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Jan 18

‘Neighbours’ spoilers: Kyle Canning has a honeymoon NIGHTMARE! – What To Watch

Newlyweds Kyle Canning (played by Chris Milligan) and Roxy Willis (Zima Anderson) are super-excited to head off on their honeymoon on today's episode of Neighbours (6:00pm - see our TV Guide for listings).

Kyle, who is still on the mend after being diagnosed with testicular cancer and his subsequent surgery last year, is determined not to let his new bride, Roxy down in the bedroom.

As soon as the couple arrive at their luxury accommodation, they start to feel frisky!

So Kyle secretly slaps on several extra testosterone patches so he can perform in the bedroom.

Unfortunately, the extra testosterone boost works a bit too well.

And very soon, Kyle has a rather, er, persistent issue to deal with down below!

Zara Selwyn (Freya Van Dyke) is in a whole lot of trouble after just one day at Erinsborough High School.

The building had to be evacutaed and the fire brigade called after Zara deliberately set off the school fire alarm.

Word soon gets back to Zara's mum, Amy Greenwood (Jacinta Stapleton), who is not happy.

Zara's friend Hendrix Greyson (Ben Turland) checks in on her while they are on shift together at Harold's Cafe.

However, rather than cleaning-up her act, Zara is intent on upping her game and causing even more trouble at school!

Amy is determined to make her new fast food truck business a success, after losing her job as manager of The Flamingo Bar.

After what has just happened at Erinsborough High School, Amy reckons she needs to keep a closer eye on her daughter, Zara.

She she offers Zara a job so that they can run the business together.

But as usual, Zara is full of attitude and gets into a shoving match with Amy.

As Zara storms off, she is unaware that Amy has suddenly collapsed to the ground in terrible pain...

Neighbours continues weekdays at 1:45pm and 6:00pm on Channel 5

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'Neighbours' spoilers: Kyle Canning has a honeymoon NIGHTMARE! - What To Watch

Jan 3

Testosterone for Erection Problems | Choosing Wisely

When you need testosterone treatmentand when you dont

Most men have problems with erections from time to time. But some men have erectile dysfunction, or ED. This is when it is difficult to get or keep an erection thats firm enough for sexual intercourse.

If you have ED, you may think that testosterone treatment will help. Testosterone is a male sex hormone. After age 50, mens levels of testosterone slowly go down and ED becomes more common. But unless you have other symptoms of low testosterone, you should think twice about the treatment. Heres why:

Testosterone treatment has not been shown to improve erections in men with normal testosterone levels. And studies show that it does not help men with low testosterone levels if ED is their only symptom.

ED is almost always caused by low blood flow to the penis. This is a result of other conditions, such as hardening of the arteries, high blood pressure, and high cholesterol. These conditions narrow the blood vessels and reduce blood flow to the penis. Low testosterone may affect the desire for sex, but it rarely causes ED.

Testosterone treatment can cause the body to retain too much fluid. It can also cause acne, an enlarged prostate, and enlarged breasts. Other side effects include lower fertility; an increase in red blood cells; and an increase in sleep apnea symptoms.

Women and children should avoid touching unwashed or unclothed areas of skin where a man has applied testosterone gel. The gel can be transferred through skin contact.

Although available data is conflicting, the Food and Drug Administration (FDA) has concluded that increased cardiovascular risk (problems with the heart and blood vessels) associated with testosterone use is a possibility. The AUA recommends that only FDA-approved medications should be used and a physical evaluation and follow up are important.

Testosterone treatment can be an injection, a gel, or a patch that is put on the skin. All of these are costly. They may cost hundreds of dollars a month, depending on the treatment.

Men who use a testosterone treatment must use it indefinitely to get and keep the full effect.

If youve had trouble having erections for three months, talk to your doctor. He or she will ask about all your symptoms and give you a physical exam. Symptoms of low testosterone can include less of a sex drive, loss of body hair, breast growth, needing to shave less often, a drop in muscle size and strength, and bones that break more easily.

If you have some of these symptoms, your doctor may have you get a blood test to measure your testosterone levels. The blood test should be done more than once. It is best to do it in the morning when testosterone levels are highest.

If the tests show that you have low testosterone levels, your doctor should look for possible causes. For example, the low levels might be caused by a problem in the pituitary glands.

If no other cause is found, you can try testosterone treatment.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

2018 ABIM Foundation. Developed in cooperation with the American Urological Association.

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Testosterone for Erection Problems | Choosing Wisely

Jan 3

From relationships to the size of your manhood what your finger length says about YOU… – The Sun

HOLD out your hands - you've probably never realised clues to your personality and health could be right at your very fingertips...

It turns out the length of your fingers can be a sign of how much testosterone - the male sex hormone - you were exposed to in the womb.


Testosterone plays a pretty crucial role in a babys development and it also determines how long your index and ring fingers will be as an adult.

But what does all that mean for the kind of person you become?

Tanith Carey reveals how finger length could determine whether

Next time youre on a date, dont look into the other persons eyes - check out their hands instead.

The shorter their index finger in relation to their ring finger, the more likely they are to have been exposed to higher levels of testosterone in the womb, and may be more prone to cheat.

Psychologists from Oxford University and Northumbria University studied 600 men and women in Britain and the US, looking at the link between hand shape and promiscuity.

The study for the journal Biology Letters found people tended to divide into two groups those who are more inclined to stay in relationships and others who want to try lots of partners.

While the scientists couldnt use it to predict everyones fidelity, they found that men and women were generally more likely to cheat if they have slightly longer index fingers (like Tiger Woods appears to have), even though the difference was mere millimetres.

Youd have to look quite hard to notice, says Oxford University Professor Robin Dunbar, who says the differences are "subtle" and "only visible when we look at large groups of people".

"Human behaviour is influenced by many factors, such as the environment and life experience, and what happens in the womb might only have a modest effect on something as complex as sexual relationships," he said.

Women have long been led to believe that checking out a man's shoe size was the best guide to the length of his manhood.

But it turns out we've been looking in the wrong place all along.

According to a study in the Asian Journal of Andrology, men whose ring fingers are longer, in comparison to their index fingers, tend to have bigger penises.

To investigate this link, South Korean doctors measured the index - or pointer finger - on the right hand of 144 male volunteers aged 20 and over.

They also measured the length of each man's ring - or fourth - finger.

Then measured their penises while they were both flaccid and stretched which shows how long they would be when erect.

They found the men who had a small gap between the length of their ring and index digits, like Simon Cowell or Justin Bieber, tended to have bigger penises.

Those with bigger differences, like Donald Trump, tended to be less well-endowed.

And thats not all. In 2014, another study by South Korean researchers found that men with a longer ring finger on their right hand, compared to their right index finger, also had bigger testicles.

If youre a man hoping to seduce a woman with a gorgeous body when you next go out, your chances may have already been decided in the womb.

Men with long ring fingers, like Brad Pitt, are four times more likely to end up with a partner with a combination of a slim waist and prominent chest

Researchers from Polands Jagiellonian University Medical College looked at the hands of 50 young men in long-term relationships and measured the vital statistics of their partners.

They found men with ring fingers longer than their index fingers tended to have partners with classic hourglass figures.

This is possibly because high testosterone levels have also been found to make male faces more symmetrical and attractive to the opposite sex, giving them more chance of attracting a partner with proportions that typically have indicated fertility.

According to the study in the journal Personality and Individual Differences: Our results suggest mens pre-natal environment has an impact on the likelihood of being in a relationship with a more attractive and presumably more fertile woman.

You may go running every day to train for that 5K, but its the length of your fingers that may help decide how long it takes you.

Researchers found young male athletes with long ring fingers compared to their index fingers also had more lung power.

One theory is that higher exposure to testosterone in the womb may boost the development of a baby's lungs for life, improving how well their bodies use oxygen.

In the best runners, they found their ring fingers could measure as much as a centimetre longer than their index fingers.

A similar effect has been seen in women too.

A separate study of female x-rays in the British Journal of Sports Medicine found that more sportier women also had ring fingers longer than their index fingers.

Let your fingers do the talking

Straighten out your hands, holding your fingers together.

Look for the creases at the base of your index and ring fingers.

If there's more than one crease, measure it from the lowest and mark it with a pen.

Next, measure your finger in millimetres from the mark to the tip.

Divide the index finger length by the ring finger length.

A short ratio is about 0.976 while a long digit ratio is around 0.99.

In most women, the ring and index finger tend to be more similar in length.

However, in men it varies more.

If you want a clue as to whether a man is destined to be a high earner, check out his mitts.

For a study in the Proceedings of the National Academy of Sciences, researchers measured the right hands of 44 male stock market traders, some who earned up to 4 million in the city.

Over 20 months, they found the traders with longer ring fingers made 11 times more than those with shorter ring fingers.

Researchers believe that due to a higher exposure to testosterone, they were more confident, happier taking risks and had quicker reaction times.

When you look on a menu, are you the type to opt for a burger and fries, rather than a salad?

While you may think youre being led by your stomach, your choice may actually be down to your finger length.

Researchers at Scandinavia's University of Agder, looked at the food choices of 216 men and women for study in the journal Food Quality and Preference.

They found those with only a small difference in size between their ring and index fingers, like pizza-loving Hunger Games star Jennifer Lawrence, were more likely to reach for stodgy and meaty foods when their tummies were rumbling.

Scientists believe the group with longer ring fingers may have been influenced by ads promoting masculine food products on television, which may particularly appeal to both men and women with higher testosterone levels.

For an early clue as to whether your child will be good at maths, check their fingers.

The hormones in the womb which help make a child good at maths can also make a child's ring finger longer than their index finger, according to University of Bath researchers.

According to study author Dr Mark Brosnan, a childs digit ratio is pretty much set by the time they reach Year 2.

In a study published in the British Journal of Psychology, researchers compared photocopies of the hands of 75 six and seven-year-olds and measured the length of their index and ring fingers on both hands.

They then compared their results in Maths and English tests and found the kids with longer ring fingers whod had more exposure to testosterone in the womb - were better at Maths than English.

Kids who had shorter ring fingers, in comparison to their index fingers - were better at language than maths.

Testosterone is thought to encourage the development of spatial and math skills, while slowing development in the brain's left hemisphere, the part of the brain that deals with language.

Brosnan said: Finger length is by no means a measure of intelligence or ability, but added that a child's finger length might show if a child has a leaning towards maths.

Men with longer ring fingers have a lower risk of dying from Covid and are more likely to get milder symptoms if they do catch it.

The difference may only be a matter of millimetres, but according to research by Swansea University, men with longer finger lengths are likely to have been exposed to more testosterone in the womb, which helps protect organs from the virus.

So if his index finger length divided by the ring finger length is longer 0.99 plus rather than shorter around 0.97 - you may have extra protection.

This is believed to help because testosterone may increase the number of ACE-2 receptors proteins on the surface of cells - in the lungs, which seem to reduce the damage the virus can cause.

However women's finger lengths don't seem to affect their death rates, according to the study, published in the journal Early Human Development.


Original post:
From relationships to the size of your manhood what your finger length says about YOU... - The Sun

Jan 3

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Jan 3

The Places Where Truth Goes To Die – The Dispatch

Late last week I had an experience thats both completely normal and fundamentally absurd. It was thisI spent a ridiculous amount of time agonizing over the wording of a simple Twitter thread. I struggled to use exactly the right words to express what should be a completely normal and reasonable point.

As some readers may know, after competing for three years as a male swimmer at the University of Pennsylvania (and earning all-Ivy honors) as a male, a transgender swimmer named Lia Thomas is now competing as a female, and dominating the competition. Thomass physical advantage is blatantly obvious. Yes, there are NCAA guidelines mandating testosterone suppressant, but testosterone suppressants dont repeal puberty.

Writing in Swimming World, editor-in-chief Don Lohn describes the problem well:

Despite the hormone suppressants she has taken, in accordance with NCAA guidelines, Thomas male-puberty advantage has not been rolled back an adequate amount. The fact is, for nearly 20 years, she built muscle and benefited from the testosterone naturally produced by her body. That strength does not disappear overnight, nor with a years worth of suppressants. Consequently, Thomas dives into the water with an inherent advantage over those on the surrounding blocks.

So, what was my point and what was my struggle? My point was that it is not invidious discrimination to prohibit a biological male from competing in female sports. Indeed, drawing rational distinctions between biological males and biological females might be necessary to protect equal opportunities for women to enjoy access to athletic opportunities.

As Ive written before, the phrase invidious discrimination is a legal term of art that refers to a classification which is arbitrary, irrational and not reasonably related to a legitimate purpose. Bans on invidious discrimination are legally proper and often necessary. Racial classifications, for example, are virtually always invidious. Sex-based classifications can be invidious as well, but sometimes theyre benign. Sometimes theyre even necessary.

To take an obvious example, segregating bathrooms or showers by race is invidious. By contrast, segregating bathrooms and showers by sex isnt just rational, its prudent.

Theres absolutely such a thing as invidious discrimination against transgender Americansimagine if teachers marked down trans students simply because they were trans, or if employers fired productive employees simply because they were trans. But drawing biological sex-based distinctions in sports not only isnt invidious, it protects women from unfairness.

What was my struggle? I wasnt afraid of cancellation. The Twitter world is full of broadsides against Thomas and the NCAA, and there are legions of right-wing voices who relish taking on this issue, and doing so as contemptuously and snarkily as possible and bask in thunderous applause of their tribe. Besides, thanks to my readers, Im pretty tough to cancel anyway.

No my struggle was simply this: How do I make my point in a way that skeptical and hostile readers will hear it and consider it, rather than simply dismissing it out of hand as the bigoted rantings of a hateful Evangelical? After all, I dont just want to be heard. I want to persuade. I believe what Im saying is true, and I want readers to at least consider my words.

Take transgender rightsor virtually any contentious issueand youll find that there are million different ways that people will not just reject your reasoning but refuse to engage with you at all.

Youre the wrong speaker (who wants to hear from a cishet Evangelical?) You chose the wrong words (did he use the acceptable pronouns? Was his language offensive in any other way?) You have the wrong priorities (American democracy is in peril, and were talking about a single trans swimmer at a single school?)

At any rate, this was my short thread. You can determine whether I made my points in a way that skeptics at least might listen:

Despite that long introduction, this isnt a newsletter about transgender athletes. Its about something much deeper and more consequential. Its about one of the most common and pernicious ways in which we lose the ability to hear the truth. In many ways, its about how we defend ourselves from the truth. Let me introduce you to the process foul.

A process foul is any perceived breach of trust or decorum in the delivery of the message that distracts from the substance of the message. To be crystal clear, Im not remotely arguing that process doesnt matter. Indeed, if youre about to have a tough conversation (say, for example, an intervention) with a person you love, you often obsess about the process, almost to the exclusion of substance.

Do you talk on the phone or gather in person? If in person, where? Who should be in the room? Who should speak first? Who shouldnt speak at all? Indeed, taking exquisite care in the process of communicating difficult truths is an act of love. Were talking to human beings, after all, not factbots who can simply hear a hard word (Dude, you drink too much) and respond accordingly.

Process is so important to persuasion that the persuasion industry is consumed by concepts like manner and method. When I litigated, I didnt just try to master the facts and law of the case, but I practiced my delivery to the judge and the jury. I worried about my ties. I talked to my client about his demeanor on the stand and even while simply sitting at the counsels table.

Why do southern trial lawyers have the most impressive accents in the South? Process, not substance. Its an almost unconscious affectation that says to the jury, Im real. Im you.

The problem, however, should be obvious. Our concerns about process can overwhelm our concerns about truth, and our sense of entitlement about process can completely wall us off from hearingmuch less believingdifficult truths. And once you see the process objections in American politics, you cant unsee them. They dominate our discourse.

In my experience, here are the four most common wrongs that prevent us from hearing and understanding whats right.

Wrong messenger. This is perhaps the easiest and most popular method of discounting uncomfortable information. Once you categorize someone as Never Trump or a warmonger or fake news or then youve put on the bulletproof vest. Nothing that comes out of his or her mouth will penetrate your armor.

Wrong motives. Arguments over, for example, the so-called Evangelical elite often center around motive. We place a condition on truth that says, I will listen to true things only when spoken for the right reasons. After all, why should anyone listen to a grifter? And I definitely shouldnt listen to anyone whos simply trying to curry favor with the left or wants to be accepted by the elite.

And who makes the judgment about motive? How do we have confidence that we can peer into a man or womans heart and know their motivations. I appreciated these words from Thomas Sowell:

Wrong manner. In our populist age, there are few more deadly accusations than condescension or elitism. There are cases where even the assertion of any kind of expertise is virtually self-discrediting.

In far-left spaces, ever-shifting and intolerant language norms can mean that ordinary people can find themselves struggling to even find the right words to discuss contentious topics. Even words like racism are subject to different, evolving meanings, and certain terms of art, like land acknowledgment or BIPOC separate individuals into separate classes of understanding.

Wrong target. This is perhaps the most subtle and versatile of the process fouls. Its how you can still be wrong even when youre right. It encompasses concepts like punching down (people with larger platforms shouldnt take on those with less influence), misplaced priorities (youre squeezing out the gnat and swallowing the camel), and whataboutism (Donald Trump has abused women? What about Bill Clinton? Donald Trump hasnt accepted the results of his election? What about Stacey Abrams?)

The process of communication is laden with reciprocal responsibilities. As a communicator, my job is to do my best to know my audience, to understand them, and to speak in words that I believe theyll hear. In other words, my job isnt to fly over the target, dump my truth bombs like Im a B-52 over Hanoi, and then log off congratulating myself for a job well done.

I especially shouldnt congratulate myself for my bravery when the response is exactly the flak I was told to expector even perhaps hoped to receive.

As a listener, however, I have my own responsibilities. I should do my best to shun the calling of process fouls and listen hard to substance. This is not easy. Some of the most important lessons Ive learned have come from the most unlikely teachers. Some of the harshest words spoken to me have turned out to be the most true.

One way that truth dies is that when we place such exacting preconditions on its delivery into our lives that there is virtually no messenger or message that can penetrate our hearts.

Lets make this lesson a bit personal. Just before Christmas a pastor in my denomination named Kevin DeYoung wrote a piece in a Christian magazine called World called The Temptation of the Jeremiad that gained some traction in my little corner of the world. It was aimed mainly at me and the way in which Ive mounted various critiques of white Evangelical politics and cultural engagement in the age of Trump.

I dont know Kevin, but I have many friends who do. I respect his work a great deal, and so I listen to his critiques carefully. While he agrees with some things I say, these two paragraphs contain his core complaint:

And this is my biggest complaint with the white evangelical jeremiad. It has the same head-shaking you people vibe that prompted the deplorables to embrace Trump in the first place. Its one thing to object to an idea or to a set of propositions. Its another to object to a class of people. Even if French is right, and evangelicals should not have supported (voted for?) Trump and evangelicals should not be skeptical about many of the Covid protocols, there is little sympathy for trying to understand why evangelicals might have behaved in these ways. There is no persuasion, only pique and annoyance.


At the risk of seeming biased toward my own profession, I cant help but notice that the leading voices decrying the moral bankruptcy of white evangelicalism are not pastors but professional writers, academics, and full-time commentators. Given the nature of these vocationsvaluable, honorable vocationsit is easier to produce frequent jeremiads against the church than to produce a positive vision for the church. If your natural rhythm is not the whole counsel of God Sunday after Sunday, but another critique of the church in your inbox on Sunday morning, that should tell you something. The Lord knows there is much to criticize in the church, but I doubt that relentless, unsympathetic, exasperated censure against one specific people is the best way to convince them of your criticisms, let alone build them up in Christ.

These are textbook process fouls. Im the wrong messengernot a pastordelivering the message in the wrong way (with a head-shaking you people vibe). He says that even if Im right there is little sympathy for trying to understand why evangelicals might have behaved in these ways. I write only with pique and annoyance.

But this doesnt mean I should disregard what DeYoung says. If Im trying to communicate things that I believe to be both true and gravely important, and a thoughtful man says Im communicating through pique and annoyance then I need to think very hard about how I write.

In fact, I need to repent of my initial response to this essay. Since I believe he mischaracterized much of my work, my initial response was purely reactionary. I defended myself. But I should have reflected more. I should still reflect. As a communicator, am I failing in my responsibilities? Am I communicating a message that I do not intend?

At the same time, this sentence from DeYoung troubled me greatly: It [my work] has the same head-shaking you people vibe that prompted the deplorables to embrace Trump in the first place.

This is the dark place that an emphasis on process over substance can take you. A distaste for a persons tone should never prompt anyone to embrace a man like Trump. After all, even granting that my tone can be better, is that a reason to embrace a person whose tone is inarguably much worse and whose grasp on the truth is inarguably far more tenuous? Are people placing so many preconditions on critique that theyve effectively walled themselves off from hard truths?

When were communicating, we should care about people, and that means caring about process and truth. We should do our best as fallen and imperfect people to say true things in a careful, compassionate, and persuasive way. But we cannot ever allow often-shifting and sometimes-escalating demands about process to silence the truth.

When were listening, by contrast, we should resist the urge to filter truth through process. Strange messenger? Fine. Heck, even one of Jesuss disciples once tried to reject him by asking, Can anything good come out of Nazareth?

Obscure or tough delivery? That can work. Jesus often spoke in parables that few understood, and his own speech could be incredibly blunt and direct. And what about the prophets? Could they rake a man over the coals? Google the etymology of the word jeremiad, and youll find that answer fast.

Wrong motives? Who cares? And besides, how can I presume to know a persons true motivations?

In a recent Atlantic essay I wrote about our incredibly difficult task. In an age of cruelty, how do we open ourselves to legitimate critique? Heres my answer: The best folks I know have achieved the near impossible. Theyve constructed a thick skin while preserving an open heart. Their defense mechanisms are porous enough to allow fair critiques to penetrate while keeping the bad-faith actors at arms length.

Any other approach and our own heart and mind risk becoming the places where truth goes to die.

One more thing

In the lastest Good Faith podcast, Curtis and I talk about how January 6 helped both of us understand that it was time to grow up. We have to be adults now.

What does that mean? Please listen to the pod to find out.

A personal update

I apologize for the lack of a Tuesday newsletter last week. COVID came to our house, and I caught a breakthrough infection, along with three other members of the family. As the old guy of the bunch, I fared the worst, but it was still never worse than a moderate flu (though with quirky and shifting symptoms!), and we all were on the mend by the end of the week.

Im grateful for the vaccine, and Im grateful to have recovered so quickly. Millions have faced much greater challenges.

One last thing

This is a marvelous hymn and feels right for the first days of a new year that already can feel full of more uncertainty than promise:

Originally posted here:
The Places Where Truth Goes To Die - The Dispatch

Jan 3

Recap: Recent Updates in the Treatment of Nonmetastatic Castration-Resistant Prostate Cancer – Cancer Network

In a recent OncView discussion, Aaron Berger, MD, vice president and chief medical officer at Associated Urological Specialists in Chicago, Illinois, shared clinical experiences and perspectives regarding treatments of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC).

Clinicians need to be aware of all the treatment options available in this space, as many FDA-approved indications have emerged in the past few years, Berger said.

Thereve been several new options for nonmetastatic castration-resistant prostate cancer to come to market, he noted. The first was enzalutamide [Xtandi] followed shortly thereafter by apalutamide [Erleada], and then most recently darolutamide [Nubeqa]. Weve used all of them in our advanced prostate cancer clinic, and its certainly an improvement over the previous options [such] as first-generation antiandrogen therapies.

Berger detailed his strategies for therapy selection in this patient population, including insights in baseline patient characteristics, clinical trial data, and toxicity profiles of each novel agent that guide his decisions.

Berger said his first consideration in a patient with nmCRPC is whether they need additional systemic therapy. Age, comorbidities, prostate-specific antigen (PSA) doubling time, and medication adherence are some of the factors that may incline a clinician to treat a patient with a newer antiandrogen medication.

Some of these patients have a lot of other [medical] issues, Berger said. If theyre not excited about another medication or are worried about [adverse] effects, we may just observe them, especially if their [PSA is] rising somewhat slowly.

Ultimately, the treatment goals in this setting are to prevent progression of disease from nonmetastatic to metastatic, as survival rates dramatically decrease in later stages of the disease. Typically, we will check PSA and testosterone levels every 3 months, Berger said. He noted that testosterone less than 50 ng/mL and a PSA doubling of 10 months or less was the threshold for administering medication to patients in clinical trials.

Thats not in the labeling for all these medications. You certainly can use the medication if their doubling time is 11 months or 12 months, but normally its [with a PSA doubling time of] 10 months or less were really focused on, he said.

For imaging in a patient with a significant PSA rise, Berger said he references the RADAR III guidelines, which recommend next-generation imaging techniques for detecting previously metastases (Table 1).

We would certainly consider doing conventional imaging initially, such as a CT scan or bone scan, and if its negative then we would likely continue observation, Berger said. I typically wouldnt wait until PSA is 5, 10, or 20 ng/mL and just keep doing conventional imagingwe would likely move on to doing next-generation imaging studies earlier. Some other factors that might motivate imaging sooner include pain in the back, hips, or legs; urinary symptoms; or obstructions in the kidneys.

Regarding the 3 available next-generation androgen receptor inhibitors that are available to treat patients in this setting, Berger said their mechanisms of action are similar but varying molecular sizes account for the biggest differences reflected in slightly different toxicity profiles.

Darolutamide typically has less in the way of central nervous system effectssuch as fatigue, light headedness, or dizzinessthan what we sometimes may see [with the other agents], Berger said. But mechanistically, they work very similar.

Regarding metastasis-free and overall survival (OS) rates, pivotal clinical trials that led to the approval of these agents reflect similar results. The design of the studies are very similar and the results of the studies are very similar, Berger said. Sometimes theres a reason why you may not use one versus the other, such as if a patient does have significant fatigue or has any other central nervous system issues [such as] gait abnormalities. Potentially, the darolutamide may be a better choice than enzalutamide or the apalutamide. But in my experience, theyre all tolerated pretty well.

Berger then explored data from the phase 3 PROSPER (NCT02003924), ARAMIS (NCT02200614), and SPARTAN (NCT01946204) trials that led to the approvals of enzalutamide, darolutamide, and apalutamide, respectively.

All 3 trials had very similar patient populations with a PSA doubling times of 10 months or less. All the patients had rising PSA that was confirmed on more than 1 occasion and castrate levels of testosterone less than 50 ng/mL, Berger said. They were all looking at metastasis-free survival as the primary end point.

At the initial readout of the SPARTAN trial, metastasis-free survival (MFS) was statistically significantly improved with apalutamide versus the placebo group (HR, 0.28; 95% CI, 0.23-0.36; P < .001).2 Similarly, MFS in PROSPER showed a 71% reduction in the risk of metastasis or death with enzalutamide compared with placebo (HR, 0.29; 95% CI, 0.24-0.35; P < .001).3 In ARAMIS, patients treated with darolutamide derived a significant treatment benefit versus those treated in the placebo group (HR, 0.41; 95% CI, 0.34-0.50; P < .001).4

In subsequent analyses, it is now borne out that they all do result in improvements in overall survival, Berger said. OS results with next-generation agents versus placebo were statistically significant for SPARTAN (HR, 0.78; 95% CI, 0.64-0.96; P = .016),5 PROSPER (HR, 0.73; 95% CI, 0.61-0.89; P = .001),6 and ARAMIS (HR, 0.69; 95% CI, 0.53-0.88; P = .003).7

When discussing toxicity, Berger detailed each in the context of which adverse effects were commonly associated with each agent.

We typically see with enzalutamide fatigue or asthenia. These patients are all on androgen deprivation therapy at baseline [and] they have low testosterone at baseline, which can certainly decrease their overall energy level to start with, Berger said. Adding the enzalutamide in some patients does zap their energy substantially to the point where some dont really feel like they have any motivation and dont want to get out of bed.

For these patients, Berger said a slight dose reduction can have a profound effect on their energy levels. For example, reducing the dosage by 25% or switching a patient from a 4-pill dose to a 3-pill dose may help a patients experience without significant effects on their overall disease outcomes.

With apalutamide, full body rash 2 to 3 months into treatment may occur but often can be managed with oral antihistamines or topical corticosteroids. Rarely, patients have a severe full body rash that requires discontinuation of therapy.

Theres also a slightly higher risk with apalutamide of hypothyroidism, but this is not typically something we screen for routinely, Berger said. Its mainly for those patients who have a history of hypothyroidism and are on medications already for thyroid replacement that well check a thyroid panel along with their PSA and testosterone.

Regarding darolutamide, Berger said its toxicity profile is likely the most favorable of the 3 available agents with its lower rate of fatigue, with most symptoms occurring during treatment.8 The bottom line is to know what to potentially expect and let the patients know what to be on the lookout for, he said.

Berger said comorbid conditions, such as obesity or diabetes, may inform the decision to administer an androgen inhibitor but they do not necessarily preclude a patient from treatment.

If they dont have significant cardiovascular issues and havent had a heart attacks, stroke, or congestive heart failure issues, Im not going to withhold a second-generation androgen inhibitor just because theyre a bit overweight, Berger said.

In fact, the relatively manageable safety profile of these agents means that treatment can be given without many dose adjustments even to patients with renal insufficiencies, he said.

Neurologic issues that may be present, such as unsteadiness, dizziness, or a history of falls should be taken into consideration, Berger said. Then the data would indicate that darolutamide may be a better option [because] there wasnt an increased risk from falls and fractures in the ARAMIS trial.

Regarding unmet needs in the treatment space, Berger said that guidance for prescribers on drug-drug interactions is lacking. There are a lot of medications patients are on, whether its antihypertensives, diabetes medications, or cardiovascular medications, especially the anticoagulants that may have some interactions with these medications. And the guidance, as far as what we can glean from the studies, is not always clear about whats safe and what may not be safe, he said.

Another consideration is whether nmCRPC will continue to be a disease state in the future, as next-generation imaging techniques become more prevalent in the treatment landscape and reveal metastasis in patients who would have been formerly considered nonmetastatic.

When you have a scan that can pick up an area of metastasis at [PSA of] 0.2 to 0.3 ng/mL, it may turn out that these patients are metastatic. All of these studies were done with conventional imaging, Berger said. The big question as far as this entire disease state is, will it still be a disease state 5 years from now?

Overall, Berger said clinicians shouldnt shy away from prescribing these medications to their patients, given their tolerability and ease of administration. I would not be afraid of these medications because you can easily add them into your clinical practice without a lot of trepidation, he said.

1. Crawford ED, Koo PJ, Shore N, et al. A clinicians guide to next generation imaging in patients with advanced prostate cancer (RADAR III). J Urol. 2019;201(4):682-692. doi:10.1016/j.juro.2018.05.164

2. Smith MR, Saad F, Chowdhury S, et al. Apalutamide treatment and metastasis-free survival in prostate cancer. N Engl J Med. 2018;378(15):1408-1418. doi:10.1056/NEJMoa1715546

3. Hussain M, Fizazi K, Saad F, et al. Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2018;378(26):2465-2474. doi:10.1056/NEJMoa1800536

4. Fizazi K, Shore N, Tammela TL, et al. Darolutamide in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2019;380(13):1235-1246. doi:10.1056/NEJMoa1815671

5. Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. Eur Urol. 2021;79(1):150-158. doi:10.1016/j.eururo.2020.08.011

6. Sternberg CN, Fizazi K, Saad F, et al. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med. 2020;382(23):2197-2206. doi:10.1056/NEJMoa2003892

7. Fizazi K, Shore N, Tammela TL, et al. Nonmetastatic, castration-resistant prostate cancer and survival with darolutamide. N Engl J Med. 2020;383(11):1040-1049. doi:10.1056/NEJMoa2001342

8. Gratzke CJ, Fizazi K, Shore ND, et al. Time course profile of adverse events of interest and serious adverse events with darolutamide in the ARAMIS trial. Ann Oncol. 2021;32(suppl 5):S626-S677. doi:10.1016/annonc/annonc702.

Continued here:
Recap: Recent Updates in the Treatment of Nonmetastatic Castration-Resistant Prostate Cancer - Cancer Network

Jan 3

Features of a new corOnavirUs infection course and optioNs therapy DEpending on the andRogenic status (FOUNDER): androgenic status in men with…

This article was originally published here

Urologiia. 2021 Dec;(6):85-99.


OBJECTIVE: Analysis of androgen status in men hospitalized with a moderate COVID-19 and its relationship with the severity of the disease.

MATERIALS AND METHODS: The study included 152 males with a confirmed diagnosis of COVID-19 based on the results of a positive PCR for the SARS-CoV-2 virus and/or computed tomography of the lungs hospitalized at the MSU University Clinic due to the moderate and severe COVID-19. Examination of the level of biochemical blood parameters (CRP, creatinine, urea, glucose, total testosterone (T)); CT of the lungs. To objectify the severity of the clinical symptoms, the NEWS2 distress syndrome severity scales and the original scale for assessing the clinical condition of patients with COVID 19 (SHOCS-COVID) were used.

RESULTS: The median T level in 152 examined patients was 2.14 [1.21; 3.40] ng/ml. In patients with a T level below the median, the CRP level was more than two times higher, and the D-dimer value was almost two times higher than in patients with T level above median. The duration of treatment in the hospital was longer in men with COVID 19 and an initial T level below the median than in patients with T about the median (13 days vs 10.5 days, p=0.003). Low T level was correlated with lung damage by lung CT. After improving the clinical condition, there was a linear increase in the level of T independent of its initial level.

CONCLUSION: Among men with moderate and severe COVID-19, a decreased testosterone level is detected in 46.7% of cases. Patients with low testosterone levels on admission have more severe COVID-19. A significant increase in testosterone level was observed after successful COVID-19 treatment without any special action regarding testosterone level.


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Features of a new corOnavirUs infection course and optioNs therapy DEpending on the andRogenic status (FOUNDER): androgenic status in men with...

Jan 3

Perfect Sting had positive test; Holloway appealing – Harnesslink

It has been discovered that Perfect Sting had a positive test back on June 26, 2021, when he was second then placed first in the $148,332 Pennsylvania Sire Stake for harness racing 3-year-old male pacers at The Meadows.

A split sample was also sent to the labs and was found to be also positive for testosterone.

Before this report was published today, Perfect Sting had gone on to be named the Dan Patch Three-Year-old Pacing Colt of the Year and his trainer, Joe Holloway named as the Dan Patch Good Guy Award Winner.

Mr. Holloway has said that he will be appealing the decision.

Here is the ruling found on the USTA website.

HOLLOWAY, JOSEPH J FREEHOLD, NJ YOB 1956Mea on 6/26/2021 FINED: $500FULL 15 DAYS, 1/17/2022 THRU 1/31/2022HORSE DISQUALIFIED PLACED 9, PURSE REDISTRIBUTIONPOSITIVE TEST- POST RACEPA Code Title 7-203.22,401.2 A(1),401.41, 205.33, 205.501 (14).

Sample #376342 was found to contain testosterone at a level of 3765pg/ml, a class 3 violation.

Sample #376342 was provided by #7 Perfect Sting, who was placed 1st through a disqualification, and was trained by Mr. Holloway. A split sample and DNA was requested and confirmed at a level of 3635pg/ml and a match of DNA.

Thus, #7 is disqualified and placed 9th, the purse ($74,166) is ordered to be redistributed, and Mr. Holloway, the trainer of record, is fined $500 and given a 15-day full suspension.

During his suspension, Mr. Holloway is denied the use and privileges of all the grounds sanctioned by the Pennsylvania SHRC.

All horses owned and/or trained by Mr. Holloway may only be transferred through the Judges office at the Meadows.

The fine and purse return must be paid within 10 days of this ruling.

ViewFines and Suspensions for the week of December 31, 2021,as reported to the USTA by racing commissions in the United States.

This bulletinreports actions that have been taken by the USTA and rulings as submitted by the various racing commissions in an abbreviated form; we are not responsible for the accuracy or timeliness of such information. For full ruling text, or if you have questions or concerns about the information found in this report, please contact the racing commission where the ruling was issued.

All reported rulings, current and past, may be found by usingPathway, the USTAs official database. Although there is no charge for this information, aUSTA accountis required.

For a list of archived bulletins, clickhere.

Looking for Canadian Rulings?

Viewrulingsposted at Standardbred Canada. This information is collected and posted by Standardbred Canada. The USTA assumes no liability for errors or omission.

From the USTA and Harnesslink

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Perfect Sting had positive test; Holloway appealing - Harnesslink

Dec 23

How effective are testosterone pellets: Side effects and …

Many pharmaceutical professionals promote the benefits of testosterone replacement therapy. They state that administering this hormone in the form of a gel, injection, or pellet can relieve the symptoms of low testosterone.

These symptoms can include:

Using a product such as testosterone pellets may relieve some of the symptoms associated with low testosterone levels. However, testosterone pellets have many risks and side effects. People should discuss these with a doctor before trying this treatment.

Testosterone pellets are a form of hormone replacement therapy. They are about the size of a grain of rice, and a doctor will implant them under the skin.

These pellets contain crystallized testosterone and deliver a steady, low dose of this hormone to the individual for up to 6 months at a time.

Although many people believe that testosterone replacement therapy can be beneficial, it can cause side effects and increase the risk of certain health conditions.

The possible side effects of testosterone replacement therapy include the following:

Too much testosterone can increase a persons risk of the following conditions:

Testosterone pellets also come with specific health risks. These risks include:

Taking testosterone supplements disrupts the bodys ability to make testosterone.

This means that when a person stops taking testosterone supplements, they may feel worse suddenly because their body has not adjusted to making testosterone on its own again yet.

Testosterone pellets work by emitting a steady, low level of testosterone over a period of several months. A doctor will typically implant the pellets under the skin, or subcutaneously, near the hip or on the buttocks. This procedure is quick and can take place in the doctors office.

First, the doctor will thoroughly clean the area where they plan to implant the pellets. They will then administer a local anesthetic before making a small incision in the skin and using a tool called a trocar to insert about ten pellets.

The pellets should release a steady dose of the hormone for several months following the implantation.

Testosterone pellets have received mixed feedback.

Many people who use some form of testosterone replacement therapy, including the pellets, report feeling an immediate boost in energy and sex drive.

In a 2014 study, only 17 percent of people who had testosterone replacement therapy chose to use testosterone pellets. However, of those who did, 70 percent were satisfied. The rate of satisfaction was similar for the testosterone gels and injections.

The same study shows that 64 percent of the people who chose testosterone pellets favored them over the other forms of therapy due to their ease of use.

A 2013 study investigating mens decisions to begin and stop using testosterone pellets reported that there was no difference in the testosterone levels of the men who continued to use testosterone pellets and those who discontinued the therapy.

Even so, many doctors still recommend testosterone pellets as an option for males with hypogonadism, a condition in which the body does not produce enough testosterone.

It can take some trial and error to achieve the correct testosterone dosage in replacement therapy.

However, the dosage is difficult to adjust when using testosterone pellets because adding or removing pellets requires an additional medical procedure each time.

As a result, some doctors recommend that people start with another form of testosterone replacement therapy, such as gels or injections, to get the dosage right before switching to testosterone pellets.

Most doctors will consider using testosterone pellets for a person once they have determined a dosage that alleviates the symptoms of low testosterone without raising red blood cell counts.

Medical professionals remain divided regarding the benefits of testosterone replacement therapy and whether or not it can help alleviate the symptoms of hypogonadism.

Harvard Mens Health advise people considering testosterone therapy to consult a doctor and learn about all of the side effects and risks before making a decision. They also recommend that people interested in this therapy try to boost their energy by making lifestyle changes first.

However, for people using testosterone replacement therapy, testosterone pellets may offer benefits over other forms of this treatment. Potential advantages include:

More research on testosterone replacement therapy is necessary to verify its benefits and minimize its potential risks. Testosterone pellets may be a more convenient treatment option than other forms of testosterone replacement therapy for those with hypogonadism.

However, people should not view testosterone pellets as a quick fix to boost their energy levels and sex drive. It is vital to always speak with a doctor before starting testosterone replacement therapy and to be aware of the potential side effects and risks.

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How effective are testosterone pellets: Side effects and ...

Dec 23

Erectile dysfunction and testosterone levels prior to COVID-19 disease: What is the relationship? – DocWire News

This article was originally published here

Arch Ital Urol Androl. 2021 Dec 21;93(4):460-464. doi: 10.4081/aiua.2021.4.460.


OBJECTIVE: We aimed to investigate the relationship between COVID-19 and Erectile Dysfunction (ED) and the effect of serum testosterone level on the disease prognosis.

METHODS: Between April-December 2020, 70 patients who were admitted with a complaint of ED after having COVID-19 and whose serum testosterone level was checked for varicocele, premature ejaculation, and infertility reasons before COVID-19. The patients filled the International Index of Erectile Function (IIEF-5) and their testosterone level was checked. The questionnaire was arranged to assess the first month before COVID-19 and after COVID-19. Testosterone levels of the patients before and after COVID-19 were compared. The relationship between testosterone levels and hospitalization in the intensive care was evaluated.

RESULTS: It was revealed that testosterone levels and IIEF-5 scores after COVID-19 in all patients were statisticaly and significantly different compared to the period before COVID-19 (p < 0.05). Testosterone levels of patients in need of intensive care were significantly higher than those without any need of intensive care (p < 0.05).

CONCLUSIONS: Our study has presented that COVID-19 may cause ED and high testosterone levels increase the rate of hospitalization in the intensive care by intensifying the disease.

PMID:34933531 | DOI:10.4081/aiua.2021.4.460

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Erectile dysfunction and testosterone levels prior to COVID-19 disease: What is the relationship? - DocWire News

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