How to diet fast 1 week

This is what Photoshop and creativity can tell us about aging men.

It has been a while since weve taken a closer look at the effects of testosterone deficiency and its replacement aka TRT. Basically thats why I decided not to waste the interesting findings from a recently published study in the The Journal of Clinical Endocrinology and Metabolism (Yeap. 2013) in the Facebook News. In combination with the findings Xu et al. report in a paper on the difference in testosterone concentrations in young healthy US versus Chinese men the Yeap study does after all make a decent addition to the 269 of hitherto ~1500 archived SuppVersity articles that deal in one way or another with the famous androgen.

Virile men live longer! Ca. 30% longer, to be precise.

If you take a look at the link between serum testosterone, free testosterone and DHT and the all-cause mortality risk of the 16,451 community-dwelling older men from Perth in Western Australia it should be obvious that the third quartile of all these serum values, is where you want your androgen levels to be, if you intend to live to see your 90th birthday.

Figure 1: Relative reduction in all-cause mortality with total and free testosterone levels, as well as dihydrotestosterone levels in quartile 2,3 & 4 vs. quartile 1 (Yeap. 2013)

To quantify: You want to have your total testosterone levels in the 12.56 – 15.75 nmol/L (362ng/dl - 454ng/dL), your free testosterone levels in the 182.66 – 216.34 pmol/L (5.3-6.2 ng/dL) and your dihydrotestosterone (DHT) levels in the 1.34 – 1.83 nmol/L (DHT; 39-53ng/dL) range if you dont want to miss a couple of years of your life.

And while your androgen levels shouldnt be significantly lower, you also dont want them in the fourth quartile, where the all-cause mortality risk begins to rise again. Unless you dont want to lose the ~30% all-cause mortality of being in the zone, you shouldnt let the rumors about a causal (not corollary) link between testosterone replacement therapy (TRT) and the incidence of prostate cancer upset you. Why, well because ...

"[...] to date, no study or review has definitively shown that androgen replacement therapy is an independent risk factor for development of prostate cancer." (Fisher. 2012) 

The thing you should ask yourself is thus whether you really want to give up on this 30% reduction in all-cause mortality, or the decrease in fatal cardiovascular events, Ramasay et al. list next to the reduction in body fat mass, and insulin resistance among the proven benefits of TRT in their 2012 review of the literature.

Its your decision and therefore you should make sure that its you and not your doctor who takes this decision. If you decide to help your low testosterone levels along, its your doctors job to help and assist you by ordering and interpreting regular hormone and, as Fisher et al. suggest, PSA tests.

Informed decisions, require information, lab values, and reference ranges!

Speaking about "interpreting" hormone panels. One of the problems youll be facing is that nobody can actually tell you what your normal testosterone level should look like. Of course, every med-school graduate will believe that he knew exactly whats good for you, but when its all said eand done, scientists (and doctors) tend to be a bit too egalitarian, when it comes to "normal ranges". So egalitarian, in fact that they simply assume that a lightweight Chinese pencil pusher must have the same testosterone levels as a 6.6 ft tall, 300lbs heavy Caucasian strongman.

Figure 2: Total and bioavailable testosterone levels in US and Chinese young men (Xu. 2013)

Its thus quite refreshing that Xu et al. followed a different path and followed the heavily underused "Equal, but different!"-princple, when they decided to conuct what they claim is the first study to analyze and compare the total (TT), calculated free (FT), and bioavailable testosterone (Bio T) levels of healthy young men (18–29 years) from the Third National Health and Nutrition examination Survey (NHANES III) in the United States (US) to those of men living in a region of China with a similar living standard to the US, i.e., Hong Kong.

By this means, the researchers wanted to find out whether the potentially existing differences in androgen levels in Caucasian vs. Asian young men would warrant a revision / specification of the "normal" range for men from different ethnic backgrounds.

As you can see the results are not exactly easy to interpret (Figure 2) - is this a difference, or not?

If we take another look at the data in Figure 2 and compare the relative differences between the total testosterone levels of young US vs. Chinese men to those that made a significant difference, in the previously discussed study by Yeap et al. (see Figure 1), we will have to concede that the xisting differences can hardly be significant. They are after all a magnitude smaller than the quartiles in the Yeap study.
That being said, there are at least three additional reason that speak against establishing specific testosterone cut-off values for different ethnic groups based on the Xu study:

1. The Xu study is not representative of "all" Chinese young men: The Xu study compares US citizens in the US to Chinese citizens in China. Who tells us that the values they obtained for young Hong Kongers are valid for 2nd generation Chinese immigrants to the US, as well? Environmental conditions, dietary factors, etc. all that could just as well be the reason for the measured differences as ethnicity-specific genetic differences.
2. The Xu study, or rather the NHANES data is not representative of a specific ethnicity: By analogy to (1), the Xu study, which uses data from NHANES III to gauge the average testosterone levels of male US citizens, relies on data from Asian, African American, Native American, Hispanic and Caucasian US citizens. How on earth would you establish ethnicity specific normal values based on that?
3. Using the Yeap study as a reference to determine "optimal levels" is unwarranted: With old men as study participants, the significance of the optimal total testosterone levels from the Yeap study (12.56 –15.75 mmol/L ≡ 362- 454ng/dL) is about as questionable as the assumption that older men are actually supposed to have significantly lower testosterone levels.

And even if you wouldnt agree that these objections are valid, there would be a simple, yet effective solution to end this discussion once and for all: Measure (or calculate) the free testosterone levels!

If you do that, i.e. compare free instead of total testosterone levels, you will find that the purported ethnic differences disappear. And this is true not solely for the comparison of the data from Chinese and US men Xu et al. analyzed, but also for the existing differences between Mexican-American, non-Hispanic black and non-Hispanic white men in the NHANES study by Rohrmann et al. (2007). Specific reference ranges for Asian, Caucasian, African American, Hispanics, ... are thus probably unwarranted (not sure about Aliens, though ;-).
References: 

• Ramasamy, R., Fisher, E. S., & Schlegel, P. N. (2012). Testosterone replacement and prostate cancer. Indian journal of urology: IJU: journal of the Urological Society of India, 28(2), 123.
• Yeap, B. B., Alfonso, H., Chubb, S. P., Handelsman, D. J., Hankey, G. J., Almeida, O. P., ... & Flicker, L. (2013). In Older Men an Optimal Plasma Testosterone Is Associated With Reduced All-Cause Mortality and Higher Dihydrotestosterone With Reduced Ischemic Heart Disease Mortality, While Estradiol Levels Do Not Predict Mortality. 
• Perry III, H. M., Miller, D. K., Patrick, P., & Morley, J. E. (2000). Testosterone and leptin in older African-American men: relationship to age, strength, function, and season. Metabolism, 49(8), 1085-1091. 
• Rodriguez, A., Muller, D. C., Metter, E. J., Maggio, M., Harman, S. M., Blackman, M. R., & Andres, R. (2007). Aging, androgens, and the metabolic syndrome in a longitudinal study of aging. Journal of Clinical Endocrinology & Metabolism, 92(9), 3568-3572.
• Rohrmann, S., Nelson, W. G., Rifai, N., Brown, T. R., Dobs, A., Kanarek, N., ... & Platz, E. A. (2007). Serum estrogen, but not testosterone, levels differ between black and white men in a nationally representative sample of Americans. Journal of Clinical Endocrinology & Metabolism, 92(7), 2519-2525.
• Traish, A. M., Miner, M. M., Morgentaler, A., & Zitzmann, M. (2011). Testosterone deficiency. The American journal of medicine, 124(7), 578-587. 
• Vermeulen, A., Verdonck, L., & Kaufman, J. M. (1999). A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology & Metabolism, 84(10), 3666-3672.
• Xu, L., Au Yeung, S. L., Kavikondala, S., Leung, G. M., & Schooling, C. M. (2014). Testosterone concentrations in young healthy us versus Chinese men. American Journal of Human Biology, 26(1), 99-102.

The deadlift probably wont benefit from blocked periodization either... at least if you do it only once a week anyway.

I hope you all remember my recent article about the beneficial effects of block periodization on the training outcome of trained cyclists (if you dont Id suggest you read up on it: "Block Periodization - Impressive Performance Gains in Pro-Athletes") and the hypothesis that the mechanism behind the beneficial effects Rønnestad et al. report in the corresponding paper are not actually a consequence of this specific periodization scheme. Rather than that, the benefits the researchers have observed may well have been a mere consequences of the "change", of "breaking out of the rut" and the provision of a new challenge thats absolutely essential to induce what everyone, from housewife to Olympian athlete is training for: adaptation.

Lets discard the mechanism for a moment, though and lets rather focus on the hard facts - hard facts that are complemented by the results of a soon-to-be-published paper by researchers from the University of Bologna and the University of Central Florida.

Whats so interesting about this paper is ...

....that it looks at the effects of block periodization in trained strength athletes and could thus help us answer a question that may have been preying on your mind, ever since I published the previously cited article about the beneficial effects of block periodization in endurance athletes: "Do Different Rules Apply for Strength vs. Endurance Athletes?" Or, put simply: Would a weight lifter benefit to a similar extend from block periodizing his training regimen as a cyclist - irrespective of what the underlying mechanisms may be?

Figure 1: The subjects trained 4x per week - identical training plans in both groups (Bartolomei. 2014)

The answer is "yes and no" - Yes, if we are talking about the upper body, no - and thats interesting because cycling obviously involves the same muscle groups - when we are looking at the lower body performance gains in Figure 2:

Figure 2: Changes in max. strength (1RM in kg), mean power (in % of baseline) and jump height (in cm) in the 24 study particpants in response to traditional linear or block periodization (Bartolomei. 2014)

As you can see, the gains in lower body power was identical - irrespective of the type of periodization (see overview in Figure 1). For the upper body, on the other hand, the subjects who did not simply ramp up the intensity continuously from 5 sets of 8-10 reps at 65-75% of  1RM  with  less  than  2  minutes  of  recovery  between  sets to 5 sets of 3 - 4 reps at 85 -95% of 1RM with 3 minutes of recovery from week 1 to week 12 (TP group), the ...

"[p]articipants  in  BP  were  more  likely  (79.8%)  to increase the area under the force-power curve than TP. Participants in BP also demonstrated a likely positive (92.76%) decrease in the load corresponding to maximal power at the bench  press compared to TP group, and a possible improvement (~ 60%) in maximal strength and power in the bench press." (Bartolomei. 2014)

Whether thats muscle-specific reaction to the three 5-week mesocycles, instead of one 15-week mesocycle is yet highly questionable - or do you think the legs respond less to the periodization program thats depicted in Figure 3, than chest, back, arms & co?

Figure 3: Illustration of the interplay between intensity and volume of the n=14 24-year-old male, resistance trained (>3 years, >3 sessions per week) subjects in the block periodization group (Bartolomei. 2014)

Personally, I would rather come back to the "novelty approach". It goes without saying that we can assume that the abrupt changes on a blocked periodization regimen favor "growth promoting overloads". In the case of the musculature of the lower body, the simple fact that it was trained just once a week may yet have provided a similarly "novel" or at least less accustomed stimulus on every leg-day.
References

• Bartolomei, Sandro, et al. "A Comparison of Traditional And Block Periodized Strength Training Programs in Trained Athletes." Journal of Strength and Conditioning Research (2014). [ahead of print]
• Rønnestad, B. R., J. Hansen, and S. Ellefsen. "Block periodization of high‐intensity aerobic intervals provides superior training effects in trained cyclists." Scand J Med Sci Sports 24 (2014): 34–42.