Author: Dr Foo Joo Pin

US Regulators Probing Cardio Risks In Testosterone Therapy

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US federal regulators said Friday they were investigating products containing testosterone after recent studies suggested a higher risk of strokes and heart attacks in men being treated with the hormone.

Although it is too premature to conclude that FDA-approved testosterone treatment increases the risk of stroke, heart attack or death, this underscores the importance of prudent use of testosterone replacement. Testosterone replacement can still be helpful, especially in men who are truly suffering from hypogonadism (a condition marked by low sex hormone). However its adverse effects cannot be neglected. It is best to consult a physician who is well versed with testosterone therapy, its adverse effects and means of monitoring the therapy, before embarking on such replacement.

Screen All Pregnant Women For Gestational Diabetes: Panel

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The U.S. Preventive Services Task Force (USPSTF) advises that all pregnant women who have not been previously diagnosed with diabetes, regardless of whether they have risk factors or not, should be given a blood test to screen for gestational diabetes.

Gestational diabetes is a form of diabetes which occurs during pregnancy. The condition affects 18% of all preganancy and can results in serious complications to the mother and infant if left untreated. The basis for this recommendation to screen all pregnancies came from several large randomized trials that have found substantial reductions in pregnancy-related outcomes in treating gestational diabetes, even in mild forms.

Often, women with gestational diabetes are at higher risk of having diabetes later on in life, after the pregnancy. Evidence also suggests that children born to women with gestational diabetes are at higher risks of having diabetes later on in life as well. Early diagnosis and active intervention is the key to reducing debilitating complications associated with diabetes.

Many Singaporeans Unaware They Have High Cholesterol

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A study, conducted from 2004 to 2007 by the National University Hospital, Singapore General Hospital and Khoo Teck Puat Hospital, with some 5,000 Singaporeans showed that 48.1 per cent had high cholesterol. But 17.3 per cent were unaware of their condition until they were tested during the study.

Leaving high cholesterol untreated increases the risk of debilitating heart attacks and strokes. Some patients remain reluctant to take statins (a class of medication used to treat hypercholesterolaemia), for fear of side effects such as liver inflammation and muscle aches. However these side effects are fairly uncommon and generally reversible upon cessation of the medication. Moreover, whenever a doctor makes a recommendation for a patient to go on medication, an assessment as to what the relative risk and benefit is, would have been made. And the doctor will make a recommendation for treatment when the benefit is clearly greater than the risk. Hypercholesterolaemia is a highly treatable condition, often with significant reduction of vascular risk upon treatment. It is advisable for patients to go for regular screening and actively discuss treatment options with their doctors for this common and potentially hazardous condition.

Infertility, Diabetes, Obesity and the Mystery of PCOS

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Polycystic ovarian syndrome (PCOS), in short, is a condition in which a woman’s hormones are out of balance. The condition is frequently associated with weight gain in a young women. This results in androgenization (acne, excessive facial and body hair), menstrual irregularities and infertility. PCOS is common, affecting as many as 1 out of 10 women. It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age.

Besides the disturbances in the sex hormones, the sinister feature of the syndrome is insulin resistance and obesity, which lead to diabetes. In fact, as many as 1 in 4 women with PCOS has diabetes. As a result of these metabolic disturbances, women with PCOS have a higher risk of cardiovascular event in their lifetime. Although termed as an ‘ovarian’ syndrome, the underlying pathology is not restricted to the ovaries. Often, there is a conglomeration of endocrine and metabolic problems in a woman with PCOS. These hormonal and metabolic disturbances can be amenable to treatment, with restoration of menstrual cycles and fertility in many instances.

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Thyroid Supplements – Caution!

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Thyroid diseases are common. In the US, more than 12% of Americans will develop a thyroid disorder during their lifetime. Many people with vague symptoms like feeling sluggish or weight gain, turn to dietary supplements that promise to jump-start metabolism by bolstering their thyroids with a mixture of vitamins and minerals. However these over-the-counter products may also contain thyroid hormones that should only be dispensed by prescription. In some cases these supplements contain amounts of thyroid hormone as high or higher than delivered by prescription medications. Indiscriminately use of such supplements that contain thyroid hormone may lead to serious side effects including nervousness, insomnia, heart problems and thinning of bone.

In Singapore, such products are not widely seen or available as yet. However given the ease of online orders, it might be relatively easy for these products to be obtained from overseas. Anyone with suspected thyroid disorders should consult a physician for a proper work up rather than relying on supplements to resolve their symptoms.

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Testosterone Replacement Therapy, Do Men Really Need It?

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Testosterone replacement has sharply increased among older men in the past decade, for treatment of ‘andropause’ (declining level of testosterone in response to aging), amongst other indications. This aggressive use of testosterone may in part be secondary to aggressive marketing campaign by all parties concerned. Many of these patients appear to have normal testosterone levels and do not meet the clinical guidelines for treatment, and are yet given testosterone replacement by their doctors. Testosterone replacement are certainly indicated and helpful in those who have true hypogonadism (condition where sex hormones are truly low). In the vast majority, where they do not have hypogonadism, such treatment can lead to a host of serious health problems. It is best to discuss the option of testosterone replacement with a physician who is well versed with testosterone therapy, who is well acquainted with means of monitoring the therapy and their adverse effects before proceeding with such therapy.

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Fad Diet Can Work, But…

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Experts have opined that fad diet can be effective in reducing weight, at least in the short term. This is not a surprising conclusion considering that fad diet often consists of some form of calories restriction, and calories restriction does reduce weight, regardless of the proportion of macronutrients. The concern is whether this weight lost induced by fad dieting can be sustainable. There are also concerns that many fad diets have little consideration that a well-balanced, nutritious diet is critical for our bodies to function properly. Besides, there are really no good evidence to suggest that one fad diet is better than the other in inducing sustained weight loss. So think again before you embark on a certain fad diet. Not that they don’t work. But sometimes a well balanced diet, with some calories restriction and an active lifestyle with adequate exercise are all that it takes.

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Obesity May Affect Men’s Semen Quality

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Overweight and obese men in a new study showed diminished quantity and quality of semen, suggesting that a weight problem might also affect fertility.This finding is not surprising considering it is well established that obese men tend to be at higher risk of having hypogonadism (condition characterized by low testosterone state). Exercise and weight loss in obese men have been found to improve erectile dysfunction. It remains to be proven whether the same intervention of exercise and weight loss would improve fertility in these men.

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The Vitamin D Debate

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Many studies have reported associations between low vitamin D levels and poor health outcomes. However it is not known if routine vitamin D supplementation would improve health outcomes. A new study reports that vitamin D supplements, despite their popularity, do not seem to have significant benefits for heart health, cancer prevention or even bone health in healthy people. Despite the reported lack of benefits of vitamin supplementation in healthy people, it must be emphasized that people with true vitamin deficiency should still receive treatment to correct the deficiency. Vitamin D deficiency can result in osteomalacia, a condition marked by inadequate mineralization of bones. This can give rise to body aches, muscle weakness and bone fragility.

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