Aging in men is accompanied by a progressive, but individually variable decline of serum testosterone production, more than 20% of healthy men over 60 yr of age presenting with serum levels below the range for young men. Albeit the clinical picture of aging in men is reminiscent of that of hypogonadism in young men and decreased testosterone production appears to play a role in part of these clinical changes in at least some elderly men, the clinical relevancy of the age-related decline in sex steroid levels in men has not been unequivocally established. In fact, minimal androgen requirements for elderly men remain poorly defined and are likely to vary between individuals. Consequently, borderline androgen deficiency cannot be reliably diagnosed in the elderly, and strict differentiation between “substitutive” and “pharmacological” androgen administration is not possible. To date, only a few hundred elderly men have received androgen therapy in the setting of a randomized, controlled study, and many of th...

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The decline of androgen levels in elderly men and its clinical and therapeutic implications.

Obesity and type 2 diabetes have become the major health problems in many industrialized countries. Here, I present the unconventional concept that a healthy organism maintains its systemic homeostasis by a "competent brain-pull", i.e., the brain's ability to properly demand glucose from the body, and that the underlying cause of obesity is "incompetent brain-pull." I describe the energy fluxes from the environment, through the body, toward the brain as the final consumer in a "supply chain" model. There is data-based support for the hypothesis, which states that under conditions of food abundance incompetent brain-pull will lead to build ups in the supply chain culminating in obesity and type 2 diabetes. There is also support for the related hypothesis, which states that under conditions of food deprivation, a competent brain-pull mechanism is indispensable for the continuation of the brain's high energy level. To experimentally determine how the competent brain-pull functions to demand for cerebral energy, healthy young men undergoing psychosocial stress were studied. It was found that the brain under stressful conditions demands for energy from the body by using a brain-pull mechanism, which is referred to as "cerebral insulin suppression" and in so doing it can satisfy its excessive needs during stress. This article gives an overview about the recent work on the "Selfish Brain" theory dealing with the maintenance of the cerebral and peripheral energy homeostasis.

The Selfish brain: competition for energy resources

The following study tested the hypothesis that women with post-traumatic stress disorder (PTSD) related to childhood sexual abuse would display elevated norepinephrine-to-cortisol ratios similar to that found in male combat veterans diagnosed with PTSD. Twenty-four-hour urine samples were collected from 28 women: 11 women with PTSD who experienced childhood sexual abuse (PTSD+), 8 women who experienced childhood sexual abuse without PTSD (PTSD-), and 9 nonabused controls. All urine samples were tested for creatinine, total catecholamines, free-cortisol, and 17-ketosteroid levels. Psychological testing validated that the PTSD+ group was significantly elevated on all three subscales of the Impact of Events Scale. Both abused groups (PTSD+ and PTSD-) showed a tendency for polyuria, and the PTSD+ group showed a tendency towards obesity. Thus, neuroendocrine values (micrograms/day) were adjusted by creatinine clearance rates (creatinine mg/day/kg body weight). The corrected values indicated that the PTSD+ group had significantly elevated daily levels of norepinephrine, epinephrine, dopamine, and cortisol. However, because of the parallel elevation in cortisol, the norepinephrine-to-cortisol ratio was not significantly elevated in the PTSD+ diagnosed women in contrast to the findings reported for male PTSD patients. This discrepancy may reflect an important gender difference, an interaction between gender and age at onset of the traumatic experience (childhood abuse in females vs. combat experience in young adult males), or physiological variation related to phase of the disorder. Language: en

Abuse-related posttraumatic stress disorder: evidence for chronic neuroendocrine activation in women.

The selfish brain: competition for energy resources

Individual differences in the diurnal cycle of salivary free cortisol: a replication of flattened cycles for some individuals

Androgenic hormones were investigated during two separate 5-day military endurance training courses, with physical activities around the clock corresponding to a daily energy consumption of about 40,000 kilojoules, but with an intake of only 2,000 kilojoules. Altogether, the cadets slept for 1-3 h in the 5 days. Eleven male cadets participated in course I, and 10 in course II. Plasma levels of testosterone, free testosterone, dehydroepiandrosterone, 17 alpha-hydroxyprogesterone, and androstenedione decreased by 60-80% during the course. In contrast, plasma cortisol, aldosterone, progesterone, and dehydroepiandrosterone sulfate increased. LH, FSH, and ACTH decreased to about 50-80% of precourse levels. Weak correlations between plasma levels of hypophyseal and levels of adrenal and testicular hormones indicate a multifactorial regulation. In conclusion, both adrenal and testicular androgens decrease during prolonged physical strain combined with energy and sleep deficiency.

P K Opstad

Papers

Androgenic hormones during prolonged physical stress, sleep, and energy deficiency