Sunday, December 4, 2022

Can Ulcerative Colitis Cause Low Testosterone

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Obesity Can Lower Testosterone Increase Estrogen

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When you carry too much weight, the excess fat in your body causes a hormone called aromatase to convert testosterone into estradiol, a female hormone. The result: Your testosterone levels drop, while your levels of estrogen, another female hormone, rise. Thats why obese men have decreased libido and decreased sexual function, says Dr. Ghalib. That, in turn, can cause a drop in your energy level. You become fatigued and less able to exercise, so you gain more weight, and your T level drops even more. Its a vicious circle, she adds.

How To Deal With A Lack Of Sex Drive

Addressing nutritional issues can be an answer for some people who find their libido has changed. Low levels of iron, folic acid, and vitamin B12, in particular, can lead to anemia and leave a person feeling quite tired. With proper supplements, either by mouth or through injection, iron and vitamin B12 levels can be raised to combat the anemia.

Prednisone is a fact of life for some people living with IBD. Patients often work toward reducing the use of prednisone as soon as possible because it can play havoc with so many body functions. With dosage decreases as small as 1 mg, tapering down from 40 mg to 5 mg or 10 mg a day can be a long process. The good news is that once the drug is stopped, many of prednisone’s side effects are usually reversed.

Until fistulas are treated effectively through medication or surgery, they can affect sexual desire. A personal lubricant may help in some instances of recto-vaginal fistulas that are causing discomfort. It’s important here to try to avoid activities or positions that cause discomfort. It may be necessary to avoid penetrating sex but instead to enjoy oral sex or mutual masturbation at times when a fistula is flaring up.

Can I Get Surgery For My Ulcerative Colitis

Surgery is an option if medications arent working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery or during a colonoscopy.

Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.

After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. Youll need to wear the bag at all times to collect waste. Youll have to change the bag frequently throughout the day.

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People With Crohn’s And Colitis May Experience A Lack Of Libido

Since a diagnosis of inflammatory bowel disease , is it true that sex isn’t what it used to be? It’s not uncommon for adults with IBD to experience a change in their sex drive. This side effect can be frustrating for both the person with IBD and for their partner. The good news is that there are ways to cope with this problem. With some patience, couples can work towards having the intimate moments that they want. Couples who find that the problems are too much to conquer alone, don’t hesitate to ask a gastroenterologist or another medical professional for help. In some cases, a few visits with a mental health professional can improve the situation immensely.

Exhaustion Of Cd8+ T Cells Might Be Benefitial In The Gut

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T cell exhaustion is a stage where T cells are chronically stimulated by antigens, effector functions are reduced and the expression of inhibitory receptors is upregulated . That these less responsive exhausted T cells persist during chronic antigen presentation might also reflect their nature to partially prevent immunopathology . Accordingly, exhausted expression signature of CD8+ T cells correlated to a milder disease course and better prognosis .

CD8+ T cell exhaustion transcriptional signatures revealed by single-cell RNA sequencing are unique . Corridoni et al. identified chronically activated Tc17, IL26+ and granzyme K+ CD8+ T cells in the mucosa of ulcerative colitis patients showing features of exhaustion. Furthermore, some subsets, for instance, IL26+ CD8+ exhausted T cells exhibit a regulatory phenotype suggesting its ability to reduce inflammation . Since exhausted CD8+ T cells are less responsive to microbiota-derived antigens, their existence in mucosal tissue might contribute to homeostasis. Thereafter, the adoptive transfer of highly suppressive exhausted CD8+ T regs into IBD recipients might be a treatment worth to explore.

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Treatment Starts With A Low T Diagnosis

Getting diagnosed with low testosterone means measuring levels of the hormone in your bloodideally, on two different occasionsand discussing symptoms with your doctor. If you take your symptoms and pair them with a lab value that demonstrates low testosterone, then you can make a diagnosis of symptomatic hypogonadismthe medical term for low T, says urologist Rajiv Jayadevan, M.D., of UCLA Health.

New Insights On Cd8+ T Cells In Inflammatory Bowel Disease And Therapeutic Approaches

  • 1Mucosal Immunology Group, Department of Pediatrics, Rostock University Medical Center, Rostock, Germany
  • 2Center for Immunobiology, Blizard Institute, The Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom

CD8+ T cells are involved in the pathogenesis of inflammatory bowel disease , a complex multifactorial chronic disease. Here, we present an overview of the current research with the controversial findings of CD8+ T cell subsets and discuss some possible perspectives on their therapeutic value in IBD. Studies on the role of CD8+ T cells in IBD have contradictory outcomes, which might be related to the heterogeneity of the cells. Recent data suggest that cytotoxic CD8+ T cells and interleukin 17-producing CD8+ cells contribute to the pathogenesis of IBD. Moreover, subsets of regulatory CD8+ T cells are abundant at sites of inflammation and can exhibit pro-inflammatory features. Some subsets of tissue resident memory CD8+ T cells might be immunosuppressant, whereas others might be pro-inflammatory. Lastly, exhausted T cells might indicate a positive outcome for patients. The function and plasticity of different subsets of CD8+ T cells in health and IBD remain to be further investigated in a challenging field due to the limited availability of mucosal samples and adequate controls.

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What Is The Best Diet For Ulcerative Colitis

Theres no single diet that works best for ulcerative colitis. If the disease damages the lining of the colon, your body might not absorb enough nutrients from food. Your healthcare provider may recommend supplemental nutrition or vitamins. Its best to work with your provider and nutritionist to come up with a personalized diet plan.

Who Diagnoses Ulcerative Colitis

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If you have symptoms of ulcerative colitis, your regular healthcare provider will probably refer you to a specialist. A gastroenterologist a doctor who specializes in the digestive system should oversee the care for adults. For young patients, a pediatric gastroenterologist who specializes in children should manage the care.

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Androgen And Estrogen Receptors

It is clear that only the unbound, bioavailable testosterone can affix to loci in the Androgen Receptor on the cell wall. The increased presence of SHBG and decreased total testosterone production works against the host maintaining anabolic homeostasis. When xenoestrogens are ‘added-to’ to the individual’s genetic makeup, they induce abnormal mRNA and DNA which propagate inflammation and disease. Xenoestrogens, heavy metals, and synthetic and conjugated equine estrogens increase SHBG they work in concert to diminish the bioavailable testosterone, measured as the FAI. Directly, xenoestrogens affixing to the AR loci are transported into the cytoplasm of the cell and to the Estrogen Receptor and signal inflammatory responses.

The Androgen Receptor serves as the rate limiting step in the movement of both xenoestrogen and testosterone through the cell. The greater the bioavailable quantity and greater affinity for the AR loci favors the androgens: Dihydrotestosterone and nandrolone have a 30-fold greater affinity for the AR than 17- estradiol. While testosterone has a 10-fold greater affinity than 17- estradiol, 98 percent of testosterone is bound to SHBG. Only 5 percent of nandrolone is bound to SHBG. Nandrolone, milligram for milligram is up to 30 times more important in shifting the FAI toward normalcy. The increased exposure to xenoestrogens and suppression of bioavailable testosterone production favors a state of “Estrogen Dominant”.

Cd8+ T Cells Contribute To The Pathogenesis Of Ibd

Figure 1 Heterogeneity in the CD8+ T cell pool. Upon antigen presentation and cytokine release by dendritic cells , naïve CD8+ T cells differentiate into different subsets including cytotoxic/cytolytic , Tc2, Tc9, Tc17, Tc22, and immunosuppressant T regulatory . CD8+ T cells produce different cytokines according to their phenotype. A few clones remain and constitute the memory compartment . Modified from Golubovskaya and Wu , Mittrücker et al. and St. Paul and Ohashi . CTL, cytotoxic T lymphocyte DC, dendritic cell Tcm, central memory T cell Tem, effector memory T cell Trm, tissue-resident memory T cell.

Table 1 The contribution of CD8+ T cells in IBD.

Interestingly, newly diagnosed and medication-free pediatric ulcerative colitis and Crohn´s disease patients differ in their T cell activation pattern. On one hand, pediatric ulcerative colitis patients had higher frequencies of activated HLA.DR+1-integrin+ CD8+ T cells in the periphery and that correlated positively to systemic and mucosal inflammation biomarkers . On the other hand, pediatric Crohn´s disease patients showed equal levels of activated HLA.DR+1-integrin+ CD8+ T cells to controls, but an increase on the CD23+ B cell population . Given that both diseases are closely related and that precise diagnosis is difficult in some cases, patterns of lymphocyte subsets could be a tangible extra diagnostic tool, at least in pediatric IBD patients.

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What Should I Ask My Doctor On Behalf Of My Child Or Teenager

Ask your healthcare provider the following questions in addition to the ones listed above:

  • What vitamins should my child take?
  • Will my other children have pediatric ulcerative colitis?
  • Is my child at risk for other conditions?
  • Can you recommend a psychiatrist or therapist to help my child with emotional issues related to pediatric ulcerative colitis?
  • Is my child growing at a normal rate?
  • What can I do to help my child cope at school?

A note from Cleveland Clinic

When you have ulcerative colitis, its essential to work closely with your healthcare team.

Take your medications as prescribed, even when you dont have symptoms. Skipping medications youre supposed to take can lead to flareups and make the disease harder to control. Your best shot at managing ulcerative colitis is to follow your treatment plan and talk to your healthcare provider regularly.

Immunosupressant Cd8+ T Regs As A Therapeutic Approach In Ibd

Complications of ulcerative colitis

There is no doubt that regulatory T cells represent an attention-grabbing strategy for reaching homeostasis in chronic inflammatory diseases. However, regulatory T cells cannot be isolated in sufficient numbers, let alone those specific to self-, microbiota-, or food-derived antigens. Engineering of T cells carrying a synthetic receptor, the so-called chimeric antigen receptor , has been proven with optimistic results, mainly in treatment of cancer. Briefly, autologous CD8+ T cells obtained by leukapheresis are enriched and engineered to express a specific recombinant receptor that recognizes a given antigen expressed on tumor cells . Viral and non-viral vectors can be used for gene transduction. Afterwards CAR T cells are expanded ex vivo and the non-/poorly-engineered T cells are depleted by CliniMACS Prodigy, an automated good manufacturing practice -compliant . The resultant CAR T cells are re-infused into patients where they lyse tumor cells that express the specific antigen the newly CAR T cell were engineered for . It is important to point out that some CAR immunotherapeutic approaches have been GMP-approved as an anticancer immunotherapy .

These studies show that reassigned antigen specific CD8+ T regs, by CAR technology or continuous antigen stimulation, might be a therapy worth investigating.

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Try Not To Stress About Sex

The more you stress about your sex drive and performance, the less likely youâll be able to get in the mood. Thatâs why itâs important to give yourself a break if youâre noticing occasional issues, like being too tired to be intimate with your partner. âThatâs normal, especially as we get older,â Berman says.

But if your libido is consistently low or you have issues like vaginal pain or erectile dysfunction, tell your doctor. Some UC medications can impact your sex drive and ability to have sex. A new medication or sexual aid, like lubricant, may improve the way you feel and function. If you have physical problems like a fistula or weak pelvic floor, a specialist should be able to help.

Being open with your partner can also ease anxiety. âIf youâre just dating or in a new relationship, youâll want to establish trust before telling them about your condition,â Berman says. âBut once youâre in a committed relationship, it can take pressure off to be up-front about your needs and fears.â

Consider getting your partner involved in your medical care, too, especially if youâre going to have surgery for your UC. âWe encourage partners to come to appointments and have an open discussion about this stage of treatment,â McClure says. âIt helps make everyone more comfortable and get prepared for what comes next.â

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Gastroenterology & Hepatology: âSex-Specific Issues in Inflammatory Bowel Disease.â

Start With Your Doctor

âDonât ignore problems and wait for them to get better. Talk to your health care team,â Rubin says. Most IBD doctors believe that treatment for it should also address sexual health. But only 14 percent bring up sex to their patients most or all of the time, according to a 2014 study from Rubin and his colleagues.

And another 31 percent only bring it up sometimes. But thatâs because most doctors feel crunched for time, not because they donât care. âYou may need to bring it up to your doctor, so they know itâs a priority for you,â Rubin says.

Be clear about how your symptoms impact your ability to be intimate. For example, if urgency issues make you avoid sex, your doctor may be able to adjust your treatment plan. Itâs important to remember that feeling good shouldnât be your only treatment goal, Rubin says. âThe goal is deep remission,â he says. âThat gives you much more control, which can improve your confidence.â

If youâre worried your doctor isnât comfortable or doesnât want to discuss sex, ask them for referrals to a nurse, sex therapist, counselor, or urologist or gynecologist who can help.

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What Is Ulcerative Colitis

Ulcerative colitis causes irritation and ulcers in the large intestine . It belongs to a group of conditions called inflammatory bowel disease . It often causes diarrhea with blood, cramping and urgency. Sometimes these symptoms can wake a person up at night to go to the bathroom as well.

The inflammation in ulcerative colitis usually starts in the rectum, which is close to the anus . The inflammation can spread and affect a portion of, or the entire colon. When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.

The severity of UC depends on the amount of inflammation and the location. Everyone is a little different. You could have severe inflammation in the rectum or very mild inflammation in the entire colon .

If you have ulcerative colitis, you may notice a pattern of flare-ups , when symptoms are worse. During times of remission, you might have little to no symptoms. The goal with therapy is to remain in remission as long as possible .

Chronic Disease Is Linked To Low T

Ulcerative Colitis

Still, as men get older, they become more likely to develop a range of chronic conditions, such as diabetes, obesity, high cholesterol, and heart disease, and they also tend to become less physically active. Men who do have those things will likely develop low testosterone with aging, says Dr. Ramasamy. Why do these health issues have this impact? Thats the million-dollar question, says endocrinologist Luma Ghalib, M.D., of the Ohio State University Wexner Medical Center in Columbus. There are multiple layers to how lifestyle and comorbid diseases can affect testosterone levels.

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Testosterone Therapy Could Help Improve Crohns Symptoms

Research published in May 2016 in the journal Endocrine Abstracts suggests that men with IBD are more likely to have relatively low testosterone levels, possibly due to chronic inflammation, says Salem. Plus, he says, corticosteroids have been shown to decrease levels.

Theres some evidence, including research published in June 2015 in the journal Hormone Molecular Biology and Clinical Investigation, showing that testosterone replacement therapy improves Crohns symptoms, although Salem says its not standard treatment. At this juncture, testosterone replacement therapy, when indicated, should be addressed by an endocrinologist and shouldnt be perceived as a form of therapy in patients with Crohns disease, he says. Talk to your doctor if you have symptoms of hypogonadism , including decreased sex drive and fatigue. You may be referred to an endocrinologist for testing and diagnosis.

On the whole, men with Crohns tend to have a harder time managing their condition than women, partly because theyre hesitant to acknowledge their symptoms and seek treatment, so theyre diagnosed at a later stage, says Salem.

Many people with IBD are not open with providers about problems like sexual dysfunction, hypogonadism, depression, and anxiety, says Qazi. Providers are not normalizing these kinds of questions in practice. Some questions are not easy for men to ask, for a variety of reasons.

Fortunately, there are treatments available. You just need to speak up.

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