Well, yeah. Adipocytes multiply when you get fat. But when you lose weight, they don't apoptose, they just shrink in volume by giving up their lipid stores.
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But maybe it can also be a useful and healthy weight loss strategy?
"Tirzepatide promotes M1-type macrophage apoptosis and reduces inflammatory factor secretion by inhibiting ERK phosphorylation" [1]
[1] https://www.sciencedirect.com/science/article/abs/pii/S15675...
Visceral fat is literally enclosing the intestines, major blood vessels, organs, etc. of the abdomen.
Nevertheless, it is possible to surgically remove this sheet of fat that's covering your organs, it's called an omentectomy. But it's a big surgery, and done only in case of cancer, not for weight loss. That is, in humans: https://pubmed.ncbi.nlm.nih.gov/29367725/
I lost 100 lbs fasting over 1.5 years. I did gain some weight back after stopping, but not much. Strangely, where I saw fat return was not where most of it came off.
Once you’ve reached a level of physical strength it’s easier to return to that level in the future. This has been a topic of debate in the sports world because past anabolic steroid use could therefore carry benefits into the future long after the athlete has stopped using the steroid. Non-professional athletes shouldn’t get too excited about using steroids, though, because the damage steroids do to the body’s own hormone systems also has lasting effects unless you plan on doing TRT for the rest of your life, which has its own downsides.
For average people this does show the importance of getting at least some exercise when you’re young. It’s much easier to get a little bit fit when you’re young which then makes it easier to stay fit in the future. Never too late too start.
But the doctor was mentioning that none of the influencers influencing young people to try T and Steroids (which is rampant right now) are ever mentioning that you are on a ticking clock to infertility as soon as you start this stuff. Some people can regain their fertility but it might take years, and some people are going to be permanently infertile even staying on HRT.
Plenty of those "alpha male" guys on social media are shooting blanks.
I know that's different than permanent TRT but I feel like you couldn't get very far researching that stuff without understanding that you natural test production (and sperm production) would get "shut down" as soon as you started adding exogenous androgens.
There are two problems with framing it as an infertility problem:
1 - It reduces fertility but many users retain some fertility. The bigger problem for most is that natural testosterone production won't come back to the same level if they ever discontinue, so they're on it for life. Managing testosterone injections every week or multiple times per week for the rest of your life is doable but a pain, especially if you have to travel or you're not the best at keeping up with prescriptions. There are also ups and downs and side effects that come from artificial testosterone dosing. Many people are surprised to discover that after the first year or two they don't feel "great" any more and it's just back to where they started, but with a lifetime dependency now. Others get serious side effects like Gynecomastia (breast growth in men, possibly requiring surgery) or secondary hormonal alterations that negatively impact mood, cognition, or libido.
2 - Many young men in their 20s or even teens see infertility as a positive rather than a negative. It's very common for people of this age to think they've made up their mind for life, but they have yet to even have a serious relationship or even know any peers with kids. People who work in fertility fields are starting to see a lot of men who went into TRT or steroids when they were young because they thought the consequences would never be a problem for them.
> Plenty of those "alpha male" guys on social media are shooting blanks.
Honestly, they don't care. I skim the testosterone subreddits occasionally and many people brag and joke about how small their testicles are.
It's crazy to me to see this shift happening. TRT clinics that advertise on the radio, TikTok, and everywhere else will entice people to come in for "free tests" but the trick is that it doesn't matter what your numbers come back as, they'll always find a way to prescribe you TRT because it's easy recurring revenue for them with lifelong dependence attached.
Similar advantage is conveyed to athletes who had elevated (~male) testosterone levels in the past, even if they subsequently take blockers / go on HRT to ~female hormone levels.
If you're reading this and you're < 30 and physically weak (not overweight, but lacking muscle mass) I cannot stress enough what a year or two hitting the gym could do for your permanent strength and muscle mass.
I was ridiculously skinny and physically weak going into my 20s and I just assumed that was the way I was built. But I got into fitness in my early 20s and packed on quite a bit of muscle and it's genuinely shocking to me how much base-level muscle mass and strength I've retained now 15 years on.
I always felt one of the most demotivating things about working out was that all the effort I was putting into the gym would eventually go to waste when I stopped, but that's not true. Had I known this I'd probably have started working out much earlier and for much longer than I did.
The problem is that when you kill an adipocyte, it releases all of its triglycerides, which are then free to move around the blood stream. But when blood triglyceride levels are high and there isn't significant oxidation, other metabolic processes are triggered to start to store them. So you kill an adipocyte, release the triglycerides, which get reabsorbed into still living adipocytes, which now get engorged and then multiply again, replacing the fat cells that have been killed.
After learning quite a bit about these processes, I think these devices might actually be useful, not for losing fat, but by eliminating this sort of fat memory. In other words, they should be used after significant weight loss, because adipocytes are relatively empty and externally triggered apoptosis can kill the cells without releasing significant quantities of triglycerides which can be reabsorbed and trigger adipocyte mitosis. I think this would effectively reset that person to a state as if they had never been fat in the first place. Thoughts?
Additionally, trans women on HRT typically have their T suppressed below standard cis women levels, and thus well below the levels of cis women athletes (the top levels in any sport by definition tending to be outliers in performance).
The male-pattern skeletal growth isn't necessarily a disadvantage. E.g., narrower hips and stronger bones is likely an advantage in running.
> If the net effect were actually an advantage, you'd expect the womens' sports which are allowing trans women to be dominated by them, but they really just aren't.
My understanding is the opposite. In fact, if it wasn't the case, there is basically no reason to have separate mens and womens fields.
An aggressive protocol of HCG and HMG (analogues for FSH and LH in the pituitary) reactivated the testes to get back to spermatogenesis and T production after about 5 years of complete dormancy. It took about 4 months of daily needles and well-timed marital conception-attempts. The son I fathered as a result is anecdotally very strong and a voracious eater. My urologist said it sounded like I knew everything I needed to do and was satisfied to let me self-treat.
It might or might not help, but if it were a net benefit then you'd expect trans women runners to perform more strongly than they actually do.
> My understanding is the opposite. In fact, if it wasn't the case, there is basically no reason to have separate mens and womens fields.
This sentence seems to presuppose that trans women are men. There are some womens' divisions which allow trans women (typically with stipulations requiring some duration of HRT), and they are not dominant there. To me, the sensible conclusion seems to be that trans women perform roughly on par with cis women, not that cis women perform roughly on par with cis men.
They’ve known this for centuries. Quoting the great Socrates:
“No man has the right to be an amateur in the matter of physical training. It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable."
Maybe beginner bodybuilders understand this. But I'd argue the average new steroid user is more likely the be un/mis-informed. The average person gets all their information from Instagram/Tiktok/Youtube/Reddit.
But my observation is a lot of people are jumping on gear for purely aesthetic reasons. They are ordering online from research chemical sites and they're almost always not working with a trainer/coach/doctor (vast majority of young people on gear are not doing it under any type of supervision, also means many skip basic necessities like regular bloodwork).
It's much more common for people to jump on gear, experience a negative effect, and then do research afterwards. Which is fine for substances that are relatively benign, but risky when you're messing with your hormones especially at a young age.
Two years and I was bigger than anyone I knew unless they also trained hard.
The study and the discussion here however are focused on reducing the quantity of those adipocyte cells in the body, which aren't reduced through ketosis. I think ketosis causes more of a volumetric reduction of each adipocyte cell but I'm really not sure.
Like a balloon filling with air, do adipocyte cells expand in volume while storing lipids?
It's not because they couldn't recover, it's because they don't want to or see the point.
> There are some womens' divisions which allow trans women (typically with stipulations requiring some duration of HRT), and they are not dominant there.
I think there are maybe two things I'd poke at here. (1) Sports where transwomen enjoy greater advantage are more likely to have already excluded transwomen from womens' fields. And (2) the number of transwomen is tiny to begin with and AFAIK they have lower rates of participation in sports than ciswomen.
I think you can basically make a case for including or excluding transwomen in women's sports depending on whether you think inclusion or fairness is most important.
A pretty wide spread of sports have allowed trans women*, and they have not dominated. If trans women did have an outsized performance in women's sports, there'd be examples to point to. I don't think you can make an evidence-based case for fairness and inclusion being at odds, given there aren't any unfair examples of inclusion to point to.
Some of the most notable examples include weightlifting and swimming. In weightlifting, probably the sport I'd expect an unfair advantage to make itself most apparent, Laurel Hubbard got a DNF in the Olympics, and did merely pretty good in several other events. Or in swimming, another sport I'd expect body proportions to have a significant impact in, Lia Thomas, who was the center of a ton of controversy, also did merely fine.
I'm not sure there are sports where trans women would have a bigger advantage than weightlifting, if such an advantage existed. And the tiny number of trans women interested in sports means that erring on the side of inclusion (if it does turn out to be an error) would also have a tiny negative impact,
* - Pedantic side note, combining "transwomen" and "ciswomen" into single words implies that we're different base nouns. It's similar to how "chinamen" is not acceptable, but generally there's nothing wrong with "Chinese men". "Trans" and "cis" are just adjectives modifying "men" or "women".
On the contrary, Laurel Hubbard is a good example of how apparent this male physical advantage is when male athletes are allowed to compete in the female category.
Here's a chart showing ranked lifts for both men's and women's weightlifting in the World Masters Games, where Hubbard won a gold medal in the women's category in 2017: https:/i.ibb.co/WWf7CMQD/hubbard.jpg (the source of this graph is a developmental biologist who, amongst other things, studies sex differences in sport).
This shows that the set of lifts by female and male weightlifters are entirely distinct. Hubbard falls within the middle range of the male rankings and is a huge outlier compared to the female rankings.
For the Olympics, if Hubbard had been female, qualification for the competition would have been unprecedented. Hubbard was competing in the wake of an earlier elbow injury, had taken a years-long career break, and was considerably older than any female weightlifter ever to qualify for Olympic weightlifting: female weightlifters peak at around age 26 and Hubbard was 43 years old at the time.
Being male in the female category was sufficient to mitigate all the effects of older age, chronic injury, undertraining, and - compared to other males - lack of world class talent.
It's also worth noting that Hubbard came last at the Olympics due to being disqualified for improper technique, not because of being unable to physically manage the lifts.
At least it is much less serious than people in the opposite situation, that think they want a child at 19 without understanding the implications.
Bear in mind, dialysis does work, however it certainly does not work as well as we hope it should. Dialysis, in all of its different forms, takes a huge toll on the body, and dialysis itself significantly increases mortality; it is also an invasive intervention.
All that being said, we certainly should be doing more research on this.
If I had to advise a patient on whether they should consider liposuction vs gastric bypass vs GLP1R agonists, I would tell them to not consider liposuction in that equation at all.
As with most cosmetic surgery, risks like these are downplayed by practitioners (willfully and otherwise) as well as by people in these social media circles.
This doesn't mean liposuction shouldn't ever be used, however. It can have good uses in reconstructive surgery, for example, where fat is sucked up to be used in reconstructing a different area. In this case, the potential reduction in morbidity and restoration of function to the patient, or increasing their autonomy, might make the risks associated with lipo worth it.
If you have the time, I would really appreciate it if you reached out to me. You can find my contact info on my profile page, there's also a link to an anonymous contact form, if you'd prefer that. Thank you!