Male hypogonadism - 2014 Lancet review

Clinical presentations vary dependent on:

- time of onset of androgen deficiency
- whether the defect is in testosterone production or spermatogenesis
- associated genetic factors
- history of androgen therapy

Diagnosis of hypogonadism is made on the basis of:

- signs and symptoms consistent with androgen deficiency
- low morning testosterone concentrations in serum on multiple occasions

Several testosterone-replacement therapies are approved.

Contraindications to testosterone-replacement therapy include:

- prostate and breast cancers
- uncontrolled congestive heart failure
- severe lower-urinary-tract symptoms
- erythrocytosis


Male hypogonadism - The Lancet
Image source: The shield and spear of the Roman god Mars, which is also the alchemical symbol for iron, represents the male sex. Wikipedia, public domain.

Real doctors, real people: from beekeeper to "tough mudder"

Dr. Jonathan Kirsch, a hospitalist at UNC Health Care, is also a beekeeper. He enjoys both the honey and the benefit of pollinated fruit trees and hand-picked fruit.

A team from the UNC Bone Marrow and Stem Cell Transplant Program headed up by Tippu Khan, PharmD, BCOP and Nicole Frazier, RN, BSN participated in an epic journey which included leaping over fire, trekking through waste-high mud, tossing spears, dodging attacks and most of all braving near freezing temperatures in the driving rain. What is all this about? It's the Spartan Race, an event of pure primitive craziness that promises it's participants an experience they'll never forget.


real doctors, real people - Oliver Smithies - YouTube

Altmetric tracks the buzz around scholarly articles: You can make a difference

Altmetric tracks the buzz around scholarly articles - see an example:

You can make a difference.

See how my blog contributed to one of highest ever scores in this journal for this article (ranked #7 of 972): Children with severe asthma have 32 times higher risk for developing COPD

Here is the blog post: Allergy Notes: What are the top 3 asthma articles for March 2014? Vote here

The article will be included in the next edition of What Is New In Small Airways Research

The beautiful flower of Internet Conversation has lost quite a few petals since 2008 but it still works:

Don't close blog comments on your site. See how one comment changed influenza treatment: and

From the Guardian:

"But then a Japanese paediatrician called Keiji Hayashi left a comment that would trigger a revolution in our understanding of how evidence-based medicine should work. This wasn't in a publication, or even a letter: it was a simple online comment, posted informally underneath the Tamiflu review on the Cochrane website, almost like a blog comment.

Cochrane had summarised the data from all the trials, explained Hayashi, but its positive conclusion was driven by data from just one of the papers it cited: an industry-funded summary of 10 previous trials, led by an author called Kaiser. From these 10 trials, only two had ever been published in the scientific literature. For the remaining eight, the only available information on the methods used came from the brief summary in this secondary source, created by industry. That's not reliable enough.

This is science at its best. The Cochrane review is readily accessible online; it explains transparently the methods by which it looked for trials, and then analysed them, so any informed reader can pull the review apart, and understand where the conclusions came from. Cochrane provides an easy way for readers to raise criticisms. And, crucially, these criticisms did not fall on deaf ears. Dr Tom Jefferson is the head of the Cochrane respiratory group, and the lead author on the 2008 review. He realised immediately that he had made a mistake in blindly trusting the Kaiser data. He said so, without defensiveness, and then set about getting the information needed."


CasesBlog - Medical and Health Blog: The beautiful flower of Internet conversation: how many petals do you have?

Top medicine articles for April 2014

A collection of some interesting medical articles published recently:

Vitamin D supplements are taken by nearly half of American adults. Low levels of vitamin D are a result, not a cause, of poor health. Therefore, supplement may not help -- Vitamin D supplement sales increased more than 10-fold, from $24 million in 2002 to $605 million in 2011 (US data)

"Is Your Stethoscope Going to Join Typewriter in the Storage Closet?" - However, you can't listen to lungs with ultrasound.

Coffee Hydrates as Well as Water - Study defined moderate intake of coffee as 4 cups per day.

Caramel color: The health risk that may be in your soda (no real caramel there, it's 4-MeI). Artificial caramel coloring contains a potentially carcinogenic chemical called 4-methylimidazole (4-MeI). Caramel color is the single most used food coloring in the world

Older adults with impaired hearing may have a faster rate of "brain shrinkage" as they age

For preventing colds, frequent hand washing came out on top (review study)

Whole Foods Bans Produce Grown With Sludge made from municipal waste and feces/urine "biosolids"

Study: Children's Vitamins Contain Far More Than Recommended Amounts (except vitamin D)

Adrenal "Incidentalomas" May Increase Cardiovascular Risk - Follow-up and clinical monitoring may be indicated.

Are Dietary FODMAPs a Cause of Irritable Bowel Syndrome? (Fermentable, Oligo-, Di-, Monosaccharides, And Polyols). IBS symptoms improved with a diet low in short-chain carbohydrates (FODMAPs - fructose, lactose, polyol sweeteners)

Pesticide Byproduct Linked to Alzheimer's Disease (DDT metabolite)

We Are Giving Ourselves Cancer: CTs, once rare, are now routine. One in 10 Americans undergo a CT scan every year. 3-5% of all future cancers may result from exposure to medical imaging. A single CT scan exposes a patient to amount of radiation that epidemiologic evidence shows can be cancer-causing. Radiation doses of CT scans are 100 to 1,000 times higher than conventional X-rays (depends on the type of scan)

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT and you will receive acknowledgement in the next edition of this publication.

Sugar is hiding in plain sight - TED-Ed video by UCSF endocrinologist

When you eat something loaded with sugar, your taste buds, your gut and your brain all take notice. This activation of your reward system is not unlike how bodies process addictive substances such as alcohol or nicotine -- an overload of sugar spikes dopamine levels and leaves you craving more

While sugar is easy to spot in candy, soft drinks and ice cream, it also hides out in foods you might not expect -- including peanut butter, pasta sauce and even bologna! Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco, decodes confusing labels and sugar's many aliases to help determine just how much of that sweet carbohydrate makes its way into our diets.

Lesson by Robert Lustig, animation by The Tremendousness Collective.

More info: Sugar: Hiding in plain sight - Robert Lustig | TED-Ed
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