OBJECTIVE: In obese men, sex hormone-binding globulin (SHBG) as well as total testosterone (TT) levels are decreased. Data concerning serum free testosterone (FT) levels in obese men are discordant. FT levels are decreased in only some morbidly obese men, consistent with an impairment of the feedback regulatory mechanism. In this study we aimed to verify serum levels of TT and FT in two groups of obese men (BMI`35.0 kgam 2 and BMI b 35.1 kgam 2 ) before and after weight loss. DESIGN: Two groups of obese men (group 1: BMI 35 kgam 2 ; and group 2: BMI ! 35.1 kgam 2 ) were studied before and after 6 months of a low energy diet (1200 kcaladay). Every patient received a therapeutic prescription of dexfen¯ur-amine (15 mg b.i.d.) that was maintained for 6 months. SUBJECTS: Thirty-seven obese men and 20 normal weight men. MEASUREMENTS: Serum sex hormones (TT and FT), serum luteinizing hormone (LH) and insulin were analyzed by RIA assays. Plasma insulin levels, serum TT, FT and LH concentrations were obtained before and after weight loss. RESULTS: Moderately obese men (BMI 32.3 AE 1.9 kgam 2 ) presented signi®cantly decreased TT levels (390 AE 120 ngadl) as well as FT (mean AE s.d. : 16.0 AE 4.8 pgaml) as compared with normal controls. FT serum levels had a signi®cant and negative correlation with body mass index (BMI), whereas for TT concentrations this correlation was not signi®cant. Serum LH concentrations (4.5 AE 2.9 mlUaml) were normal. Insulin levels were elevated in all patients (46.3 AE 30.1 m mUaml). After weight loss there was a signi®cant (P`0.01) increase in TT, FT and LH levels, whereas insulin concentrations signi®cantly decreased. In massively obese men (BMI 43.0 AE 6.7 kgam 2 ), TT (320 AE 110 ngadl), FT (11.0 AE 2.1 pgaml) and LH (3.1 AE 1.3 mlUaml) were decreased and signi®cantly lower as compared with the previous group and normal controls. As expected, after weight loss TT, FT and LH levels increased signi®cantly while insulin concentrations decreased. CONCLUSIONS: We concluded that FT levels are dependent on the degree of obesity, massively obese men (BMI ! 35.1 kgam 2 ) being considered as candidates for consistently low FT levels. A functional decrease of LH pulse amplitude and serum LH levels as well as a possible negative action of excess of circulating leptin on the steroidogenesis may be related to the decreased androgens levels in massively obese men.

We prospectively evaluated the effect of thyrotropin (TSH)-suppressive therapy with levothyroxine (LT4) on the size of a benign, solitary, solid nodule and multinodular goiter in a relatively low iodine intake area. In this study, 101 euthyroid subjects with a benign, solitary, predominantly solid nodule (n = 54) confirmed by biopsy or multinodular goiter (n = 47) received 200 microg of levothyroxine daily as a single morning tablet for 12 months. Thirty-five receiving no therapy were considered as controls (solitary nodules, n = 20, multinodular, n = 15). Patients were admitted to the study after evaluation of thyroid biochemical parameters (thyroxine [T4], free thyroxine [FT4], triiodothyronine [T3], thyrotropin [TSH], and thyroglobulin [Tg]), thyroid scanning, ultrasound examination, and fine-needle aspiration biopsy. Every 3 months, thyroid function tests and every 6 months ultrasound examinations were repeated. Twelve months later 20 of 54 (37.1%) patients with single, solid nodules had 50% or more regression of the nodular volume (responders). Eleven of 54 (20.3%) patients had more than 20%, but less than 49.9% reduction of nodular volume (partial responders). Nonresponders were 23 of 54 (42.5%). One-third of subjects with multinodular goiter had 50% or more regression of the glandular volume, whereas 46.8% were considered as nonresponsive. The mean serum Tg levels decreased significantly only in responders with solitary nodular disease or multinodular goiter. In the control group only 1 patient (5% of total) with a solitary nodule had a 50% reduction in the nodular volume. Five others had a partial response (<49%, >20% reduction). None of the patients with multinodular goiter had a significant reduction (>50%) of the combined nodular volumes. We concluded that LT4 may be effective, among other factors, in arresting the growth or in reducing the volume of relatively small, benign, solitary, solid thyroid nodules or the combined nodular volume of multinodular goiter.

Background: Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP), and may rep-resent a greater risk in older individuals.

Acute resistance exercise can reduce the blood pressure (BP) of hypertensive subjects. The aim of this study was to evaluate the effect of different volumes of acute low-intensity resistance exercise over the magnitude and the extent of BP changes in treated hypertensive elderly individuals. Sixteen participants (7 men, 9 women), with mean age of 68 ± 5 years, performed 3 independent randomized sessions: Control (C: 40 minutes of rest), Exercise 1 (E1: 20 minutes, 1 lap in the circuit), and Exercise 2 (E2: 40 minutes, 2 laps in the circuit) with the intensity of 40% of 1 repetition maximum. Blood pressure was measured before (during 20 minutes) and after each session (every 5 minutes during 60 minutes) using both a mercury sphygmomanometer and a semiautomatic device (Omrom-HEM-431). After that, 24-hour ambulatory blood pressure monitoring was performed (Dyna-MAPA). Blood pressure decreased during the first 60 minutes (systolic: p < 0.01, diastolic: p < 0.05) after all exercise sessions. Only the highest volume session promoted a reduction of mean systolic 24-hour BP and awake BP (p < 0.05) after exercise, with higher diastolic BP during sleep (p < 0.05). Diastolic 24-hour BP and both systolic and diastolic BP during sleep were higher after E1 (p < 0.05). Concluding, acute resistive exercise sessions in a circuit with different volumes reduced BP during the first 60 minutes after exercise in elderly individuals with treated hypertension. However, only the highest volume promoted a reduction of mean 24-hour and awake systolic BP.

Approximately 50% of patients with essential hypertension, both treated and untreated, appear to be insulin resistant, and CVD risk factors are greatly accentuated in this subset of patients.

OBJECTIVES:The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults.METHOD:Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week.RESULTS:Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group.CONCLUSIONS:The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass.

Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.

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