been associated with Alzheimer’s disease risk and ADT lowers testosterone levels. Despite these findings, we could not identify any studies examining the association between ADT and Alzheimer’s disease risk. We therefore felt this study could make an important contribution in guiding future research to fully understand the relative risks and benefits of ADT. We examined electronic medical record data from Stanford University and Mt. Sinai hospitals to identify a cohort of 16,888 patients with prostate cancer. We found that men with prostate cancer who received Androgen Deprivation Therapy were more likely to develop Alzheimer’s disease than men who did not receive  Androgen Deprivation Therapy. We also found that this risk increased with a longer duration of ADT. These results were consistent using multiple statistical approaches and separately at both Stanford and Mr. Sinai. (more…)
Author Interviews, Cancer Research, Endocrinology, Journal Clinical Oncology, Menopause, NIH / 07.11.2015

MedicalResearch.com Interview with: Elizabeth K. Cahoon, PhD Radiation Epidemiology Branch Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health Department of Health and Human Services Bethesda, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cahoon: Although basal cell carcinoma (BCC) is the most common cancer in the United States, there is relatively little research on risk factors since few population-based cancer registries do not capture information on this malignancy. Sun exposure (in particular ultraviolet radiation) is the primary risk factor for basal cell carcinoma, but less is known about other factors that may affect this risk. A previous study found a relationship between menopausal hormone therapy (MHT) use and increased risk of BCC in a population of Danish women. In our study we looked to see if factors related to estrogen exposure from multiple sources was associated with basal cell carcinoma risk in a large, nationwide, prospective study. These included use of oral contraceptives or menopausal hormone therapy, but also reproductive factors (like age at menarche and menopause). We observed that women who experienced natural menopause later in life were more likely to develop basal cell carcinoma compared to women who had natural menopause at a younger age. In addition, women who reported using menopausal hormone therapy for one year or longer were more likely to develop basal cell carcinoma compared to women who did not report MHT use. Women who reported natural menopause and menopausal hormone therapy use for 10 or more years had the highest risk of basal cell carcinoma, compared to women with no menopausal hormone therapy use. (more…)
Author Interviews, Endocrinology, Exercise - Fitness, Heart Disease, Vitamin D / 03.11.2015

Dr Emad Al-Dujaili Reader in Biochemistry and Nutrition, Queen Margaret University Department of Health Science Queen Margaret UniversityMedicalResearch.com Interview with: Dr Emad Al-Dujaili Reader in Biochemistry and Nutrition, Queen Margaret University Department of Health Science Queen Margaret University Medical Research: What is the background for this study? What are the main findings? Dr. Al-Dujaili: Recent studies have implicated vitamin D deficiency as a risk factor for Cardiovascular disease and its deficiency is a potential biological predictor of increased rates of CVD. We have done 2 earlier studies investigating the effects of Vitamin D intake on Blood pressure and the stress hormone level cortisol and found that people taking the supplement of Vitamin D had reduced systolic and diastolic blood pressure compared to those who took the placebo. Vitamin D deficiency has also been associated with hypertension, obesity, diabetes mellitus and oxidative stress and reduced exercise performance. For instance, the Framingham offspring study proved that low levels of vitamin D are independently related to Cardiovascular disease incidence. In this placebo-controlled study, We have observed that people given 50ug of Vitamin D daily for 2 weeks showed a significantly reduced systolic and diastolic blood pressure, reduced urinary free cortisol (the hormone that produces stress and high blood pressure if its levels are high. Moreover, the distance cycled in 20 minutes significantly increased by 30% with slightly less efforts compared with that before Vitamin D supplement. (more…)
Author Interviews, Endocrinology, Genetic Research, Weight Research / 22.10.2015

Urszula T. Iwaniec, Ph.D. Associate Professor Skeletal Biology Laboratory School of Biological and Population Health Sciences Oregon State University Corvallis, OR 97331MedicalResearch.com Interview with: Urszula T. Iwaniec, Ph.D. Associate Professor Skeletal Biology Laboratory School of Biological and Population Health Sciences Oregon State University Corvallis, OR 97331 Medical Research: What is the background for this study? What are the main findings? Dr. Iwaniec: Excessive weight gain in adults is associated with a variety of negative health outcomes. Unfortunately, dieting, exercise, and pharmacological interventions have had limited long-term success in weight control and can result in detrimental side effects, including accelerating age-related bone loss.  Leptin, a hormone produced by fat cells plays an essential role in weight regulation. Delivery of leptin directly into the hypothalamus by gene therapy normalizes body weight. We investigated the efficacy of using hypothalamic leptin gene therapy as an alternative method for reducing weight in skeletally-mature female rats and determined the impact of leptin-induced weight loss on bone. Our findings show that hypothalamic leptin gene therapy reduced body weight with minimal effects on bone mass or microarchitecture. (more…)
Author Interviews, Cancer Research, Endocrinology, JAMA, Menopause / 05.10.2015

Rodrigo R. Munhoz, MD Hospital Sírio Libanês São Paulo, Brazil MedicalResearch.com Interview with: Rodrigo R. Munhoz, MD Hospital Sírio Libanês São Paulo, Brazil  Medical Research: What is the background for this study? What are the main findings? Dr. Munhoz:  Chemotherapy-induced early menopause and its impact on quality of life is clinically relevant issue that often arises during the treatment with curative intent of premenopausal patients with early breast cancer. The use of neo-/adjuvant chemotherapy is associated with risks of ovarian dysfunction, permanent or transient amenorrhea, infertility and symptoms of menopause with a premature onset. In addition to osteoporosis, loss of libido, increased cardiovascular risk and atrophic vaginitis, early ovarian dysfunction may adversely impact quality of life and result in significant psychosocial burden. Currently available guidelines addressing fertility preservation in young women undergoing treatment for early breast cancer recommend that patients at reproductive ages should be advised about the potential risks of fertility impairment and additional effects of adjuvant chemotherapy and that preservation techniques should be carefully considered. However, “evidence regarding the effectiveness of ovarian suppression” is quoted as “insufficient” and the use GnRH agonists as “experimental” . The current meta-analysis includes a large number of patients and also the results of recently presented clinical trials, and suggest that the use of GnRH agonists is associated a higher rate of recovery of regular menses in patients with breast cancer undergoing chemotherapy.These results summarize the findings of different clinical trials and has immediate clinical implications - this was not clear in the literature, since negative results had been reported across different clinical trials. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Prostate Cancer, Testosterone / 27.09.2015

Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical SchoolMedicalResearch.com Interview with: Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. D'Amico: Controversy exists as to whether androgen deprivation therapy (ADT) used to treat prostate cancer can cause fatal cardiac events. We found that in men with moderate to severe comorbidity based most often on a history of a heart attack that the use of 6 months of androgen deprivation therapy to treat non metastatic but clinically significant prostate cancer was associated with both an increased risk of a fatal heart attack and shortened survival. (more…)
Author Interviews, Endocrinology, OBGYNE / 25.09.2015

Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of MedicineMedicalResearch.com Interview with: Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Legro: Weight loss is recommended for obese women with PCOS, but there are no randomized studies to show that it improves fertility outcomes. Both Lifestyle modification and oral contraceptives are also recommended for chronic treatment of women with PCOS so that this study has relevance to all obese women with PCOS. We designed this study to prospectively examine the effects of these common treatments on reproductive, metabolic and quality of life parameters, as well as on fertility in women seeking pregnancy. The main findings are summarized in the abstract and conclusion to the study.  I would repeat those here.  I would highlight that quality of life improved in all treatment groups, but the group that had both oral contraceptives and lifestyle modification had a significant improvement in their physical well-being compared to the oral contraceptive group. (more…)
Author Interviews, Endocrinology, JAMA, Prostate Cancer / 18.09.2015

MedicalResearch.com Interview with: Sindy Magnan, MD, MSc, FRCPC Division of Radiation Oncology, Department of Medicine CHU de Québe Université Laval Québec City, Québec, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Magnan : Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. Intermittent administration of this treatment could offer several advantages over the standard continuous administration by delaying the development of castration-resistant disease and by reducing the drugs’ adverse effects. However, this mode of administration remains controversial. We thus conducted a systematic review with meta-analysis of randomized controlled trials to compare the effectiveness and tolerability of intermittent versus continuous androgen deprivation. Intermittent therapy was non-inferior to continuous therapy with respect to overall survival. No major difference in global quality of life was observed between the two interventions, but some quality-of-life criteria, mainly in relation with physical and sexual functioning, seemed improved with intermittent therapy. (more…)
Author Interviews, Endocrinology, JCEM, Menopause, Mineral Metabolism / 01.09.2015

MedicalResearch.com Interview with: Emily Krantz (né Amundson) MD Södra Älvsborgs Hospital Borås, Sweden Medical Research: What is the background for this study? What are the main findings? Response: This study is a 10-year follow up of a double-blind placebo controlled trial in which women with post menopausal osteoporosis received Growth Hormone (GH) for 3 years (Landin-Wilhelmsen JBMR 2003;18:393-404). Positive effects of the treatment on the patients bone mineral density and bone mineral content were seen after another 7 years. Furthermore and most interestingly, fracture incidence decreased dramatically from 56% to 28% (p=.0003) in the osteoporosis patients while fractures increased significantly in the control group, from 8% to 32% (p=.0008). Health Related Quality of Life was also measured throughout the study’s duration and it did not change nor did it differ from the control group. (more…)
Author Interviews, Dermatology, Endocrinology / 27.08.2015

Abdulmaged Traish; Photo by Vernon Doucette for Boston University Photography MedicalResearch.com Interview with: Abdulmaged M. Traish, MBA, Ph.D. Professor of Biochemistry Professor of Urology Boston University School of Medicine Boston, MA 02118   Medical Research: What is the background for this study?  Dr. Traish: This study was undertaken to evaluate the data in the contemporary literature on the use of finasteride and dutasteride for treatment of ( benign prostatic hypertrophy) BPH and androgenetic alopecia (AGA). These drugs were proven effective in management of patients withy BPH andandrogenetic alopecia; however, these drugs inhibit a family of enzymes widely distributed in many tissues and organs and therefore may have undesirable effects. Most importantly, few studies have been undertaken to evaluate the effects of these drugs on the central nervous system. The adverse impact of these drugs on sexual function and well-being in a subset of patients raised the questions that we do not know much about the safety of such drugs. Medical Research: What are the main findings?  Dr. Traish: The main findings of this study is that these agents, while useful in treatment of BPH and androgenetic alopecia, exert undesirable side effects on sexual function and well-being. More importantly, limited data is available on the impact of these agents on the central nervous system. (more…)
Author Interviews, Endocrinology, JAMA, Radiology, Surgical Research, UCSF / 28.07.2015

Quan-Yang Duh MD Endocrine surgeon UCSF Medical CenterMedicalResearch.com Interview with: Quan-Yang Duh MD Chief, Section of Endocrine Surgery UCSF Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Quan-Yang Duh: At UCSF we have a monthly Adrenal Conference (involving surgeons, endocrinologists and radiologists) to discuss patients we are consulted for adrenal tumors. About 30% of these are for incidentally discovered adrenal tumors (versus those found because of specific indications such as clinical suspicion or genetic screening). Of these 15-20% has bilateral adrenal tumors. The evaluation of unilateral incidentaloma has been very well studied and many national guidelines have been published with specific management recommendations. So during our monthly adrenal conference, we have a routine "script" for evaluation and recommendations (rule out metastasis by looking for primary cancer elsewhere, rule out pheochromocytoma and Cushing, resect secreting tumors or large tumors, and if no operation recommended repeat scan in 6 months, etc.). This “script” has worked very well for patients with unilateral incidentaloma. However, we were less certain when we made recommendations about bilateral incidentalomas because there was very little literature or guidelines written about it. We had some gut feelings, but we were not sure that we were recommending the right things. We needed more data. That was the main reason for the study. What we found in our study was that although the possible subclinical diseases were the same – hypercortisolism and pheochromocytoma, the probabilities were different. The patients with bilateral incidentalomas were more likely to have subclinical Cushing’s and less likely to have pheochromocytomas than those with unilateral incidentalomas. (more…)
Author Interviews, CDC, Endocrinology, JCEM / 16.07.2015

MedicalResearch.com Interview with: Hubert W. Vesper, PhD Director, Clinical Standardization Programs in the National Center for Environmental Health, Centers for Disease Control and Prevention Co-author, “Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues” Co-chair of the PATH Steering Committee Medical Research: What is the background for this study? What are the main findings? Dr. Vesper: Accurate data on estrogen levels are needed to ensure appropriate and effective patient care. Research studies found high inaccuracies among different estrogen tests, especially at low estrogen levels commonly observed in postmenopausal women, men and children. Accurate estrogen measurements can be achieved through standardization. Stakeholders should support standardization efforts of the Centers for Disease Control and Prevention (CDC) or alternative strategies to arrive at estrogen measurement methods that are accuracy-based and reliable. (more…)
Author Interviews, JCEM, Sexual Health, Testosterone / 11.07.2015

Darius A. Paduch, MD, PhDAssociate Professor of Urology and Reproductive Medicine Director Sexual Health and Medicine Research Director of Male Infertility Fellowship Co-Director Male Infertility Genetics Laboratory Weill Cornell Medical College Dept of Urology New York, NY 10065MedicalResearch.com Interview with: Darius A. Paduch, MD, PhD Associate  Professor of Urology and Reproductive Medicine Director Sexual Health and Medicine Research Director of Male Infertility Fellowship Co-Director Male Infertility Genetics Laboratory Weill Cornell Medical College Dept of Urology New York, NY 10065 Medical Research: What is the background for this study? What are the main findings? Dr. Paduch: Ejaculatory dysfunction, inability to ejaculate or delayed ejaculation affects 10-8% of men. Inability to ejaculate either intravaginally or at all is independent of erectile function. Men with normal erection may take very long time to ejaculate (>30 min) or not able to ejaculate at all. The men in our study had either normal erections or minimal erectile dysfunction. Men of all ages have spontaneous erections but don't ejaculate just from erection, it is progression of arousal and activation of spinal cord motor generator for ejaculation which is necessary for ejaculation. One of important factors in our ability to ejaculate is testosterone (T), testosterone allows for normal function of CNS centers for ejaculation, it is a modulator and is necessary; preadolescent boys don't ejaculate because their spinal cord centers for ejaculations are not mature – process dependent on testosterone. However testosterone is just one of many neurotransmitters and hormones needed of normal ejaculation. Actually our study showed that in men who achieved normal levels of testostosterone the ejaculatory function have improved. As this was first double blinded and randomized clinical trial we had to report our results based on radomization to testosterone treatment or placebo. Unfortunately only 70-80% of men treated with topical testosterone preparation will achieve normal testosterone level , we simply didn’t reach statistical significance based on randomization and  considering relatively low number of patients in each group. But in men who achieved normal testosterone levels the difference was statistically significant. Testosterone should not be used to treat any conditions, including ejaculatory dysfunction, in absence of low testosterone  level. EjD is very common but it bares significant embarrassment stigma, it is difficult for the couple to bear fact that male partner can’t ejaculate, it also creates issues within couple and question about attraction and fidelity. We have previously showed that treatment with tadalafil improves ejaculatory and orgasmic dysfunction and these data has been published. This study was focused on effect of testosterone, but its main significance was it’s design: we developed new tools to assess ejaculatory function and learned a lot about when patients or their partners start to be bothered by EjD. If time to ejaclate takes > 30 min We are now looking into novel and available pharmacotherapy modulating dopaminergic and canabioid signaling and reward mechanisms. I am also very excited about our potential work in direct spinal cord motor generator nano stimulator, this could be very useful for men with spinal cord injuries and diabetic patients. We paved the road for others and I am sure new treatments are just a matter of time. (more…)
Author Interviews, Breast Cancer, Endocrinology, Lancet, Menopause / 08.07.2015

MedicalResearch.com Interview with: Dr. Jürg Bernhard Ph.D. International Breast Cancer Study Group Coordinating Center and Bern University Hospital, Inselspital, Bern, Switzerland Medical Research: What is the background for this study? What are the main findings? Response: In the combined analysis of the SOFT and TEXT trials, the aromatase inhibitor exemestane was more effective than tamoxifen in preventing breast cancer recurrence in young women (premenopausal) who also receive ovarian function suppression (OFS) as adjuvant (post-surgery) treatment for hormone-sensitive early breast cancer, providing a new treatment option for these women. These trials were conducted by the International Breast Cancer Study Group (IBCSG) and involved more than 4700 patients of over 500 centers in 27 countries. Now we present patient-reported quality of life outcomes from these trials. In the TEXT and SOFT trials, patients assigned exemestane+OFS reported more detrimental effects of bone or joint pain, vaginal dryness, greater loss of sexual interest and difficulties becoming aroused, while patients assigned tamoxifen+OFS were more affected by hot flushes and sweats. Global quality of life domains (mood, ability to cope and physical well-being) were similar between the randomized treatment groups. (more…)
Author Interviews, Depression, Sexual Health, Testosterone / 03.07.2015

Michael S. Irwig MD Division of Endocrinology Medical Faculty Associates George Washington UniversityMedicalResearch.com Interview with: Michael S. Irwig MD Division of Endocrinology Medical Faculty Associates George Washington University Medical Research: What is the background for this study? What are the main findings? Response: Many factors are associated with lower testosterone levels and many men who have their testosterone levels checked have non-specific depressive symptoms. The main finding is a remarkably high rate of depression and depressive symptoms (56%) in men who are referred for borderline testosterone levels. Other significant findings include a prevalence of overweight and obesity higher than the general population. (more…)
Author Interviews, Diabetes, Endocrinology, JAMA / 21.06.2015

MedicalResearch.com Interview with: Francis de Zegher, MD, PhD Department of Development and Regeneration, University of Leuven Leuven, Belgium & Lourdes Ibáñez, MD, PhD Hospital Sant Joan de Déu, University of Barcelona Barcelona, Spain Medical Research: What is the background for this study? Response: Hyperinsulinemic androgen excess is the most frequent hormonal disorder of adolescent girls. It seems to be mainly driven by an excessive and/or inappropriate storage of fat due to a chronically positive energy balance. The traditional approach (not approved by FDA or EMA) is to silence the ovaries by giving an oral contraceptive. An alternative approach is to change the storage of fat by giving an insulin-sensitizing combination of generics in low dose. (more…)
Author Interviews, Cost of Health Care, Endocrinology, OBGYNE, Yale / 12.06.2015

Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT 06510MedicalResearch.com Interview with: Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT Medical Research: What is the background for this study? What are the main findings? Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy.  For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice. When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient.  Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion. In fact, over half of U.S. pregnancies are unintended.  Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient. However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital.  This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby.  Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant). The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion.  Women can get pregnant again within 4 weeks of delivering a baby.  Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit. Even for women who want another pregnancy soon, the implant has benefits.  When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death.  Birth spacing is better for moms and babies. (more…)
Author Interviews, Cognitive Issues, Endocrinology, OBGYNE / 03.06.2015

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with: Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone "replacement" therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms. Medical Research: What is the background for this study? What are the main findings? Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo. (more…)
Author Interviews, Diabetes, Endocrinology, HIV, Infections, JCEM / 18.05.2015

Kevin Yarasheski, PhD Assistant Director, Biomedical Mass Spectrometry Research Facility Professor of Medicine, Cell Biology & Physiology, Physical Therapy Washington University School of MedicineMedicalResearch.com Interview with: Kevin Yarasheski, PhD Assistant Director, Biomedical Mass Spectrometry Research Facility Professor of Medicine, Cell Biology & Physiology, Physical Therapy Washington University School of Medicine Medical Research: What is the background for this study? Dr. Yarasheski:   People living with HIV and taking combination antiretroviral therapy (cART) have successfully reduced the amount of HIV virus in their blood and have partially reconstituted their immune system (CD4+ T-cell count >250 cells/µL).  Despite this, many still experience residual immune cell activation and inflammation that is believed to increase HIV morbidity (non-AIDS conditions e.g., CVD, T2DM, obesity, liver fat, bone loss, dementia) and mortality.  Scientists are seeking safe and effective interventions for residual immune cell activation and inflammation, that have the potential to reduce non-AIDS complications that threaten quality and quantity of life among HIV infected adults. We have been testing the safety and efficacy of sitagliptin in people living with HIV; a dipeptidyl peptidase 4 inhibitor that is FDA approved for treating T2DM, and appears to have favorable anti-inflammatory and immune modulatory properties that might specifically benefit people living with HIV and experiencing cardiometabolic complications associated with residual immune cell activation and inflammation. Medical Research: What are the main findings? Dr. Yarasheski:   In a randomized, double-blinded, placebo controlled 8-wk trial, we found that sitagliptin had beneficial anti-inflammatory, immune regulatory, hematopoietic progenitor cell mobilizing, and glucose lowering effects in cART-treated virally suppressed HIV adults with impaired glucose tolerance.  Sitagliptin improved glucose tolerance (a risk factor for CVD), reduced circulating and adipose-specific inflammatory markers (risk factors for obesity, T2DM, liver fat accumulation, and CVD), and increased the number of blood stem cells that can repair damage and inflammation in the vascular walls. (more…)
Author Interviews, Testosterone, Urology / 18.05.2015

Ranjith Ramasamy MD Assistant Professor of Urology University of MiamiMedicalResearch.com Interview with: Ranjith Ramasamy MD Assistant Professor of Urology University of Miami Medical Research: What is the background for this study? Dr. Ramasamy: The association between testosterone supplementation therapy (TST) and thrombotic risk in elderly men remains controversial. We evaluated the prevalence of thrombotic events and all-cause mortality in men older than 65 years with hypogonadism treated with testosterone therapy. We compared men treated with testosterone to an age and comorbidity matched cohort of hypogonadal men not treated with testosterone supplementation therapy. Medical Research: What are the main findings? Dr. Ramasamy: No man who received testosterone supplementation therapy died, whereas 6 hypogonadal men who did not receive TST died (p=0.007). There were 4 thrombotic events (1 MI - myocardial infarction, 2 CVA/TIA - stroke, 1 PE - pulmonary embolism) in men who received testosterone supplementation therapy compared to 1 event (CVA/TIA) among men who did not receive TST (p = 0.8). All the events (except one death which took place at 6 months of follow–up) occurred 2 years or more after follow–up. Strengths of the study include long follow–up (>3 years), availability of serum testosterone levels before and after therapy and of a control group (hypogonadal men not treated with TST) for comparison. Limitations included retrospective study design, and a small sample size. (more…)