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Dad needs a good night’s sleep for better health – Johnson City Press (subscription)

Posted: June 19, 2021 at 1:50 am

This Fathers Day marks the end of National Mens Health week.

The goal of this week along with the whole month of June, which is designated as Mens Health Month is to call attention to the things men need to do to take better care of themselves.

Many of the most serious threats to mens health can often be prevented by exercise, eating healthier and giving up smoking. Also, getting enough sleep is very important to maintaining good heath.

Unfortunately, a year of the COVID-19 pandemic has widened waistlines and created many sleepless nights for many Americans.

The Centers for Disease Control and Prevention says on its website: Insufficient sleep is associated with a number of chronic diseases and conditions such as diabetes, cardiovascular disease, obesity and depression which threaten our nations health. Not getting enough sleep is associated with the onset of these diseases and also may complicate their management and outcome.

Being overweight is a main contributor to most of the health problems that plague men, including sleep problems. In fact, obesity and diabetes often go hand in hand. And it is a problem that manifests itself profoundly in Tennessee.

There are ways to address the problem. Regular physical activity provides a number of health benefits, including improvements in muscle strength and a reduction in the risk factors for chronic diseases.

Doctors say exercise, along with a nutritious diet, is the key to shedding both pounds and health risks.

There is no miracle pill that can help you to lose weight quickly and safely. Likewise, there are no shortcuts to dropping weight and becoming physically fit.

Yes, some diet plans and health supplements can help in achieving weight loss and better fitness. But it must be stressed that these are just tools that, along with healthy eating and regular exercise, can help determined men lose weight.

Unfortunately, there are products on the market that purport to be magical formulas for losing weight.

Its important to consult a physician before trying any weight-loss program or diet products.

And men should also remember that making better lifestyle choices, such as eating healthier and engaging in walking or some other form of regular exercise, are good steps to take to see that they are around to enjoy many more Fathers Days to come.

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Dad needs a good night's sleep for better health - Johnson City Press (subscription)

DASH Diet: What Is It, Meal Plans and Recipes – Health Essentials from Cleveland Clinic

Posted: June 19, 2021 at 1:50 am

Lots of diet plans have come and gone (cabbage soup diet, anyone?) but DASH is here to stay. The DASH eating plan (or DASH diet) has been around for decades because it has solid science to prove that it works.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

Dive into what the DASH diet is and how you can use it to boost your health with dietitian Kate Patton, MEd, RD, CSSD, LD.

DASH stands for Dietary Approaches to Stop Hypertension. This eating plan was designed to lower the risk of hypertension (high blood pressure). High blood pressure affects 1 in 3 American adults and is a major risk factor for heart disease.

When you follow the DASH diet, you consume higher amounts of potassium a heart-healthy mineral. You also consume less sodium, which can help lower your blood pressure and improve heart health.

The benefits of DASH are well-documented. Multiple studies have found that people who follow DASH can lower their blood pressure within a few weeks, says Patton.

But its not just about improving blood pressure. The DASH diet can help you lose excess weight and cut your risk for certain health problems. Research has found that following DASH could lower your risk of:

The best part about the DASH diet? Its flexible. It doesnt require special foods and you dont have to go hungry or eliminate treats, notes Patton. Instead, DASH recommends incorporating heart-healthy foods into your daily life.

The DASH diet focuses on eating heart-healthy foods that you can find in your grocery store. These foods are naturally high in fiber, magnesium, potassium and calcium. Theyre also low in sodium.

If you follow the DASH diet, youll eat plenty of:

DASH also encourages you to cut back on foods that can raise your blood pressure. These include:

If you follow DASH, you dont have to eliminate these foods, says Patton. Instead, take steps toward healthier choices each day. The plan will be easier to stick with. For instance, consider replacing a meat entre with a meatless option once a week.

Most Americans eat more meat than necessary at the expense of their vegetable intake. DASH recommends consuming no more than 6 ounces of meat per day. In its place, eat more fruits and veggies, which contain disease-fighting antioxidants, fiber and other nutrients.

Many Americans eat too much sodium (salt). And eating a diet high in sodium can increase blood pressure and heart disease risk.

The standard DASH diet limits sodium intake to 2,300 milligrams per day. But if you want stronger results, go with the lower-sodium DASH diet. On this plan, you aim for 1,500 milligrams of sodium or less per day.

The DASH combination of nutrient-rich foods and lower sodium intake has a proven effect on blood pressure. Multiple studies have found that following the DASH diet quickly lowers blood pressure in as little as two weeks.

Most of the sodium people consume doesnt come from the saltshaker. Processed and packaged foods are often high in salt, even if they dont taste salty, says Patton. Restaurant and takeout foods can also be very high in sodium.

If youre following DASH, read food labels for sodium content and keep track of how much youre getting. If youre eating out, try these tips to cut back on sodium:

If you follow the DASH eating plan, youll likely shed pounds. Combine the DASH diet with calorie cutting if you want to lose more weight. Find out how many calories you should eat based on your age and activity level. Keep track of your calorie intake and cut back a little at a time.

But dont go to extremes, cautions Patton. If you try to cut calories quickly and dramatically, youll probably feel hungry and tired, she says.

If you need help creating your weight loss plan, talk with your healthcare provider. Your doctor can help you get started or refer you to a nutritionist or dietitian.

A DASH diet meal plan can look different for everyone. The key is to emphasize healthy foods and sideline the less healthy ones, says Patton.

When you go to the grocery store, fill your cart with whole foods and choose boxed, bagged or canned options that are low sodium.For example, original or quick cook oats in the canister have zero milligrams of sodium, but instant oatmeal packets have sodium added.

Beans are also an important part of the DASH diet. If you dont have time to prepare dry beans, canned beans are a good alternative. Look for no-salt-added versions, though, and be sure to rinse them.

Build your meals around foods you like that fit into the DASH plan. Dont like green peppers? Enjoy red peppers, celery or carrots instead. Make your favorite stir fry, but use less salt, add more veggies and swap whole grain brown rice for white rice.

Take recipes you already love and make them DASH-friendly by:

Looking for some inspiration? There are plenty of DASH-friendly recipes to explore. These tasty recipes contain higher amounts of fruits and veggies with low saturated fat and sodium.

Start your day right with a nutrient-rich breakfast:

Skip the afternoon slump by filling up with nutritious foods on your lunch break:

These recipes help keep dinner simple and healthy after a long day:

If you want to increase your weight loss and health benefits, pair the DASH plan with more movement and activity, says Patton.

This doesnt mean you have to join a gym or start hard-core training. Instead, aim for at least 30 minutes of exercise a day. Walking, biking and swimming are all good options. And you dont have to do it all at once. Break it up into two 15-minute chunks or three 10-minute chunks.

Youll boost your health even more if you get 60 minutes of moderate-intensity exercise five days a week. Moderate intensity means your heart rate is about 50% higher than your resting heart rate. There are endless options for moderate-intensity exercise, from taking a brisk walk to swimming laps or playing basketball.

These steps can also boost your heart health:

You dont have to follow DASH perfectly to reap its benefits. Each day, take small steps toward healthier eating, says Patton. Over time, youll start to feel better and lose weight, which can motivate you to keep going.

The flexibility of DASH makes healthy eating fit in with your tastes and lifestyle. And that helps you stick with it for the long-term.

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DASH Diet: What Is It, Meal Plans and Recipes - Health Essentials from Cleveland Clinic

10 clean eating tips to lose weight and feel better – AsiaOne

Posted: June 19, 2021 at 1:50 am

Nutrition and diet is perhaps more important in losing weight than exercise. With some adjustments to your diet, you can improve your overall health and shed those extra kilos.

Clean eating may sounds daunting and troublesome, but is actually manageable and easy to do. This phenomenon has become the craze for many who wish to shed some weight and feel better. However, while this is diet trend has caught on quickly and widely, many people may still not know what clean eating is exactly, or how to start cleaning up their diet.

Simply put, clean eating is consuming more healthier options in each food group and less of the unhealthy ones. More specifically, it means choosing whole foods such as fruits, vegetables, whole grains and healthy fats, and cutting down (not eliminating!) on processed foods such as refined grains, preservatives, and unhealthy fats.

A lot of clean-eating diet plans tend to eliminate entire food groups such as dairy, carbs and more. But this can backfire badly not only do they take away the enjoyment of eating, they can also deprive your body of essential nutrients.

It helps to find a clean-eating plan that works for you, even if it includes having a cheat meal from time to time. Your body will thank you for making the effort to cut back on processed foods and replacing them with healthier options. Here are some clean eating tips to get you started:

The Food Pyramid is like your grocery list vegetables, fruits, proteins, carbohydrates,and healthy oils should make the list every week, along with a little dairy if desired. It is a visual representation of how many servings of what foods to eat in a day. The base, which constitutes the largest portion, are foods that should be eaten more. The peak, which is narrower, are foods that can be indulged on, but in limited quantities.

The food pyramid makes clean eating much *simpler eat more of what is at the bottom, and less of what is at the top. To none of our surprise, fruits and vegetables dominate the bottom layers, and fats, oils and sugar are found at the top. So the first clean eating tip is to remember to consult the food pyramid to see if you are consuming the right things! More specific details below.

*Note: Different iterations of the food pyramid order different classes of food differently. Consult your doctor to learn what types of food you should eat more, and which kinds to cut down.

The base of the pyramid isfruits and vegetables. Besides being a great source of vitamins, fibres, antioxidants and much more, fruits and vegetables are an integral part of a diet. They are low in calories and packed with nutrients.

Frozen fruits and vegetables are in fact just as nutritious as fresh produce. However, (another clean eating tip!) beware of certain foods that are disguised as being healthy.

Fruit juices, which are often marketed as healthy, often contain high amounts of sugar. Scary! Most of these pure juices also lack the much-needed fibres that fruits provide. Dried fruits should also be eaten in moderation as their nutrients are concentrated into a smaller package. This makes it easier to accidentally over-consume on fructose and exceed caloric thresholds.

Try to aim for at least two servings of fruits, and two servings of vegetables each day. That can mean two medium apples, two cups of leafy greens, or one full cup of broccoli. Of course, nothing is holding you back from consuming more fruits and vegetables.

Next, we have ourcarbohydrates. Carbs are our main source of energy, and it powers us to walk, run, and even breathe. Many people associate going on a diet with cutting out carbs thats one of the 21st centurys biggest myth! Carbs are an important part of any diet. The problem comes when one consumes too much of unhealthy carbs.

Instead, a clean eating tip is to opt for healthier options like wholegrains over refined grains. That means brown rice over white rice, or wholemeal bread over white bread. Wholegrains are minimally processed and are more nutritious than refined ones.

ALSO READ:What's the deal with veganism, intermittent fasting and clean eating?

As delicious as rice or pasta can be, remember to not overload on these simple carbs. If you are diabetic, eating too much carbs may raise your blood glucose quickly.

Choose complex carbohydrates over simple carbohydrates. Why? Because the body uses more energy to break down complex carbs. The more complex the carb, the better were talking oatmeal, barley, beans, and also wholegrains. Simple carbs are higher in sugar and should be eaten in moderation.

Next, we have ourproteins they come from meat, fish, eggs, beans, and even tofu. Proteins is necessary for growth and development, and they help make us stronger.

While most meats contain protein, they are not created equal. Lean meats such as chicken and fish provide more protein per calorie than fatty meats like beef brisket and T-bone steak. Always opt for lean meats so you get your protein without clogging up your arteries.

The way your protein is prepared matters too. Opt for grilled fish, steamed chicken or pan-fried tofu, and ditch the fried chicken, greasy steaks and processed meats. Processed meats, while convenient and cheaper, are full of additives and preservatives which we should avoid.

In recent years, there has also been a call to reduce meat intake. Besides the negative health impacts of consuming too much meat or processed meats, the industry (meat and fish production) has also been a major contributor to environmental problems. If you can, why not choose a day or two to go meatless? If this sounds tough, we have another clean eating tip for you. Read on!

As mentioned, not all protein comes from meats and fish. Beans, nuts and legumes are also rich sources of protein. Beans come in many forms too soybeans and its tofu, black beans, kidney beans the list goes on. Going meatless doesnt mean sacrificing protein you can get your fair share of it from these alternative sources.

If you cant completely give up meat, you may consider plant-based meats. These innovative, ground-breaking foods tastes and feels just like meat, but actually arent.

These meats are made from beans, mycoproteins, legumes, and other healthier, plant-based choices. Iron is added to these foods to give you the satisfaction you get when eating meat. However, be sure to check the food labels when buying plant-based meats.

Sometimes, artificial plant-based meats may be jam-packed with all sorts of chemicals that we may not want in our bodies. Tip: If it looks a bit too questionable? Go with your gut and opt for natural plant protein instead.

Next on list of clean eating tips isthe dairy section. While milk, yoghurt and cheese are excellent sources of calcium and nutrients, they may contain undesirable amounts of unhealthy fats. Much of the fat in milk and dairy foods is saturated fat.

For older children and adults, eating too much fat can contribute to excess energy intakes, leading to becoming overweight. A diet high in saturated fat can also lead to raised levels of cholesterol in the blood.

ALSO READ:Is 'clean eating' making you sick?

If possible, always choose low-fat options, and enjoy cheese in small amounts. Switch out your sugar-loaded yoghurts with greek, and your cows milk with plant-based milk if you can. Other things to note is to go for lower-fat butter and spreads, and to cut down on the amount of cream in your diet.

Oils and fats, as undesirable as they sound, are an important part of a healthy diet. However, it is the unhealthy, saturated fats that are the leading cause for heart diseases. Saturated fats raise cholesterol levels, and are found in butter, lard, fatty meats, and palm oil.

Highly-processed foods are also a source of these unhealthy fats they include hot dogs, french fries, donuts and other snack foods.

What needs to be done? First, reduce the amount of fats and oils you consume. You can still reward yourself to a Krispy Kreme or a side of fries, but in limited amounts. Save these indulgences for your cheat days. Secondly, opt for unsaturated fats.

These can be found in some nuts, avocados, and non-hydrogenated margarine. Lastly, watch the oil. Instead of regular cooking oil, get olive oil, canola oil, or peanut oil. These have unsaturated fats.

A good dessert is needed to end off a wonderful meal, or is it? Sugar is another component to watch as you eat clean. Sugary drinks are not only excessively sweet, but they are packed with calories too. Instead of your usual sugared beverages, choose diet sodas and zero-calorie options instead.

Its also time to watch your bubble tea, frappuccino, and fruit juice intake. These beverages are high in sugar, and causes your body to produce high amounts of insulin as your blood sugar rises. Once again, you can continue to have these in your diet. Just keep them to a minimum!

Cakes, ice cream and even white rice are also sources of sugar. Remember to eat them in moderation, and choose the healthier alternatives.

Not literally but were talking eating a variety of food groups. Eating clean and healthy doesnt mean eating boring and bland rabbit food. Theres a wide variety of healthy, tasty food to choose from! For example, instead of brown rice and wholemeal bread, opt for: Wild rice, black glutinous rice, brown rice bee hoon, whole-wheat pasta, soba, thosai or chapatti.

And eat a rainbow of fruit and veggies, from reds like papaya and peppers, greens like kiwi and chye sim, and purples like grapes and brinjal.

Calorie deficit is the key to weight loss. This means to consume less calories than your recommended daily intake (RDI). For men, the RDI is around 2,500 kilocalories, and the number is around 2,000 kilocalories for women.

Of course, this number varies with age, physical activity and genes. There are many apps and platforms online that help you with tracking calories. Most food products also print nutritional labels which inform you of calorie content as well as the ingredients used.

With that said, getting too obsessed over calorie-counting is counterproductive and isnt the best for mental wellness. We say: Do what feels right in moderation. Excessive restrictions do more harm than good. Its okay to indulge a little every now and then. After all, youre only human!

To sum it all up, clean eating is all about doing what is sustainable: Choosing healthier alternatives and holding back on the not-so-healthy foods. Continue eating more fruits and vegetables, go for wholegrains over refined grains for carbs, and vary your sources of protein.


Consume dairy products sparingly, and reward yourselves with some sugar and fats only from time to time. Remember these clean eating tips and youll be well on your way to feeling better about yourself!

Is this the secret formula to losing weight? Well, not quite. Clean eating is a necessary step towards shedding some pounds and making yourself feel better.

At the end of the day, when you consider the science behind it calories count, but theyre not the only factor. Eating well, regular exercise and recovery, getting enough sleep, managing stress, stay hydrated are important factors too. Because a healthy lifestyle is after all, a culmination of everything.

This article was first published in The Finder.

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10 clean eating tips to lose weight and feel better - AsiaOne

(PDF) Testosterone Replacement Therapy Sales Market | Detailed Study by Stratagem Market Insights with Upcoming Trends The Manomet Current – The…

Posted: June 19, 2021 at 1:49 am

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The market is designed to serve as a ready-to-use guide for developing accurate pandemic management programs allowing market players to successfully emerge from the crisis and retract numerous gains and profits. The SMI analyzes recent strategic activities, such as partnerships, acquisitions, mergers, collaborations, and joint ventures. The report analyzes the demographics, growth potential, and capability of the market through the forecast period 2021 to 2027. The players included in this report are chosen in terms of their product portfolio, market share, brand value, and the well-being of the organizations. Our report is based on current situations across the globe.

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A top doctor on the truth about hormone imbalances and how to tackle them – Tatler

Posted: June 19, 2021 at 1:49 am

Hormones are chemical messengers secreted by various glands in the body, and provide a delicate balance between metabolic functions. These include insulin, cortisol (steroid), adrenaline, thyroid, oestrogen/progesterone and testosterone, to name but a few. They are responsible for the body's core temperature, appetite/weight, reproductive cycle/libido, growth/development, sleep cycles, mood and stress levels. Any disruption can lead to key changes in many of the body's organs, leading to brain, skin, gut and cardiovascular symptoms.

Some sex hormone imbalances can quite literally change your persona, with levels of irritability, low mood and altered perception. This can happen for women in the menstrual cycle or menopause, and occasionally in men from the age of 40 onwards (but with more subtle effects).

There are many different treatments available, not all carry the health risks the media have portrayed, and to the contrary, may offer substantial benefits.

Male Hormone Replacement:

From the age of around 40, men's testosterone can reduce by two per cent every year. Over time, this may cross the threshold of deficiency, causing low mood, reduced libido and the redistribution of body fat/muscle, as well as diminishing bone density. However, there is still controversy over whether testosterone replacement therapy, on balance, provides more health benefits versus the risk of prostate/cardiac issues and blood clots, if it is not carefully monitored. A morning blood test (pre-10am) can help to identify your levels, and an endocrinologist should advise on supplementation. A better way to naturally provide more testosterone to the body, is through resistance training (a good personal trainer can help to avoid injury), good quality sleep, optimal weight and a healthy balanced diet (ensuring adequate nutritious vegetables, fats, protein, zinc, magnesium and vitamin D).

Female Hormone Replacement (HRT):

The menopause can happen early for some women, but most occur around the age of 50. The symptoms can vary widely and usually starts before the periods stop (peri-menopause), they can include: anxiety, mood swings, hair/skin issues, hot flushes and memory loss. It is often misdiagnosed as depression and incorrectly treated with antidepressants. Up to 75 per cent of women do not know enough about HRT to make an informed choice, and a review of the initial scaremongering studies have shown that used correctly, HRT can provide many benefits with very few risks. HRT has shown some reduction in Alzheimer dementia, diabetes, osteoporosis, heart attacks and bowel cancer. The oestrogen in HRT can also increase skin collagen and have anti-ageing properties. Obesity, alcohol and lack of exercise increases the risk of breast cancer considerably more than HRT.

The treatments are usually a combination of oestrogen and progesterone.

1. Synthetic HRT. It is regulated by the Medicines Authority (MHRA), is easy for compliance (a single oestrogen/progesterone tablet) and the risks of breast cancer and blood clots are very small if started around the time of menopause (50+) for seven to 10 years.2. 'Bio-identical' HRT. It is not regulated and despite being promoted as 'natural', it is not an exact science, has no safety/efficacy data and can be expensive, but is preferential to some patients.3. 'Body-identical' HRT. Consisting usually of an oestrogen patch and progesterone pill (surprisingly plant-based, derived from yams/soy). 'Body identical' HRT, is regulated by MHRA and has shown to be highly effective; it also significantly reduces the risks of blood clots and breast cancer seen with synthetic HRT.4. Natural options. Lifestyle changes through regular exercise, low alcohol, a Mediterranean diet, low refined carbs/sugar, vitamin D/calcium supplementation and quality sleep may all help to reduce the effects of menopause (but may only be modest). There are some 'natural' products which can be found in most chemists (eg black cohosh, red clover, gingko, St John's wort), but all have limited scope. Acupuncture and homeopathy has also been used, but with little evidence.

Some add-on treatments include: vaginal oestrogen creams and testosterone if libido or energy levels have not benefited from standard HRT (quite surprisingly, reproductive women produce four times more testosterone than oestrogen).

As you can see, it can be a complex area, even for many GPs. So you may want to see a GP or gynaecologist who has an interest in hormone replacement.

Dr Tim Lebens is a private GP in Central London, with a subspecialty in health optimisation and latest advances in medicine. You can follow him on Instagram @_modernmedicine

Although every effort has been made to ensure that all health advice is accurate and up to date, it is for information purposes only and should not replace a visit to your doctor or health care professional.

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Combination of human chorionic gonadotropin and clomiphene | RRU – Dove Medical Press

Posted: June 19, 2021 at 1:49 am


Male hypogonadism is divided into hypergonadotropic and hypogonadotropic (male hypogonadotropic hypogonadism, MHH). MHH is caused by insufficient secretion of gonadotropins and can be classified into three, namely, congenital, acquired and idiopathic. MHH presents as absent/delayed/arrested sexual maturation and infertility. It has lower prevalence than primary hypogonadism.1 To optimise the management of MHH after confirmation of the disease and consideration of future fertility prospects, the timing and choice of therapeutic intervention are important. Therapy involves the use of testosterone to induce the development of secondary sexual characteristics, which in turn leads to puberty and to the maintenance of secondary sexual characteristics.2 Therapy is likely to be life-long and requires regular monitoring. Thus, choosing a therapy to optimise responses and avoid adverse events is essential. Testosterone can come from exogenous or endogenous sources. Testosterone replacement therapy using exogenous testosterone is good for improving the quality of life and achieving physical benefits, but this therapy is not suitable for those who are currently seeking fertility.3,4 Exogenous testosterone suppresses gonadotropin hormones in the hypothalamuspituitarytestes axis, which is necessary for normal spermatogenesis to occur. To maintain fertility, exogenous testosterone treatment should be stopped.

Gonadotropin replacement therapy (GRT) induces both spermatogenesis and endogenous testosterone. GRT requires either pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropin administration. Gonadotropins can be self-administered subcutaneously and are not inferior to the more costly GnRH.5 Human chorionic gonadotropin (hCG) injection is also an effective therapy for patients with MHH.6 The benefits of hCG treatment for MHH patients instead of testosterone was confirmed in the current review.7 Clomiphene citrate (CC), a selective oestrogen receptor modulator, is being used (offlabel) for testosterone deficiency and does not interfere with spermatogenesis. CC effectively increases serum testosterone with few side effects in men with testosterone deficiency8 and is safe for the longterm management of hypogonadism.9

We believe in the possible synergy of hCG and CC in MHH patients. In this study, we evaluated the efficacy of a short course (12 months) of the combination CC + hCG on MHH patients who wished to preserve their fertility.

This prospective study included 19 azoospermic patients with MHH who were admitted to the Andrology and Fertility Hospital of Hanoi between March 2016 and March 2018.

The MHH diagnosis were made as follows: a male older than or equal to 18 years old without puberty development, with a serum testosterone level <100 ng/dL (3.5 nmol/L) and with a low or normal level of gonadotropins. After MHH diagnosis, the patients were grouped into two, as follows: partial MHH, onset of puberty but not complete (Tanner 3); and total MHH, childhood reproductive organs remaining and no onset of puberty (Tanner stages 1 and 2). The azoospermia diagnosis was made only after the technician had surveyed a minimum of two semen samples obtained at least 2 weeks apart. The entire semen sediment was centrifuged at a rate of 3000 g for 15 min prior to examination, and no spermatozoa were found.

The inclusion criteria were adult MHH patients suffering from azoospermia who seek fertility treatment and who agreed to participate this study. The exclusion criteria included: patients with MHH who are under 18 years old; adult patients with MHH whose tests showed the presence of sperm before the treatment; patients with MHH being treated for acute and sexually transmitted diseases using drugs or chemicals that affect spermatogenesis; patients with MHH who present with other endocrine diseases. Nineteen participants fitted the selection criteria and were enrolled in this study.

This prospective study aimed to evaluate the combination of hCG and CC in the treatment of MHH. The flowchart of study (Figure 1) was shown to clarify the process of this research.

Figure 1 Flowchart of study.

The clinical manifestation, history of medical problems, drug use and family history were recorded at the first visit. The physical examination included age, height, weight, vital signs, Tanner staging (pubic hair), stretch penis length, and testis volume (TV) measured by Prader testicle orchidometer. Laboratory examination included taking peripheral blood tests and measuring gonadotropin level (LH/FSH), total testosterone (TT) level and pituitary/olfactory nerve MRI scans to diagnose the causes of MHH. This study was approved by the ethics committee of the Andrology and Fertility Hospital of Hanoi.

One of the two brands of hCG (Pregnyl, Merck & Co., Inc or IVF-C, LG Lifesciences) was used every 3 days, the dose depended on the response of each patient (from 3000 IU to 10,000 IU) in combination with CC at 25 mg per day until normal testosterone levels are reached. The dose is maintained until spermatozoa appeared in the semen. Supplementation with HMG or FSH was made if the patient wanted to have children, as shown in the following schema (Figure 1).

The primary outcomes were the appearance of spermatozoa in semen after treatment and the total testosterone level. The secondary outcomes were the development of secondary sex characteristics, height, stretch penis length, average bilateral testicular volume, Tanner stage and achievement of childbirth after spermatogenesis (induced treatment).

Patients follow-up was performed once every 6 months for up to 2 years. Medical checks, TT level measurement and semen analysis were conducted every 3 months. The height, testicular volume, penis length and Tanner stage were measured every 6 months in the first year.

The LH, FSH and TT levels were determined by automatic systems (Elecsys 2010 of Roche) based on the sandwich principle and electrochemiluminescence immunoassay. The blood sample was collected at 7:00 am8:00 am. Normal values for males were LH =1.59.3 IU/L, FSH =1.418.1 IU/L and TT =13.423.6 nmol/L. The detection limit for LH was 0.2250 IU/L, that for FSH was 0.1200 IU/L and that for TT was 0.1222 nmol/L.

All patients underwent semen analysis every 3 months according to the 2010 WHO standards10 to analyse the semen volume, sperm density and sperm morphology. Sperm motility was divided into three groups, namely, progressive motility (PR), non-progressive motility (NP) and immotility (IM). Semen was obtained by masturbation and then placed in a neutral plastic vial. Samples were examined by a microscope (20 and 40 objective lens).

The volume of the testes was measured by the Prader orchidometer, and the average volume of bilateral TV was also analysed. The stretch penis length was measured from the pubic bone to the tip of the dorsal part of the stretched flaccid penis.

The R 3.6.2 software was used for the statistical analysis of data. The measurement data, such as normal distribution, were described by the mean standard deviation (X SD). If the distribution was skewed in accordance with the median, then the median was used. The comparison of follow-up data differences from the two groups was examined by the paired t-test or MannWhitneys U-test depending on the distribution of variables. P < 0.05 suggested that the difference was statistically significant. All charts were built with R graphic.

The average age of patients was 30 years old (30.2 5.6). Among them were 10 married patients (52.6%) and nine unmarried patients (47.4%). No significant difference in age, height, basal TV and LH, FSH and TT levels in the partial and total MHH groups (Table 1). However, the difference in penis length was significant (P=0.005) (Figure 2). The causes of MHH in patients include hypopituitarism (47.4%), Kallmann syndrome (26.3%), pituitary adenoma (15.8%), after basilar skull surgery (5.26%) and unknown etiology (5.26%). The average dose of hCG was 5000 IU per dose (5579 1773.7 IU), and the lowest dose was 3000 IU twice a week. The highest dose for hCG was 10,000 IU at 23 times per week. The detailed information followed one patient had 3,00 IU, 15 patients had 5000 IU, one patient had 8000 IU, and two patients had 10,000 IU.

Table 1 Baseline Clinical Data of the 2 Groups of Patients with HH

Figure 2 Penis length and testicular volume. (blueline: partial HH, redline: total HH).

Before treatment, mean TT level was 0.76 1.84 (in the range 0.088.2) nmol/mL. After 6 months with CC and hCG therapy, mean TT level sharply increased to 17.9 6.07 (in the range range 12.134.1) nmol/mL. The mean TT level was 19.6 5.6 (in the range 12.233) nmol/mL after 12 months of treatment. This change was statistically different (p < 0.001). The average testes volume, height and stretch penis length were also statistically increased after treatment. All details are described in Table 2. The change of clinical features in all patients and the total MHH group was statistically significant (P<0.001). In particular, the differences in testosterone hormone levels in the partial MHH group were also noted (P=0.03) (Figures 2 and 3).

Table 2 Features Changes Before and After Treatment

Figure 3 Testosterone level. (blueline: partial HH, redline: total HH).

No adverse event was noted in our study.

Nine patients had sperm in their semen (47.4%).All partial MHH patients (100%) and 37.5% of total MHH patients showed restoration of spermatogenesis. The earliest sperm appearance was 3 months after treatment (Table 3).

Table 3 The Appearance of Sperm in Semen

In the abovementioned nine cases, two had natural conception and childbirth, and two underwent IVF-ICSI; one case achieved children, whereas the other had frozen embryos but did not achieve pregnancy yet. Seven of the nine cases underwent sperm vitrification for fertility purposes in the future. The characteristics of sperm in nine patients was shown in Table 4.The sperm concentration under the combination treatment with hCG and CC was usually less than 5 million/mL. The highest sperm concentration was 24 million/mL, which was achieved in a patient with partial MHH. Evaluation of motility and morphology showed that the average progressive motility rate was below 8%, and the normal morphological rate was 1% or lower.

Table 4 Characteristics of Sperm

Recently, several studies have evaluated the effectiveness of CC in treating male infertility patients. The mechanism of action of CC involves the inhibition of the negative feedback of oestrogen at the level of the hypothalamus and pituitary, thereby increasing FSH and LH concentrations. LH stimulates Leydig cells to increase the secretion of testosterone.11,12 CC has been approved by the FDA to treat ovarian dysfunction and has been shown to have a beneficial effect on male hypogonadism.12 Most randomised controlled clinical trials showed that CC has a significant effect on the concentration of FSH and testosterone in plasma.13,14 In our study, we just only measured FSH before treatment. For that reason, testosterone was measured to evaluate the effect of combination. However, the improvement of semen parameters is controversial. A number of randomised controlled clinical trials suggested that CC does not change the semen parameters.15 Some reports have suggested that CC improves sperm count and pregnancy rate.14,16,17 In our study, the subjects were patients with MHH whose spermatogenesis had not occurred, and thus, increasing hormone levels was an important goal for these patients.

In the present study, we aimed to assess the efficacy of combined therapy (CC + hCG) in spermatogenesis. We conducted this study to find out if adding CC to hCG treatment would be beneficial. Objectively, we found that such a combination of hCG + CC was effective in restoring normal hormone secretion, especially testosterone serum levels, after 12 months. The effect of stimulating sperm production with hCG + CC in our study after 12 months was 9 (47.4%).This was considerably low, because the follow-up time in our study was not long enough. Indeed, in Vietnam, detection is often late for men who are infertile due to secondary hypogonadism, and the treatment is often long and difficult, resulting in high costs and failed results. Couples desire to have children as soon as possible. In some cases in our study, when no sperm was found in the semen after 12 months, the couple refused the subsequent treatment, instead switching to an alternative regimen and accepting donor sperm for the next steps. With early sperm production time and 6 months follow-up period, Lin et al reported that GnRH infused subcutaneously was a preferred method than the combination of hCG and human menopausal gonadotropin.18 In our study, we did not have a control group, but we used CC, which has been proven as effective in improving the sperm count, sperm motility and the morphology of the sperms (to a certain extent).19 It effectively led to spermatogenesis.

In our study, spermatogenesis differed between the two subgroups of MHH. The rate of sperm appearance in the semen of the total MHH group was 7/16 (43.75%), whereas this was 100% in the partial MHH group. These results were in line with those obtained by a study showing that hCG can complete the spermatogenesis in men with partial gonadotropin deficiency.20 No difference in hormonal profile was found between the two groups but the differences in height, penis length and testicular volume were statistically significant, showing that we can use clinical evaluation to predict the success rate as in some previous studies, in which the response to hCG of patients with MHH was predicted (especially in terms of the testicular volume).20,21 In our study, the testicular volume of most unsuccessful cases ranged from 1 mL to 2 mL. Larger testicular volume was a useful prognostic indicator of response and was a predictor of fertility outcome.22 The quality of sperm recovered in our study was low with 7/9 (77.7%) showing deformed morphology. There were two cases with normal morphology, but they differed in etiology, concentration and motility.

In our study, one special patient was classified into the total MHH group even if he had puberty symptoms (Tanner 3) at initial evaluation, ie, Tanner 2 according to the testicular volume (5 mL) and Tanner 4 according to the hair distribution, because he had been using testosterone therapy for 12 consecutive years. Sperm appeared in his semen after 13 months of follow-up.

In accordance with spermatogenesis, secondary sex characteristics also developed. After treatment, a steadily increasing trend with statistically significance in height, penis length and testicular volume was observed in the total MHH group in particular. However, such a trend was not shown in the partial MHH group. We also noted that the oldest person (37 years old) was still growing (up to 5 cm). Moreover, the tallest height reached (up to 8 cm) was observed in a 24-year-old patient. Testicular volume was increased by about two times after 12 months. Our therapy increased serum testosterone level, which in turn induced and maintained secondary sex characteristics and also improved the quality of life and wellbeing, especially in patients aiming to become fertile.23

Testosterone level increased by approximately 25 times (mean) and was at a normal range at 12 months after treatment. Mean TT level was 0.76 1.84 nmol/mL (at baseline), which increased to 17.9 6.07 nmol/mL at 6 months after treatment and to 19.6 5.6 nmol/mL after 12 months of treatment. Testosterone level increased quickly and was maintained after 12 months of treatment with the combination of hCG and CC. Such combination therapy was effective for normalising testosterone level. When the testosterone level became normal, the development of sex characteristics was enhanced. Gonadotropin normalised testosterone level; spermatogenesis began even without the use of exogenous testosterone.

The most important issue when using hCG to treat MHH and to achieve the desired outcomes was the dose and duration of treatment.24 In the present study, the group was treated with CC at 25 mg daily and hCG at an average dose of 5000 IU administered twice weekly (i.m. or s.c.). To support endogenous testosterone production for the period of infertility treatment, hCG treatment can be administered at the appropriate dosage to prevent serum FSH level suppression.25 In this situation, through a negative feedback mechanism, CC supported the effect of hCG and optimised the treatment.

The hormone hCG induces testosterone production by stimulating Leydig cells directly. Its effect is similar to that of LH, but its elimination half-life is longer than that of LH, thereby avoiding the need for daily injections. The level of testicular testosterone increased, thereby inducing the onset of spermatogenesis21,26 and stimulating Sertoli cell maturation and proliferation.21,27 Kobori et al reported that by using hCG, spermatogenesis was restored in five of the seven patients with adult-onset idiopathic hypogonadotropic hypogonadism.28 FSH was not considered for MHH treatment because the role of FSH in stimulating spermatogenesis is not fully adequate and need further studies.21,29 Thus, using FSH alone as initial therapy did not show a good outcome.29 In addition, FSH treatment is expensive and is not appropriate for developing countries like Vietnam.

CC is an orally active nonsteroidal agent distantly related to diethylstilboestrol.30 CC induces the Leydig cells in the testes to produce testosterone, which together with FSH induces spermatogenesis.19 Moreover, masculinisation of the brain during development and maintenance of sexual behaviour in adult males were also noted in rats31 when CC was administered. Published data suggested that CC may be an appropriate alternative treatment for male hypogonadism, because it is safe, cheap and effective for improving serum testosterone levels in men who wish to preserve their fertility.8,9 Da Ros et al concluded that CC should be considered as a therapy for men with symptomatic hypogonadism.32 However, few studies have investigated the use of CC in MHH treatment. Available data suggested that clomiphene is an efficient and convenient alternative to testosterone replacement therapy in a substantial subset of patients with late-onset hypogonadotropic hypogonadism (at 68 weeks following initiation of treatment).33 Our study supported these results with the use of 25 mg CC combined with hCG in the treatment of MHH. As the same effect of hCG, a daily dose of 25 mg CC could given the contribution that resulted in increased posttreatment testosterone levels and improvement of the quality of life. Moreover, using CC also has economic benefits. Taylor and Levine found that CC was a less expensive option with minor side effects for men with hypogonadism.30 In addition, it had no effect on the change of prostate-specific antigen or haematocrit values34 thereby helping us evaluate the side effect of hCG23 with minimal bias.

Studies have investigated the side effects of CC medication. Side effects of the drug include headache, dizziness, gynecomastia and exacerbation of mental illness. However, according to this study, CC is generally considered to be safe and well-tolerated.11 Side effects of hCG are reportedly mild even with prolonged use and high doses. Some side effects include the following: headache; feeling restless or irritable; mild swelling or water weight gain; depression; feeling tired; breast tenderness or swelling; pain; hypertension; polycythaemia; increased haematocrit; and acne. To avoid these side effects, we used a combination of hCG and CC to reduce the dose of hCG and increase the effectiveness of the treatment. In our study, 19 patients with MHH did not report any drug side effects.

hCG and/or CC treatments protect the testis.35 The effectiveness of hCG alone or in combination with CC has been reported.36 The combination of hCG + CC is a safe, low-cost and effective treatment that can be used to preserve fertility capacity. We have not been able to demonstrate that the dose of hCG is reduced in the combination of CC and hCG due to the small and rare number of samples. Further studies are required to evaluate a larger population. Society should focus on patients with hypogonadism who need access to healthcare earlier, because monitoring the impact of the condition on long-term health and psychosocial function is necessary.

The main limitation of the present study was that we did not have a control group. This was considered impossible, because all the enrolled participants wished to maintain their fertility.

In conclusion, a combination of hCG and CC may be an option for MHH patients who desired to restore their fertility. After 12 months, 52.63% of patients showed the restoration of spermatogenesis, and spermatozoa appeared in semen. Testosterone level increased by approximately 25 times by mean and was in the normal range at 12 months after treatment. Secondary sexual characteristics improved significantly, especially the increase in body height and penile length, even in the patients over 18 years old. This therapy was considered safe because no adverse event was noted.

MHH, male hypogonadotropic hypogonadism; total HH, total hypogonadotropic hypogonadism; partial HH, partial hypogonadotropic hypogonadism; CC, clomiphene citrate; hCG, human chorionic gonadotropin.

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

The Ethics Committee of Vietnam Military Medical University approved the study protocol (QD/HVQY) and authorized its conduct and follow-up. The study was in line with the Declaration of Helsinki. Individual patient consent for inclusion in the study was obtained. Before treatment, written informed consent was provided to all participants after a thorough explanation of the purpose of this study. Patients had signed in written informed consent. Patients had the right to discontinue at any time during the study.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

There is no funding to report.

The authors declare that they have no conflicts of interest for this work.

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2. Sato N, Hasegawa T, Hasegawa Y, et al. Treatment situation of male hypogonadotropic hypogonadism in pediatrics and proposal of testosterone and gonadotropins replacement therapy protocols. Clin Pediatr Endocrinol. 2015;24(2):3749. doi:10.1297/cpe.24.37

3. Jungwirth A, Giwercman A, Tournaye H, et al. European Association of Urology guidelines on Male Infertility: the 2012 update. Eur Urol. 2012;62(2):324332. doi:10.1016/j.eururo.2012.04.048

4. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423432. doi:10.1016/j.juro.2018.03.115

5. Han TS, Bouloux PMG. What is the optimal therapy for young males with hypogonadotropic hypogonadism? Clin Endocrinol (Oxf). 2010;72(6):731737. doi:10.1111/j.1365-2265.2009.03746.x

6. Jung JH, Seo JT. Empirical medical therapy in idiopathic male infertility: promise or panacea? Clin Exp Reprod Med. 2014;41(3):108114. doi:10.5653/cerm.2014.41.3.108

7. Fink J, Schoenfeld BJ, Hackney AC, Maekawa T, Horie S. Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility. Expert Rev Endocrinol Metab. 2021;16(1):18. doi:10.1080/17446651.2021.1863783

8. Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int. 2012;110(4):573578. doi:10.1111/j.1464-410X.2011.10702.x

9. Moskovic DJ, Katz DJ, Akhavan A, Park K, Mulhall JP. Clomiphene citrate is safe and effective for long-term management of hypogonadism. BJU Int. 2012;110(10):15241528. doi:10.1111/j.1464-410X.2012.10968.x

10. Rothmann SA, Bort A-M, Quigley J, Pillow R. Sperm morphology classification: a rational method for schemes adopted by the World Health Organization. In: Carrell DT, Aston KI, editors. Spermatogenesis. Springer; 2013:2737.

11. Wheeler KM, Sharma D, Kavoussi PK, Smith RP, Costabile R. Clomiphene Citrate for the Treatment of Hypogonadism. Sex Med Rev. 2019;7(2):272276. doi:10.1016/j.sxmr.2018.10.001

12. Earl JA, Kim ED. Enclomiphene citrate: a treatment that maintains fertility in men with secondary hypogonadism. Expert Rev Endocrinol Metab. 2019;14(3):157165. doi:10.1080/17446651.2019.1612239

13. Helo S, Ellen J, Mechlin C, et al. A Randomized Prospective Double-Blind Comparison Trial of clomiphene citrate and anastrozole in raising testosterone in hypogonadal infertile men. J Sex Med. 2015;12(8):17611769. doi:10.1111/jsm.12944

14. Surbone A, Vaucher L, Primi MP, et al. Clomiphene citrate effect on testosterone level and semen parameters in 18 infertile men with low testosterone level and normal/low gonadotropines level. Eur J Obstet Gynecol Reprod Biol. 2019;238:104109. doi:10.1016/j.ejogrb.2019.05.011

15. World Health Organization. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. Int J Androl. 1992;15(4):299307. doi:10.1111/j.1365-2605.1992.tb01129.x

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17. Chua ME, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology. 2013;1(5):749757. doi:10.1111/j.2047-2927.2013.00107.x

18. Lin J, Mao J, Wang X, Ma W, Hao M, Wu X. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore). 2019;98(31):e16616. doi:10.1097/MD.0000000000016616

19. Patankar SS, Kaore SB, Sawane MV, Mishra NV, Deshkar AM. Effect of clomiphene citrate on sperm density in male partners of infertile couples. Indian J Physiol Pharmacol. 2007;51(2):195198.

20. Burris AS, Rodbard HW, Winters SJ, Sherins RJ. Gonadotropin therapy in men with isolated hypogonadotropic hypogonadism: the response to human chorionic gonadotropin is predicted by initial testicular size. J Clin Endocrinol Metab. 1988;66(6):11441151. doi:10.1210/jcem-66-6-1144

21. Rey RA, Grinspon RP, Gottlieb S, et al. Male hypogonadism: an extended classification based on a developmental, endocrine physiology-based approach. Andrology. 2013;1(1):316. doi:10.1111/j.2047-2927.2012.00008.x

22. Liu PY, Baker HWG, Jayadev V, Zacharin M, Conway AJ, Handelsman DJ. Induction of spermatogenesis and fertility during gonadotropin treatment of gonadotropin-deficient infertile men: predictors of fertility outcome. J Clin Endocrinol Metab. 2009;94(3):801808. doi:10.1210/jc.2008-1648

23. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):17151744. doi:10.1210/jc.2018-00229

24. Ylmazel FK, Karabulut , Ylmaz AH, Keskin E, Bedir F, zbey . A review of hypogonadotropic hypogonadism cases followed up in our clinic in the last decade. Urologia. 2019;391560319882231. doi:10.1177/0391560319882231

25. Dwyer AA, Raivio T, Pitteloud N. Gonadotrophin replacement for induction of fertility in hypogonadal men. Best Pract Res Clin Endocrinol Metab. 2015;29(1):91103. doi:10.1016/j.beem.2014.10.005

26. Rey RA, Musse M, Venara M, Chemes HE. Ontogeny of the androgen receptor expression in the fetal and postnatal testis: its relevance on Sertoli cell maturation and the onset of adult spermatogenesis. Microsc Res Tech. 2009;72(11):787795. doi:10.1002/jemt.20754

27. Pasqualini T, Chemes H, Rivarla MA. Testicular testosterone levels during puberty in cryptorchidism. Clin Endocrinol (Oxf). 1981;15(6):545554. doi:10.1111/j.1365-2265.1981.tb00700.x

28. Kobori Y, Suzuki K, Iwahata T, et al. Hormonal therapy (hCG and rhFSH) for infertile men with adult-onset idiopathic hypogonadotropic hypogonadism. Syst Biol Reprod Med. 2015;61(2):110112. doi:10.3109/19396368.2014.994789

29. Huhtaniemi IT. The role of mutations affecting gonadotrophin secretion and action in disorders of pubertal development. Best Pract Res Clin Endocrinol Metab. 2002;16(1):123138. doi:10.1053/beem.2002.0185

30. Taylor F, Levine L. Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost. J Sex Med. 2010;7(1 Pt 1):269276. doi:10.1111/j.1743-6109.2009.01454.x

31. Lauber ME, Sarasin A, Lichtensteiger W. Sex differences and androgen-dependent regulation of aromatase (CYP19) mRNA expression in the developing and adult rat brain. J Steroid Biochem Mol Biol. 1997;61(36):359364. doi:10.1016/S0960-0760(97)80033-7

32. Da Ros CT, Averbeck MA. Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study. Int Braz J Urol. 2012;38(4):512518. doi:10.1590/S1677-55382012000400011

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34. Chandrapal JC, Nielson S, Patel DP, et al. Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels. BJU Int. 2016;118(6):9941000. doi:10.1111/bju.13546

35. Crosnoe-Shipley LE, Elkelany OO, Rahnema CD, Kim ED. Treatment of hypogonadotropic male hypogonadism: case-based scenarios. World J Nephrol. 2015;4(2):245253. doi:10.5527/wjn.v4.i2.245

36. Habous M, Giona S, Tealab A, et al. Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short-course randomized study. BJU Int. 2018;122(5):889897. doi:10.1111/bju.14401

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Combination of human chorionic gonadotropin and clomiphene | RRU - Dove Medical Press

Testosterone Replacement Therapy Market Trend, Forecast, Drivers, Restraints, Company Profiles and Key Players Analysis by 2027 KSU | The Sentinel…

Posted: June 19, 2021 at 1:49 am

The Global Testosterone Replacement Therapy Market Report added by Reports and Data offers extensive knowledge and information about the Testosterone Replacement Therapy market with regards to market size, market share, growth influencing factors, opportunities, demands, consumer behavior, market drivers and restraints, overall competitive landscape, and current and emerging trends. The research study offers valuable insights into the business strategies, distribution channels, and value chain analysis. The report also offers positive projections of the market scenario in the coming years through in-depth assessment of the key markets features and the geographical spread of the industry. The report strives to present the reader with deep insights of the market that can assist them in making fruitful business decisions and strategic investment plans.

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The Testosterone Replacement Therapy market report offers key insights into market scope along with emerging growth opportunities over the forecast period. The report also provides information about the competitive landscape of the global Testosterone Replacement Therapy market. The global Testosterone Replacement Therapy market is fragmented due to presence of numerous key players on a global and regional scale. Key players are focused on mergers and acquisitions, joint ventures, collaborations, partnerships, and research and development activities to expand their product portfolio and gain a robust footing in the market.

Key companies operating in the Testosterone Replacement Therapy Market and profiled in the report are:

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The report provides a significant assessment of the recent market trends, revenues, segments, and key regions across the globe. The regional analysis covers major geographical regions such as North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. The report analyzes key regions for production and consumption patterns, import/export, market share, revenue contribution, growth rate, and supply and demand ratio for the forecast period 2021-2027. It also discusses the impact of government regulations, macro- and micro-economic factors, and economic growth of the region on overall market growth.

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Testosterone Replacement Therapy Market Trend, Forecast, Drivers, Restraints, Company Profiles and Key Players Analysis by 2027 KSU | The Sentinel...

One Major Side Effect of Eating Peaches, Say Science | Eat This Not That – Eat This, Not That

Posted: June 19, 2021 at 1:48 am

Let's make sure we're very clear about one thing right off the bat: Peaches are an excellent source of several key nutrients. Boasting various vitamins, minerals, and antioxidants, the fuzzy fruit can be enjoyed by itself as a snack, sliced and put on top of a salad, or incorporated into a dessert.

However, there's one pitfall (get it?) to peaches that may affect some groups of people more so than others. Since peaches are so sweet, they're a bit higher in fructose (sugar) than some other fruits, which also means they're considered a high-FODMAP food. FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides, and Polyolsaka the scientific names for carbs that could cause gastrointestinal distress.

This is more of a concern for people who have irritable bowel syndrome (IBS), especially those who are just learning they have it and are trying to figure out which foods trigger symptoms. When someone first learns they have the functional gut disorder, a physician may suggest they follow a low-FODMAP diet for a few weeks. Essentially, this diet calls for the elimination of all foods that are considered high in FODMAPS, including garlic, onion, wheat, apples, cherries, and ice cream, just to name a few.

RELATED: The Best Low-FODMAP Foods (and What Foods to Avoid)

However, this diet can be very restrictive and can also cause you to miss out on some high-fiber, prebiotic-rich foods. That's why it's extremely important for you to slowly begin to reintroduce healthy high-FODMAP foods back into your diet. This way, you'll be able to pinpoint which foods are actually triggering symptoms. For some people, it may just be a few foods that are causing bloating, diarrhea, gas, or constipation.

Another group of people that should steer clear of peaches are those who have an allergy to stone fruits. Fruits that have a hard seed or pit such as peaches, apricots, plums, and nectarines are considered stone fruits. If you eat a peach and feel itchy or swollen on your face, lips, mouth, throat, or tongue, it's possible you have a mild allergy. More severe symptoms include coughing, skin rash, and vomiting, for example.

Bottom line: Peaches can be enjoyed safely by most individuals. However, if you suspect you have IBS or get an itchy throat after consuming stone fruits like dark cherries and mangoes, it may be best to pick another fruit to munch on this summer.

For more, be sure to check out8 Low-Carb Fruits For Weight Loss.

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One Major Side Effect of Eating Peaches, Say Science | Eat This Not That - Eat This, Not That

Weight loss: Can you follow Keto and Intermittent Fasting together? Can it speed up weight loss? – Times of India

Posted: June 19, 2021 at 1:48 am

It's important to remember that both Keto and Intermittent Fasting do have their fair share of pros and cons. So, following two diets at once could also mean that you end up at the risk of double the side-effects, especially if you are a beginner.

Experiencing low blood sugar, nausea, mood swings, fatigue, constipation can also be common in the starting days. More so, do remember that trying the two diets together also requires a lot more patience and commitment, since it's a narrow way of eating.

If you do try the diets, the best would be to ease into them, rather than going all-in. Add foods in your diet which release energy slowly, and don't completely quit out carbs. If you have a history of eating disorders, trying this method out wouldn't be wise.

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Weight loss: Can you follow Keto and Intermittent Fasting together? Can it speed up weight loss? - Times of India

Flying Treats: Can Dogs and Cats Snack Safely on Cicadas? – The New York Times

Posted: June 19, 2021 at 1:48 am

Dogs eat lots of stuff they will paw open a pantry and eat five pounds of dog food before owners catch them, Dr. Hohenhaus said. One dog puked up a shark toy. So if you have a dog who goes to the country for the weekend and eats horse poop, hell have diarrhea on Monday morning.

As for those pets who have hoovered up cicadas and landed in the vet E.R., she said, cause and effect are not necessarily obvious. I dont know if the cicada shells made the dog sick or it was the Kleenexes and trash the dog ate out of the bathroom basket.

Cicadas can, however, incite some cats and especially dogs to binge. (Think potato chips: Can you eat just one?)

Because cicadas are so easy to catch, some animals are going to town eating them, said Dr. Klippen, who sees perhaps a handful of dogs a week for this reason. The risks are not from the bugs, she said, but from dehydration related to vomiting and diarrhea, or from having absorbed pesticide sprayed on the cicadas.

For dogs who cant quit cicadas, consider a basket muzzle, Dr. Klippen said. Its beneficial and doesnt prevent dogs from panting and drinking.

Also try walking your dog at dawn and dusk, Dr. Wismer advised, when cicadas are least active. Since cicadas are found in and around mature trees, avoid routes that include them.

The heebie-jeebies over pets and cicadas springs mostly from the alignment of several factors. Theres the once-in-nearly-two-decades emergence of the bugs. And the heightened attachment and overprotectiveness that owners developed toward their pets in the past year during lockdown. Moreover, veterinarians said, peoples concerns are being revved by the internet and, er, the news media.

But basically, its something for us to talk about other than the coronavirus, Dr. Klippen said.

Read this article:
Flying Treats: Can Dogs and Cats Snack Safely on Cicadas? - The New York Times

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