Testosterone and the Heart

If you are a man, at some point in your life you are likely to be a candidate for hormone replacement therapy. As we age, our testosterone levels decline, and with them often a number of physical and psychological characteristics. It has long been understood that low testosterone levels can be linked to reduced libido, sexual dysfunction, diminished energy, and a reduced overall sense of well-being. For these reasons, replacement therapy with testosterone drugs is a strong and steadily growing area of medicine for aging men.

Beyond these basic facts, testosterone remains a controversial drug. Its abuse is linked to changes in the body that may increase the likelihood of cardiovascular disease, and partly because of this, the potential benefits and risks of testosterone replacement therapy have long been the subject of much debate. Is this therapy actually safe?

In recent years, evidence has been surfacing that testosterone replacement may actually reduce cardiovascular disease risk. Usually isolated in scope, these papers concern many favorable changes in cardiovascular health markers, such as the management of triglycerides and cholesterol.

One of the first potential benefits of testosterone replacement therapy (TRT) -  is the management of triglyceride and cholesterol levels. As detailed in a growing number of studies, testosterone replacement therapy consistently improves the lipid profile in men with hormone deficiency. The most consistent endpoints of improvement appear to be a reduction in total cholesterol, a reduction in LDL (‘bad’) cholesterol, and a lowering of serum triglycerides. The improvements in lipid profile appear to be more pronounced in older men, although both young and old populations tend to show improvements in serum lipids when testosterone is given to correct a deficient state.

The effect of TRT on HDL (‘good’) cholesterol levels is less consistent. Studies giving testosterone gels, patches, or the longest-acting ester (testosterone undecanoate) tend to show improvement or no consistent effect on HDL. Studies with the more common esters such as cypionate and enanthate tend to show minor decreases in HDL during therapy, likely owing to the brief supraphysiological peaks for several days after administration. Note that HDL is often improved when TRT is combined with exercise and other lifestyle modifications.

Androgen deficiency is associated with an increase in certain inflammatory markers that can support the progression of atherosclerosis. Testosterone replacement therapy has been shown to reduce some of the same inflammatory mediators, specifically TNF-alpha (tumor necrosis factor-alpha) and IL-1B (interleukin-1beta). Inflammation in the vascular system is an especially important concern with heart disease. For one, vascular inflammation is associated with the deposition of arterial plaque, a key component of this disease. Inflammation of the blood vessels may also damage the arteries, making them both thicker and weaker. Scarring may be noticed, and blood flow may be reduced. All of this can restrict blood flow and reduce the heart’s blood pumping capacity. By helping to reduce the production of TNF-alpha and IL-1B, hormone replacement therapy may reduce inflammation, vascular damage, and the chance for atherosclerosis. Again, instead of seeing a neutral or ‘negative’ effect, we find a specific improvement in the cardiovascular disease risk profile with the administration of this drug.

A growing number of studies have linked androgen deficiency to insulin resistance, as well as increased abdominal obesity. These two factors are also common with men suffering from cardiovascular disease, and may directly contribute to (among other things) endothelial cell dysfunction and vascular damage. Androgen substitution has been shown in several studies to reduce midsection fat deposits, increase glucose tolerance, and improve the overall metabolic state. It has additionally been postulated that due to the important role of testosterone in managing insulin sensitivity, androgen deficiency may be a contributing factor to adult-onset (type 2) diabetes. Likewise, the substitution of testosterone in aging men with hypogonadism might reduce the likelihood of developing diabetes.

The endothelium is a layer of cells that lines the blood vessels throughout the entire circulatory system. These cells are responsible for managing the passage of some materials in and out of the blood vessels, and supporting the flow of blood through the system. Endothelial cells play a role in vasoconstriction and vasodilation, they regulate certain inflammatory processes, and they’re involved in blood clotting and in supporting the formation of new blood vessels. Endothelial dysfunction is linked to androgen deficiency in men, and may result in elevated blood pressure (hypertension), vascular ‘stiffness,’ and significantly increased risk of cardiovascular disease. Likewise, replacement of testosterone in men with a deficiency has been shown to improve endothelial function, blood vessel dilation, arterial vasoreactivity, and blood flow.

One additional important ‘endpoint’ of improvement to this therapy appears to be an increase in endothelial progenitor cell activity, which helps repair damage to the vascular system.

 Traditionally, most physicians are extremely cautious with testosterone drugs. Many family doctors are very willing to prescribe estrogens to their female menopausal patients complaining of symptoms such as sexual dysfunction, but when it comes to their male patients with similar complaints, the response is often different. Many of these same physicians are much more willing to prescribe a drug like Viagra than the basic male androgen testosterone. Some mistakenly consider testosterone to be ‘too dangerous’ to give most of their patients, and reserve its use for extreme cases. And when testosterone is considered, it is given only for a very narrow and specific set of psychological or physical symptoms.

It seems clear that we can no longer paint testosterone as simply a ‘bad’ hormone for the cardiovascular system. While excessive high-level elevations of this hormone may indeed damage an individual’s cardiovascular health, we have strong evidence that within a certain physiological range, it may also protect the cardiovascular system from some of the same health issues. As such, its replacement may indeed turn out to be very important medical intervention for millions of men across the country, helping us to not only live better— but also live longer.

After all this time, it appears that this very controversial hormone, the same steroid demonized in the media, might actually help reduce the risk of cardiovascular disease in aging male patients. The study we reviewed this month is, likewise, something all men should take to heart— literally.

Kai Greene: Back Workout

When Phil Heath won his second-straight Mr. Olympia title at the Orleans Arena in Las Vegas, he had a lot of people to thank in his victory speech. Kai Greene, the man who took second, figured prominently because, as Heath said, “Kai gave me everything I could handle tonight.”

Unless Heath was privy to the numbers on the judges’ scorecards, he knew how close it was based only on crowd reaction—and when the place went ballistic every time Greene was called out, Heath had every reason to worry. The pose that got the biggest rise out of the crowd: Greene’s rear lat spread. Not only did he display freakishly huge lats that nearly went down to his hips, he also presented them in exquisite detail. Every few degrees he moved his arms, the landscape of his back musculature completely transformed; with his elbows drawn tight to his rib cage, it looked as if two giant seashells were buried under his skin, facing each other across his spine.

The key to building these fan-favorite muscles that nearly earned him a Sandow, according to Greene, is a combination of relatively light weight, high volume exercise, and a deep mind-muscle connection.

“The mind-muscle connection is the No. 1 factor in training,” Greene says unequivocally. “Practice posing between sets or anytime. Eventually, your mind and muscles will speak the same language.”

In addition to posing between sets, Greene uses iso-tension and takes each rep through a full range of motion, feeling a full stretch of the lats on every negative portion before lifting the weight back up.

THE WORKOUT

• Exercise Sets Reps
• Lat Pulldown 4 10-12
• Low Cable Row 4 10-12
• T-Bar Row 4 10-12
• Machine Row 4 10-15
• One-Arm Dumbbell Row 4 10-15
• Deadlift 4 12-15 

"Visualization is an essential bodybuilding tool, but also an essential tool for success for life in general," Greene says.

Quick Tip: "I go by feel," Greene says. "The weight is just a tool. Do you focus on the hammer or the nail? You better focus on the thing you're trying to hit."

Build Massive Legs with Post Exhaustion

This post-exhaustion routine is set up so that the most neurologically demanding exercise is performed first instead of last (which makes perfect sense, if you think about it). Secondly, the reps and tempo of each exercise are varied. The idea is to knock off as many motor units from the motor-unit pool as possible. Also, make certain that all your weights are pre-set so you don’t inadvertently get some extra rest by messing around with the poundages.

Post-Exhaustion Leg Growth Routine

A1. Barbell Hack Squat: 3 x 6-8, 50X0, no rest
A2. 45-Degree Leg Press: 3 x 12-15, 20X0, no rest
A3. Leg Extension: 3 x 12-15, 2012, rest 180 seconds

A1. Barbell Hack Squat
This exercise was brought to the bodybuilding world by Russian wrestler Georges Hackenschmidt. Hackenschmidt had sought to develop an isolation exercise for the quadriceps, and he succeeded. However, in Hackenschmidt’s heyday, exercise machines weren’t exactly commonplace. Hackenschmidt invented the exercise with a barbell in mind, and the so-called Hack Squat Machine wasn’t developed until years later.

A very-low-cost alternative to back squatting, the Hack Squat will promote top-level growth in the vastus medialis. Granted, using a barbell instead of a machine makes it a little uncomfortable, but its effectiveness overrides any comfort problems.

In order to perform a true barbell hack squat, you need a barbell and an adjustable rack so you can place the barbell at an optimal height for picking up and racking the bar. Your heels should be elevated by at least one and a half inches (the depth of a two-by-four) so you can squat with a straight back and your hips are under your shoulders in the bottom position. (It’s better to use a wedged board instead of a two-by-four so the exercise is more comfortable for your arches, but a two-by-four will do). Place the two-by-four or wedged board on the ground under the middle of the power rack. Set a barbell on the rack so it is about four to six inches lower than your gluteal line. Standing with your back to the bar, grab the barbell, preferably with straps (this is one of the few exceptions when you would use straps).

Walk forward until your heels rest on the board. Initiate the squatting motion by allowing your knees to travel as far forward as possible, without allowing your glutes to move back. Keep a slight arch in your lower back. Once your knees have gone as far forward as possible, lower your hips to the bottom position of the squat. Be sure to keep your back upright by pushing the bottom of your sternum up. Don’t allow your shoulders to round forward, and be certain your hips are under your shoulders in the bottom position.

After doing the prescribed number of reps, move directly to exercise A2. Don’t take any rest.

A2. 45-Degree Leg Press

The problem with using leg press machines is that they build nonfunctional strength. However, since the focus of this article is hypertrophy and not necessarily functional strength, an exception is allowable in this case. The standard 45-degree leg press machines work fine for this workout.

One point to remember when you do leg presses is that when you extend your hips and knees, make sure to keep the tension on your thighs by going to 95 percent of knee lockout. To prevent any dizziness, make sure you breathe in during the eccentric contraction and exhale on the concentric contraction. Again, the key is to keep the tension on the muscle at all times.

By the time you finish this exercise, you’ll want to rest, but not yet. It’s time to go directly to exercise A3.

A3. Leg Extension

As a general rule, leg extensions should be avoided because they expose your knees to undue stress. However, when your legs are pre-exhausted from the previous two exercises, you won’t be able to use much weight on them and the stress will be minimal. Also, this is not the type of workout you would perform year-round.

If possible, use a machine that overloads more of the middle of the strength curve, as that’s where the quadriceps are the strongest in this movement. Keep your head in a neutral position and don’t grip the handles too tightly, as that would raise your blood pressure and increase the likelihood of dizziness. Furthermore, try to follow the tempo prescribed. Often when trainees go through this excruciating routine, they start getting sloppy with the tempo by the time they get to this exercise. It’s best to guess light and complete all the reps rather than going too heavy and ending up looking like a penguin having an epileptic fit.

By the time you walk/wobble off this machine, you’ll probably feel quite nauseated. That’s quite normal because of the high lactate levels you’ll have generated. The good news is that high levels of lactate are linked to high levels of growth hormone.

Now, take a three-minute rest before repeating the tri-set. When you’ve gone through it three times, you’ve had enough. Do this routine for six workouts, working your legs once every four or five days.

This routine is very demanding physiologically and psychologically. Make sure you don’t eat anything more than a light meal within two hours before, as it’s easy to become quite nauseated from this routine.

To break through training plateaus it’s often necessary to shock your muscles into growth. Post-exhaustion tri-sets such as this one will do just that!

More Sleep Can Double Your Testosterone Levels

Older men can sometimes double their testosterone levels by getting more sleep, according to a human study that Plamen Penev of the University of Chicago.

Nearly all of us probably get too little sleep, mainly because we are seduced every day by the technology around us. It enables us to generate light at night, provides us with 24-hour entertainment and information through electronic media, and makes it possible for us to have contact with each other whenever we want. Every evening, when our body tells us that it’s time to sleep, we can also do a thousand other things instead.

Too little sleep messes up our hormone balance. It makes our body less sensitive to insulin for example. Dutch researchers recently showed that after just one night of four hours’ sleep, young men’s insulin sensitivity went down by 20 % and that of diabetics by a quarter.

In the latter case, lack of sleep is clinically relevant, so doctors could advise diabetics who react insufficiently to their medicines to get more sleep. “Sleep duration might become another therapeutic target to improve glucoregulation in type 1 diabetes”, the Dutch researchers say.

Testosterone is also affected by amount of sleep. That’s not so strange, as our bodies make much more testosterone when they’re asleep than when they’re awake. We’ve taken the figure below from the study mentioned here. It shows how much testosterone is present in the blood of 22-32 year-old men while asleep and during the rest of the day.

The better men sleep, the higher their testosterone level rises while they are asleep.

In the average male over forty, the testosterone level goes down by 1-2 % per year, but researchers occasionally come across men in their eighties with a testosterone level you’d expect in a young man. Add to that the fact that many older men – but not all men – sleep less and less deeply as they get older, then you automatically think of the idea that Plamen Penev wanted to test in his study: does the testosterone level decrease in older men because they sleep less?

More sleep can double your testosterone level

Penev based his theory on, among other things, research done by Eve Van Cauter, a sleep researcher at the University of Chicago who has celebrity status in the field of endocrinology. Van Cauter discovered early in the 21st century that men in their forties make less testosterone while sleeping than men in their twenties.

Penev measured the amount of testosterone 12 slim, healthy, non-smoking men aged between 64 and 74 had in their blood in the morning. He also got the men to wear a small gadget around their wrist, which enabled him to see how many hours per night the men slept. That varied from 4.5 to 7.5 per 24 hours. The longer the men slept, the figures below show, the more testosterone there was circulating in their blood.

The men that slept the least had a testosterone level of 200-300 ng/dl. That’s a normal amount for men of this age, but it’s on the low side. The men in the study who slept the most had a testosterone level that was twice as high: 500-700 ng/dl. That’s a level you’d expect in healthy young men.

“These findings suggest that complaints of poor or insufficient sleep in otherwise healthy older men can be associated with a more pronounced age-related androgen decline”, writes Penev. “Eliciting such sleep complaints in the physician’s office may facilitate the judicious interpretation of lower testosterone levels in the older male patient.”

Before men consider doing testosterone therapy, they might first measure the amount of sleep they get. And ‘measuring’ is different from ‘guessing’ or ‘estimating’. Most people overestimate the number of hours that they sleep. This was also the case in Penev’s study. The men thought that they slept seven and a quarter hours per day on average, but Penev’s recordings showed that they only slept six hours a day.

Muscle Growth and Vitamin D

Vitamins are typically associated with protective functions that support overall health and wellness. For example, vitamin C has antioxidant properties that mitigate the many negative effects associated with oxidative damage to biomolecules such as DNA within the human body. Vitamin D is somewhat different. Like other vitamins, it promotes overall health— but it also plays an active role in promoting muscle growth and strength.

Vitamin D is a fat-soluble, steroid-like vitamin that functions as a prohormone— aiding manydifferent processes such as the absorption and metabolism of calcium and phosphorous, promoting bone health. Furthermore, low levels of vitamin D—which are prominent in the western world— correlate with several diseases such as cancer and cardiovascular disease.

Some of the muscle-promoting properties associated with vitamin D apparently stem somewhat from the similar chemical structure between vitamin D and steroid molecules like testosterone— as studies have shown vitamin D can bind the androgen receptor, perhaps mimicking some of the muscle-building properties of testosterone. Vitamin D can also bind and activate the vitamin D receptor— which directly regulates the expression of hundred of genes, with several of the genes turned on by vitamin D directly involved in generating muscle growth and strength.

Among the genes regulated by vitamin D, a few appear to be involved in the production of testosterone. A study by Wehr et al. investigated the association of vitamin D levels with testosterone in over 2,200 men. The study showed a strong correlation between vitamin D levels and testosterone.The group with the lowest vitamin D levels had the lowest testosterone measurements, and the group with the highest amount of vitamin D possessed the highest testosterone.

Interestingly, Wehr et al. also found that higher levels of vitamin D produced lower amounts of the sex hormone binding globulin protein (SHBG). Since testosterone circulates in the bloodstream bound mostly to SHBG and only a small fraction is unbound— and thus biologically active where it can activate the androgen receptor— vitamin D's ability to lower SHBG levels will give way to greater testosterone activity.

Thus, vitamin D not only increases the production of testosterone but it also increases testosterone activity by diminishing SHBG's inhibitory influence on testosterone function.

Since the production of vitamin D can be produced in the human body by exposure to sunlight, the differences in sunlight-induced vitamin D production should vary throughout the year. Thus, in another part of this study, Wehr et al. further validated the relationship between vitamin D and testosterone production by uncovering the tight correlation between vitamin D levels and testosterone production throughout the year.The researchers demonstrated that high vitamin D production in the summer months corresponds with greater testosterone levels, and vice versa during the winter months.

Altogether, this study highlights vitamin D's capability to raise or maintain testosterone levels. The research emphasizes the importance of consuming enough dietary vitamin D—especially during the long winter months, when exposure to sunlight is diminished and the need for dietary vitamin D is the greatest— in order to stimulate or maintain testosterone production.

In addition to increasing testosterone levels, vitamin D has been shown by researchers at the Dutch company Organext Research to stimulate the expression of the androgen receptor in isolated skeletal muscle cells. The increase in androgen receptor stimulated by vitamin D promoted the proliferation of muscle satellite cells into new muscle fibers, potentially leading to increased muscle growth. In addition to the influence of vitamin D on the androgen receptor, the researchers found that the anabolic steroid nandrolone decanoate stimulated the expression of the vitamin D receptor in isolated skeletal muscle cells— and that the combination of nandrolone decanoate and vitamin D had a overwhelmingly synergistic effect on satellite cell conversion into muscle tissue in isolated skeletal muscle cells.

These results suggest that consumption of vitamin D along with anabolic steroids should be extremely influential on muscle growth. What's more, given that anabolic steroids have negative side effects that are amplified by consuming large quantities of these drugs, ingesting smaller doses of steroids supplemented with vitamin D should mitigate some of the side effects associated with steroid use while still stimulating significant increases in muscular size and strength.

All in all, vitamin D's ability to increase the amount of testosterone and androgen receptor should powerfully stimulate muscle growth— not only by initiating satellite cell proliferation, but also by cranking up protein synthesis in muscle tissue— considering that testosterone and the androgen receptor function cooperatively to stimulate muscle cell protein synthesis.Anti-Aromatase Activity

According to an investigation by Krishnan et al., vitamin D considerably decreases the expression of the aromatase enzyme— most potently in fat cells. Since aromatase activity in fat cells can decrease testosterone levels by catalyzing the conversion of testosterone into the estrogen-like compound estradiol, vitamin D's ability to decrease aromatase represents another mechanism in its arsenal for increasing testosterone.

In the above study, mice were given large quantities of the steroid molecule androstenedione— which can be converted to the estrogen-like molecules estradiol or estrone by aromatase. Some of the mice were also given a daily injection of vitamin D, while the control group received no vitamin D injections. The mice that received vitamin D showed a significant decrease in the expression levels of aromatase and a lower amount of estradiol or estrone, specifically in fat cells, compared to the control group that received no vitamin D.

In addition, the researchers in this study showed that vitamin D diminishes aromatase levels and activity in isolated human breast cancer cells, which is a cell type that typically expresses large amounts of the aromatase enzyme. This finding implies that vitamin D functions similarly in humans by diminishing the quantity and activity of aromatase. Moreover, the researchers also investigated the influence of vitamin D in combination with aromatase inhibitors such as Arimidex on aromatase activity, also in isolated human breast cancer cells. Interestingly, their results showed that vitamin D enhances the effect of aromatase inhibitors. Since some bodybuilders and athletes consume aromatase inhibitors during anabolic steroid cycles to prevent the conversion of steroids into estrogen, vitamin D in combination with aromatase inhibitors should more potently decrease aromatase's ability to convert anabolic steroids into estrogen—thus preventing some of the unpleasant side effects associated with anabolic steroid use such as the development of breast tissue, also known as gynecomastia.

In conclusion, vitamin D has the powerful ability to regulate the expression of specific genes that are intimately involved in muscle growth. Moreover, most people appear to have suboptimal amounts of vitamin D due to dietetic inadequacy and a lack of sunlight exposure. Consequently, vitamin D is evidently a necessary and influential supplement for the athlete, bodybuilder or recreational weightlifter for gaining muscle and increasing strength.