Re: Speaking of Supplements... Carnitine

[Guest guest]

My comment:

Decrease apoptosis! Sorry ladies, so far this is for men only.

" Carnitines act as an antioxidant by promoting activity in the Krebs

cycle, while also decreasing apoptosis via a reduction in ceramide

levels along with insulin-like growth factor. "

The article:

Carnitine Improves Symptoms of Male Aging

News Author: Laurie Barclay, MD

April 14, 2004 — Carnitine is more active than testosterone for

improving symptoms of male aging such as sexual dysfunction,

depressed mood, and fatigue, according to the results of a

randomized study published in the April issue of Urology.

" Testosterone increases the tissue carnitine concentration, " write

G. Cavallini, from the Società Italiana di Studi di Medicina della

Riproduzione in Bologna, Italy. " Propionyl-L-carnitine and acetyl-L-

carnitine proved active for diseases typical of aging. "

In this trial, 120 patients were randomized to receive testosterone

undecanoate 160 mg/day, propionyl-L-carnitine 2 g/day plus acetyl-L-

carnitine 2 g/day, or placebo for six months. Mean age was 66 years

(range, 60-74 years).

Compared with baseline, testosterone and carnitines significantly

improved the peak systolic velocity, end-diastolic velocity, and

resistive index of cavernosal penile arteries, as well as nocturnal

penile tumescence (NPT), International Index of Erectile Function

score, Depression Melancholia Scale score, and fatigue scale score.

Compared with testosterone, carnitines were significantly more

active in improving NPT and International Index of Erectile Function

score. Testosterone, but not carnitines, significantly increased the

prostate volume and free and total testosterone levels and

significantly lowered serum luteinizing hormone. Prostate-specific

antigen (PSA) and prolactin did not change significantly in any

group.

No symptoms or physiological markers improved in the placebo group.

Adverse effects were negligible in all groups.

Carnitines and testosterone were effective for as long as they were

administered, with reversal to baseline values when treatment was

stopped. Six months after testosterone suspension, prostate volume

remained significantly greater than baseline.

" Testosterone and, especially, carnitines proved to be active drugs

for the therapy of symptoms associated with male aging, " the authors

write. " At least one side effect of testosterone administration

(i.e. prostate enlargement) will be avoided by carnitine

administration. "

Two of the authors are patent inventors for use of carnitines in

treating symptoms of male aging.

Urology. 2004;63:641-646

Clinical Context

Both testosterone and carnitine metabolism have been implicated in

contributing to the symptoms of sexual dysfunction, depressed mood,

and fatigue in older men. A decline of testosterone's effects in the

hypothalamic dopaminergic system, striated skeletal muscle, and

corpus cavernosum may explain why older men suffer from the symptoms

described above.

Both male and female sex hormones increase L-carnitine levels, in

vivo carnitine-acetyl-transferase activity, and the activities of

mitochondrial carnitine palmitoil-transferases. Carnitines act as an

antioxidant by promoting activity in the Krebs cycle, while also

decreasing apoptosis via a reduction in ceramide levels along with

insulin-like growth factor.

The authors of the current study sought to determine if the direct

administration of carnitine could improve symptoms of male aging to

a similar degree as androgen treatment. They also wanted to

establish the safety of carnitine administration.

Study Highlights

Patients eligible for participation were men older than 60 years

with symptoms of decreased libido and erectile quality, depressed

mood and ability to concentrate, irritability, and fatigue. Patients

with a free testosterone level less than 6 pg/mL were also included.

Patients had to be generally healthy to participate in the study.

Those with a history of obstructive urinary symptoms, alcohol or

cigarette use, or cardiovascular disease were excluded.

Subjects were randomized to receive 1 of 3 treatments: testosterone

undecanoate 160 mg/day, propionyl-L-carnitine 2 g/day plus acetyl-L-

carnitine 2 g/day, or placebo. All treatments were administered for

6 months.

Participants were followed for PSA levels and prostate volume,

measurements of penile blood flow, NPT, and serum levels of

testosterone, luteinizing hormone (LH), and prolactin. They were

also assessed for sexual function, mood, and fatigue. All of these

evaluations were performed at baseline, at 3 and 6 months after

initiation of treatment, and 6 months after cessation of treatment.

Although treatment was administered by blinded personnel, the

authors did not comment whether subjects' assessment was completed

in a similarly blinded manner.

150 patients were randomized into the study, and 130 completed the

study protocol. The authors did not perform an intent-to-treat

analysis of their data.

Baseline values for all study groups were similar. Mean age of

subjects was 64 years.

The testosterone group exhibited an increase in prostate volume as

measured by ultrasonography at 3 and 6 months. The authors mention

in their discussion that this increase prompted cessation of the

study protocol at 6 months. Prostate volume in the testosterone

group had decreased 6 months after cessation of treatment but had

not returned to baseline levels.

Carnitine administration had no effect on prostate volume.

Neither testosterone nor carnitine treatment changed PSA levels.

Both carnitine and testosterone treatment improved penile blood flow

at 3 and 6 months compared with placebo. There was no difference

between the carnitine and testosterone groups in this outcome.

NPT was improved to a similar degree in both active treatment groups

at 3 months compared with placebo, and this improvement was stable

at 6 months.

Testosterone therapy caused an increase in serum testosterone levels

and a decrease in LH levels at 3 months that remained stable at 6

months. Prolactin was unaffected by testosterone treatment.

Carnitine did not significantly change any hormonal levels measured.

Testosterone improved erectile dysfunction and sexual desire scores

at 3 months, but it did not improve scores for orgasm or general

sexual well-being at any point.

Carnitine improved erectile dysfunction, sexual desire, orgasm, and

general sexual well-being scores at 3 months, and these values

either remained stable or improved slightly at 6 months.

Carnitine was superior to testosterone in the 3- and 6-month

erectile function domain, the 6-month orgasm domain, and the 6-month

general sexual well-being domain.

Both carnitine and testosterone improved depression scores compared

with placebo, but carnitine was superior to testosterone in this

variable.

Fatigue was improved to a similar degree in both active treatment

groups compared with placebo.

Adverse events were similar among all treatment groups.

Pearls for Practice

Both testosterone and carnitine can affect symptoms of male aging

through multiple biochemical pathways in different tissues.

Carnitine appears to improve symptoms of male aging to a similar or

better degree than testosterone without causing an increase in

prostate volume.