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Due to the risk of hypotension, caution should be used in patients using alpha blockers for prostate hyperplasia and patients using other antihypertensive medications and alpha blockers, which should not be co-administered with PDE5 inhibitors. In patients who take 50 mg of sildenafil or more and use alpha blockers, sildenafil dosing should be avoided for at least 4 hours after the dose of the alpha blocker. In patients who take 25 mg of sildenafil, use of any alpha blockers is considered safe.
Important future developments will include selective androgen receptor modulators (SARMs). These drugs will be able to produce isolated effects of testosterone at androgen receptors. They are likely to become useful clinical drugs, but their initial worth may lie in facilitating research into the relative importance of testosterone's action at the androgen receptor compared to at other sites or after conversion to other hormones. Testosterone will remain the treatment of choice for late onset hypogonadism for some time to come.
Some of the effects of testosterone treatment are well recognised and it seems clear that testosterone treatment for aging hypogonadal men can be expected to increase lean body mass, decrease visceral fat mass, increase bone mineral density and decrease total cholesterol. Beneficial effects have been seen in many trials on other parameters such as glycemic control in diabetes, erectile dysfunction, cardiovascular risk factors, angina, mood and cognition. These potentially important effects require confirmation in larger clinical trials. Indeed, it is apparent that longer duration randomized controlled trials of testosterone treatment in large numbers of men are needed to confirm the effects of testosterone on many aspects of aging male health including cardiovascular health, psychiatric health, prostate cancer and functional capacity. In the absence of such studies, it is necessary to balance risk and benefit on the best available data. At the present time the data supports the treatment of hypogonadal men with testosterone to normalize testosterone levels and improve symptoms. Most men with hypogonadism do not have a contraindication to treatment, but it is important to monitor for adverse consequences including prostate complications and polycythemia.
But if a man with sleep apnea is diagnosed with low testosterone alone, taking the supplemental hormone can worsen sleep apnea. That's why it's crucial for men with low testosterone to get a thorough workup by an endocrinologist so underlying conditions that can cause low testosterone, such as sleep apnea or pituitary-gland tumors, don't go undiagnosed, Dr. Goodman says.
There is a polymorphic CAG repeat sequence in the androgen receptor gene, which codes for a variable number of glutamine amino acids in the part of the receptor affecting gene transcription. A receptor with a short CAG sequence produces greater activity when androgens attach, and men with shorter CAG polymorphisms exhibit androgenic traits, such as preserved bone density (Zitzmann et al 2001) and prostate growth during testosterone treatment (Zitzmann et al 2003). Indirect evidence of the importance of androgens in the development of prostate cancer is provided by case control study findings of a shorter, more active CAG repeat sequence in the androgen receptor gene of patients with prostate cancer compared with controls (Hsing et al 2000, 2002).
The other interesting thing about the study: men's testosterone levels were lowest in March (at the end of winter) and highest in August (at the end of summer). Sunlight affects your vitamin D production, so you have seasonal dips and peaks. Get a blood test to check your levels, and if you're low, take a high-quality vitamin D3 supplement. If you're going to take D3, take vitamin K2 and vitamin A with it. The three work in sync, so you want them all to be balanced. Here are my dosage recommendations.
The aim of treatment for hypogonadism is to normalize serum testosterone levels and abolish symptoms or pathological states that are due to low testosterone levels. The exact target testosterone level is a matter of debate, but current recommendations advocate levels in the mid-lower normal adult range (Nieschlag et al 2005). Truly physiological testosterone replacement would require replication of the diurnal rhythm of serum testosterone levels, but there is no current evidence that this is beneficial (Nieschlag et al 2005).
Some of the effects of testosterone treatment are well recognised and it seems clear that testosterone treatment for aging hypogonadal men can be expected to increase lean body mass, decrease visceral fat mass, increase bone mineral density and decrease total cholesterol. Beneficial effects have been seen in many trials on other parameters such as glycemic control in diabetes, erectile dysfunction, cardiovascular risk factors, angina, mood and cognition. These potentially important effects require confirmation in larger clinical trials. Indeed, it is apparent that longer duration randomized controlled trials of testosterone treatment in large numbers of men are needed to confirm the effects of testosterone on many aspects of aging male health including cardiovascular health, psychiatric health, prostate cancer and functional capacity. In the absence of such studies, it is necessary to balance risk and benefit on the best available data. At the present time the data supports the treatment of hypogonadal men with testosterone to normalize testosterone levels and improve symptoms. Most men with hypogonadism do not have a contraindication to treatment, but it is important to monitor for adverse consequences including prostate complications and polycythemia.
However, a review of a United Kingdom medical record database found no evidence that the use of 5-alpha reductase inhibitors independently increase the risk for ED. In 71,849 men with benign prostatic hyperplasia (BPH), the risk of ED was not increased with the use of finasteride or dutasteride only (odds ratio [OR] 0.94), or a 5-alpha reductase inhibitor plus an alpha blocker (OR 0.92) compared with an alpha blocker only. In addition, the risk of ED was not increase in 12 346 men prescribed finasteride 1 mg for alopecia, compared with unexposed men with alopecia (OR 0.95). The risk of ED did increase with longer duration of BPH, regardless of drug exposure. [48]
When many people think of someone with a high level of testosterone, they may picture a man loaded with strength, sexual prowess, and machismo. But while high-T has been correlated with all those things, it's also been correlated with aggression, sexual misconduct, and violence. One of testosterone's most common uses—as a performance-enhancing steroid—illustrates both sides of the hormone. Injecting steroids can be a quick way for athletes to dramatically improve performance, but the side effects can also be extreme, and can include excessive body hair growth, sexual dysfunction, and the hard-to-corral anger known as "roid rage."
Impotence, also known as erectile dysfunction or ED, is a very common problem, affecting up to half of 40-70 year old men in Australia.Treatment techniques for impotence have varied through the years, from external steel mechanical attachments, to static electricity attached to the penis and testicles, to simple aphrodisiacs such as oysters. Until as recently as 1970, erectile failure was almost always seen as being due to psychological causes and was usually treated with psychotherapy.Since then, the medical causes contributing to impotence have been recognised and the treatment of impotence has been revolutionised, providing a range of options which are far more acceptable and very much more successful.Treatment options for impotenceTreatment choices for erectile dysfunction include:medicines;self-injection therapy;devices such as vacuum pumps;penile implant surgery;hormone therapy; andcounselling.If you have erectile dysfunction, the treatment your doctor recommends will depend on the severity of symptoms and the underlying cause of your impotence.Your doctor will want to check that any conditions that could be contributing to or causing erectile dysfunction are being treated.Your doctor may also suggest that you make some lifestyle adjustments, such as:increasing the amount of physical activity you get;losing weight if you are overweight;reducing the amount of alcohol you drink;quitting smoking; andnot taking illicit drugs.These lifestyle recommendations can help improve impotence related to several causes and improve your health in general.Medicines for erectile dysfunctionThe first tablet available for erectile dysfunction, sildenafil (brand name Viagra), has been largely responsible for helping to bring the topic of erectile dysfunction out into the open. Similar medications — tadalafil (Cialis) and vardenafil ( Levitra) — are also available. These medicines all work in a similar way, although there is some difference in how long their effect lasts. Sildenafil, tadalafil and vardenafil belong to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors because they block the PDE5 enzyme.How do oral medicines help treat erectile dysfunction?PDE5 inhibitors help in the process of getting and keeping an erection by working on chemicals in the body that are involved in erections. These medicines work by stopping PDE5 from breaking down an erection-producing chemical called cyclic guanosine monophosphate (cGMP). cGMP helps to relax the smooth muscle cells in the penis's erectile tissue, allowing more blood to flow into the penis to cause an erection. When PDE5 is temporarily blocked by these medicines, it can't break down the erection producing cGMP, so an erection can be achieved and maintained. PDE5 inhibitors can be used in the treatment of erectile dysfunction that is due to physical or psychological causes.Medications such as Viagra, Cialis and Levitra will work only if you are sexually stimulated. They are not aphrodisiacs and won't increase your sex drive.Side effects of PDE5 inhibitorsSide effects of these medicines can include headaches, flushes, blocked nose, indigestion and dizziness.In rare situations, sildenafil and vardenafil can cause a distortion of vision or change in colour vision.Tadalafil has been associated with back pain.Who can take medicines for impotence?PDE5 inhibitors cannot be taken by all men, so your doctor will need to evaluate your suitability before prescribing either of these medications.Men taking nitrates (often used to treat angina) should never take phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors should also not be taken with some medicines used to treat high blood pressure.PDE5 inhibitors may also not be suitable for men with certain heart conditions or low blood pressure. Check with your doctor to find out if this type of medication may be suitable for you.Self-injection therapySelf-injection therapy delivers a medicine called alprostadil (brand name Caverject), also known as prostaglandin E-1, to the erectile tissue of the penis. Prostaglandin E-1 occurs naturally in the body and helps increase the blood flow to the penis to cause an erection. Unlike the PDE5 inhibitors, alprostadil will cause an erection whether the penis is stimulated or not.Self-injection therapy is usually recommended if PDE5 inhibitor medicines are not suitable or have not been effective in the treatment of erectile dysfunction.How to use self-injection therapyAlprostadil is injected into either of the 2 cigar-shaped chambers of the penis known as the corpora cavernosa, which run along the length of the penis, one on either side. Your doctor or urologist (specialist in problems with male reproductive organs and the urinary tract) will give you instructions on how to do this.Alprostadil should produce an erection in 5 to 20 minutes and, generally, the erection will last for 30 to 60 minutes.You should not use alprostadil more than once in a 24-hour period, and you should use it no more than 3 times a week.Don't try to use more than the recommended dose of alprostadil, as your erection may last longer than is medically safe.Who can use self-injection therapy?You should ask your doctor if alprostadil is suitable for you. Your doctor will also be able to tell you how much alprostadil to use, depending on your condition and whether or not you are taking any other medications, and also how to use alprostadil properly.People with certain illnesses, such as leukaemia and sickle cell anaemia, or who have a penile implant or Peyronie's disease, where the penis may be scarred and produces erections that are not straight, should not use alprostadil.Men for whom sexual activity is not advised should not use alprostadil.Side effects of injection therapyThe most common side effects of alprostadil include pain in the penis or bruising in the penis at the site of injection. Fibrosis (the development of fibrous tissue) can also develop following injections into the penis.The most serious side effect is priapism (a persistent erection), which is a medical emergency. Your doctor will inform you of what to do if you have an erection that persists for 2 hours or more. It is very important that you follow your doctor's instructions and inform them that you have experienced this side effect.Vacuum erection devicesVacuum erection devices work by creating a vacuum, which increases blood flow to the penis, producing an erection.The penis is lubricated and placed inside a hollow plastic chamber. Air is pumped out of the chamber, either manually or by a battery powered pump. This creates a vacuum which pulls blood into the penis to cause an erection. This takes about 5 minutes.Once the penis is erect, the man fits a rubber ring around the base of his penis to keep the blood trapped inside the penis when the cylinder is removed. After intercourse, the ring can be removed to return the penis to a limp state.Vacuum erection devices avoid surgery and can be used as often as required. However, they may be difficult to use, and many men and their partners feel they take much of the pleasure and spontaneity away from sexual activities. Vacuum pumps are not suitable for men who have problems with blood clotting, or blood disorders such as leukaemia.Penile implant surgery for impotencePenile implant surgery is not a common procedure but in some cases it may be the most appropriate treatment for erectile dysfunction.The procedure involves placing an implant inside the penis, along its length, so that it can become erect. The implant may be a pair of semi-rigid rods or a pair of inflatable cylinders.The inflatable implants allow the penis to look and feel limp (flaccid) or erect, depending on how much the cylinders are inflated. The cylinders in an inflatable implant are hollow, and the man gets an erection by squeezing a pump located in his scrotum to fill the cylinders with salt water (saline) stored in a reservoir implanted in his lower abdomen. A release valve drains the saline out of the cylinders and back into the reservoir.With the semi-rigid, malleable rod type of implant, the rods run along the length of the penis and can be bent upwards to produce an erect penis, or downwards when an erect penis is not required.Like all surgery, there are some risks, such as infection or bleeding. If you have had surgery and have severe pain, fever, swelling or excessive bleeding, you should contact your doctor as soon as possible.Vascular surgery for erectile dysfunctionIn cases where a man's anatomy prevents blood flow into or out of the penis, vascular surgery may be an option. This treatment option is rarely recommended, and is usually only successful in younger men.If there is a blockage that prevents blood from flowing into the penis, a doctor may recommend an operation that bypasses the blocked blood vessels, using a length of vein or manufactured tubing, to allow more blood to flow into the penis and help produce an erection.If the problem is that blood leaks back out of the penis, this can be corrected by tying off the major veins that drain the penis, a procedure known as venous ligation.Hormone treatments for impotenceIn a small number of men, blood tests may show abnormally low levels of testosterone, the male sex hormone. In such cases your doctor might prescribe a course of testosterone injections or a testosterone implant. The supplements can help boost sex drive as well as increasing the ability to have erections. Testosterone gel or patches, applied daily to the skin, are another option.Complementary medicines for erectile dysfunctionThere is a lack of scientific evidence supporting the effectiveness of complementary therapies for the treatment of impotence.Always check with your doctor before taking any herbal medicines or supplements for impotence. These formulations may contain ingredients that can interact with other medicines or cause dangerous side effects.Counselling for men with impotenceErectile dysfunction often has physical causes, but sometimes there is a psychological basis for erection problems. Often this is a form of performance anxiety. A man may have had an episode of erectile dysfunction due to some passing cause like fatigue, stress, relationship difficulty or intoxication. This may have led to embarrassment or a feeling of failure. Even if the physical cause does not remain, future attempts to have sex may trigger memories of this embarrassment and acute anxiety that it will happen again. This anxiety itself is capable of causing erectile dysfunction, and so a man may get trapped in a self-reinforcing cycle of anxiety and erectile dysfunction. In these instances, seeing a GP, counsellor or psychologist can be very helpful.Stress, anxiety, depression and low self-esteem, in fact, almost all significant emotional problems, can have a major effect on sexuality. So do many chronic physical illnesses, even if they don't directly affect genital function. Counsellors and psychologists can assist with these and a wide range of other sexual and relationship problems and can also help female partners suffering from sexual problems. They are particularly skilled in helping patients to overcome guilt or anxiety relating to sexual abuse, and in helping couples to sort out relationship difficulties. Simple problems can be dealt with in a few visits, but more complex problems may require several months or even years of therapy.Your doctor may be able to recommend a psychologist or counsellor who specialises in sexual and relationship problems. Last Reviewed: 12 December 2016
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Mood disturbance and dysthymia are part of the clinical syndrome of hypogonadism. Epidemiological studies have found a positive association between testosterone levels and mood, and depressed aging males have lower testosterone levels than controls (Barrett-Connor, Von Muhlen et al 1999). Furthermore, induction of a hypogonadal state during treatment of men for prostate cancer leads to an increase in depression scores (Almeida et al 2004). Trials of testosterone treatment effects on mood have varied in outcome. Data on the effects on men with depression are conflicting (Seidman et al 2001; Pope et al 2003) but there is evidence that testosterone treatment of older hypogonadal men does result in improvements in mood (Wang et al 1996) and that this may occur through changes in regional brain perfusion (Azad et al 2003).
When females have a higher baseline level of testosterone, they have higher increases in sexual arousal levels but smaller increases in testosterone, indicating a ceiling effect on testosterone levels in females. Sexual thoughts also change the level of testosterone but not level of cortisol in the female body, and hormonal contraceptives may affect the variation in testosterone response to sexual thoughts.[51]
Hypogonadism (as well as age-related low testosterone) is diagnosed with blood tests that measure the level of testosterone in the body. The Endocrine Society recommends testing for suspected low T with a total testosterone test. It may be performed in the morning when testosterone levels tend to be highest in young men, although this isn't necessarily the case in older men. The test may be repeated on another day if the results show a low T level. (5)
^ Jump up to: a b Lazaridis I, Charalampopoulos I, Alexaki VI, Avlonitis N, Pediaditakis I, Efstathopoulos P, Calogeropoulou T, Castanas E, Gravanis A (2011). "Neurosteroid dehydroepiandrosterone interacts with nerve growth factor (NGF) receptors, preventing neuronal apoptosis". PLoS Biol. 9 (4): e1001051. doi:10.1371/journal.pbio.1001051. PMC 3082517. PMID 21541365.
There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.
Exercise and lifestyle modifications may improve erectile function. Weight loss may help by decreasing inflammation, increasing testosterone, and improving self-esteem. Patients should be educated to increase activity, reduce weight, and stop smoking, as these efforts can improve or restore erectile function in men without comorbidities. Precise glycemic control in diabetic patients and pharmacologic treatment of hypertension may be important in preventing or reducing sexual dysfunction. [49]
^ Mehta PH, Jones AC, Josephs RA (Jun 2008). "The social endocrinology of dominance: basal testosterone predicts cortisol changes and behavior following victory and defeat" (PDF). Journal of Personality and Social Psychology. 94 (6): 1078–93. CiteSeerX 10.1.1.336.2502. doi:10.1037/0022-35220.127.116.118. PMID 18505319. Archived from the original (PDF) on April 19, 2009.
Studies show that high cholesterol and obesity are linked to erectile dysfunction, and both can be improved through diet. "A heart-healthy diet that prevents cardiovascular disease and maintains a healthy weight is also good for erectile functioning," says Feloney. An ideal diet plan involves eating foods low in saturated fat and cholesterol and having frequent servings of fruits, vegetables, and plenty of whole grains.
An occasional problem achieving an erection is nothing to worry about. But failure to do so more than 50% of the time at any age may indicate a condition that needs treatment. About 40% of men in their 40s report at least occasional problems getting and maintaining erections. So do more than half (52%) of men aged 40 to 70, and about 70% of men in their 70s.
Although not proven, it is likely that erectile dysfunction can be prevented by good general health, paying particular attention to body weight, exercise, and cigarette smoking. For example, heart disease and diabetes are problems that can cause erectile dysfunction, and both are preventable through lifestyle changes such as sensible eating and regular exercise. Furthermore, early diagnosis and treatment of associated conditions like diabetes, hypertension and high cholesterol may prevent or delay erectile dysfunction, or stop the erectile dysfunction from getting more serious.
Transdermal preparations of testosterone utilize the fact that the skin readily absorbs steroid hormones. Initial transdermal preparations took the form of scrotal patches with testosterone loaded on to a membranous patch. Absorption from the scrotal skin was particularly good and physiological levels of testosterone with diurnal variation were reliably attained. The scrotal patches are now rarely used because they require regular shaving or clipping of scrotal hair and because they produce rather high levels of dihydrotestosterone compared to testosterone (Behre et al 1999). Subsequently, non-scrotal patches were developed but the absorptive capacity of non-scrotal skin is much lower, so these patches contain additional chemicals which enhance absorption. The non-scrotal skin patches produce physiological testosterone levels without supraphysiological dihydrotestosterone levels. Unfortunately, the patches produce a high rate of local skin reactions often leading to discontinuation (Parker and Armitage 1999). In the last few years, transdermal testosterone gel preparations have become available. These require daily application by patients and produce steady state physiological testosterone levels within a few days in most patients (Swerdloff et al 2000; Steidle et al 2003). The advantages compared with testosterone patches include invisibility, reduced skin irritation and the ability to adjust dosage, but concerns about transfer to women and children on close skin contact necessitate showering after application or coverage with clothes.
Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.
The brain is also affected by this sexual differentiation;[13] the enzyme aromatase converts testosterone into estradiol that is responsible for masculinization of the brain in male mice. In humans, masculinization of the fetal brain appears, by observation of gender preference in patients with congenital diseases of androgen formation or androgen receptor function, to be associated with functional androgen receptors.[95]
What you need to know about STDs Sexually transmitted diseases (STDs) are infections that are passed on from one person to another through sexual contact. There are many STDs, including chlamydia, genital warts, syphilis, and trich. This article looks at some of the most common STDs, the symptoms, and how to avoid getting or passing an STD one on. Read now
In order to discuss the biochemical diagnosis of hypogonadism it is necessary to outline the usual carriage of testosterone in the blood. Total serum testosterone consists of free testosterone (2%–3%), testosterone bound to sex hormone binding globulin (SHBG) (45%) and testosterone bound to other proteins (mainly albumin −50%) (Dunn et al 1981). Testosterone binds only loosely to albumin and so this testosterone as well as free testosterone is available to tissues and is termed bioavailable testosterone. Testosterone bound to SHBG is tightly bound and is biologically inactive. Bioavailable and free testosterone are known to correlate better than total testosterone with clinical sequelae of androgenization such as bone mineral density and muscle strength (Khosla et al 1998; Roy et al 2002). There is diurnal variation in serum testosterone levels with peak levels seen in the morning following sleep, which can be maintained into the seventh decade (Diver et al 2003). Samples should always be taken in the morning before 11 am to allow for standardization.
Other side effects include increased risk of heart problems in older men with poor mobility, according to a 2009 study at Boston Medical Center. A 2017 study published in JAMA found that treatments increase coronary artery plaque volume. Additionally, the Food and Drug Administration (FDA) requires manufactures to include a notice on the labeling that states taking testosterone treatments can lead to possible increased risk of heart attacks and strokes. The FDA recommends that patients using testosterone should seek medical attention right away if they have these symptoms:
Clinical studies have suggested that these devices are effective and acceptable to a large number of patients with ED of varying causes, including psychogenic erectile failure. These devices are safe and can restore a man's ability to achieve penetrative intercourse, with one study suggesting nearly 95% success with adequate instruction and support.30 However, satisfaction with this treatment modality typically wanes with time, as patients report dissatisfaction with how cumbersome or unnatural the devices are to use, hinging or buckling of the erection with thrusting, and dissatisfaction with the fact that the erection is ischemic and therefore cold, which can be off-putting to the partner.
Saw palmetto: Uses, dosage, and side effects Saw palmetto is an extract from the berries of a type of palm tree. The berries have traditionally been used to ease urinary and reproductive problems. The extract is now used in herbal remedies to stabilize testosterone. Learn about its use, its effectiveness, the science behind the claims, and any side effects. Read now
Sexual dysfunction and ED become more common as men age. The percentage of complete ED increases from 5% to 15% as age increases from 40 to 70 years. But this does not mean growing older is the end of your sex life. ED can be treated at any age. Also, ED may be more common in Hispanic men and in those with a history of diabetes, obesity, smoking, and hypertension. Research shows that African-American men sought medical care for ED twice the rate of other racial groups.
Sharma, R., Oni, O. A., Gupta, K., Chen, G., Sharma, M., Dawn, B., … & Barua, R. S. (2015, August 6). Normalization of testosterone level is associated with reduced incidence of myocardial infarction. European Heart Journal, 36(40), 2706-2715. Retrieved from https://academic.oup.com/eurheartj/article/36/40/2706/2293361/Normalization-of-testosterone-level-is-associated
A large number of side-effects have been attributed to testosterone. In our clinical experience, the incidence of significant adverse effects with treatment producing physiological testosterone levels is low, and many side effects attributed to testosterone are mainly relevant to supraphysiological replacement. Some adverse effects are specific to a given mode of delivery and have already been described. Potential adverse effects concerning the prostate have also been discussed and require appropriate monitoring of symptoms, PSA and digital rectal examination. Other tumors which may be androgen responsive include cancer of the breast and primary liver tumors, and these are both contraindications to testosterone treatment
Sleep apnea is another frequently listed contraindication to testosterone treatment. There have been a few reports of the development, or worsening, of sleep apnea during testosterone therapy (Matsumoto et al 1985) but sleep apnea is actually associated with lower serum testosterone levels (Luboshitzky et al 2002). The reduction in fat mass during treatment with testosterone could potentially be beneficial for sleep apnea, so many specialists will still consider patients for treatment with appropriate monitoring. It is wise to take a clinical history for sleep apnea during testosterone treatment in all men and perform sleep studies in those who develop symptoms.
Erectile dysfunction is known to be associated with general health status, thus, lifestyle modification improves erectile function and decreases the rate of decline of function with aging. One year after discontinuation of smoking, patients were found to have a 25% improvement in erectile quality.16 In addition, multivariate analysis found obesity is associated with erectile dysfunction with an approximately 50% increase in ED in obese men as compared with normal weight men.17
More can be learned from a large, randomized, placebo-controlled trial of finasteride treatment in 18,800 men aged 55 or more. Finasteride is a 5α-reductase inhibitor which acts to prevent the metabolism of testosterone to dihydrotestosterone (DHT) – the most active androgen in the prostate. The trial showed a greater overall incidence of prostate cancer in the control group, but men treated with finasteride were more likely to have high grade tumors (Thompson et al 2003), suggesting that reduced androgen exposure of the prostate may delay the presentation of prostate cancer and/or promote advanced disease in some other way.
Clinical experience in switching medications to improve ED has been disappointing in that improvement does not often occur. Nonetheless, it is important to try to discontinue possible offending medications before proceeding to more invasive ED treatment options. Oral ED medications have changed the way clinicians discontinue medications in patients with ED and has improved the approach. For example, a patient may develop ED on a thiazide diuretic. The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. Alternatively, if diuretic therapy is effective, well tolerated, and controlling blood pressure, oral ED therapy can be used on an ongoing basis to treat the side effect of ED.
Dr. Wassersug, whose background is in evolutionary biology, also noted that lower testosterone in older men may be adaptive, a positive benefit, as our bodies age and become increasingly frail. "The argument can be made," he said, "that it's not beneficial to have the mindset of a 19-year-old when you are 49-years-old, because if you are aggressive enough to get into a conflict with an actual 19-year-old, you are going to get killed."
While studies are limited, it has been shown that male sexual dysfunction can also negatively impact the sexual function of female partners. A study comparing the sexual function of women with partners with erectile dysfunction to those without showed that sexual arousal, lubrication, orgasm, satisfaction, pain and total score were significantly lower in those who had partners with erectile dysfunction. Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm, satisfaction and pain were all significantly increased. It was concluded that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.
Barbara Mintzes, at the University of British Columbia, said in a Skype interview, "Androgel was approved for a real condition—men who have a number of clinical or acquired conditions that affect testosterone, either through the testes or pituitary gland. So testosterone replacement therapy makes sense, and producing it in a gel makes sense. Where there is an actual need for the product, there's nothing wrong with that." But, she added, "When this gets marketed for what is essentially healthy aging, the antennas go up."
Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Advancement of Science, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Urological Association, Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, Western Section of the American Urological Association, Association of Clinical Research Professionals, American Society of Clinical Oncology, International Society of Urology, International Society of Urological Pathology
This post can absolutely change your life, and probably help you avoid some pitfalls. Like shrunken balls. (I am not an expert in the synthetic anabolic testosterone drugs used by bodybuilders — they carry lots of risks but pack a big punch if you want to get swole. Bulletproof is all about having massive clean energy, looking good, and living a very long time…so anabolic steroids aren't on my roadmap.)
Conflicting results have been obtained concerning the importance of testosterone in maintaining cardiovascular health.[29][30] Nevertheless, maintaining normal testosterone levels in elderly men has been shown to improve many parameters that are thought to reduce cardiovascular disease risk, such as increased lean body mass, decreased visceral fat mass, decreased total cholesterol, and glycemic control.[31]
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the person's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.
If you're experiencing psychological ED, you may benefit from talk therapy. Therapy can help you manage your mental health. You'll likely work with your therapist over several sessions, and your therapist will address things like major stress or anxiety factors, feelings around sex, or subconscious conflicts that could be affecting your sexual well-being.
The mechanism of age related decreases in serum testosterone levels has also been the subject of investigation. Metabolic clearance declines with age but this effect is less pronounced than a reduction in testosterone production, so the overall effect is to reduce serum testosterone levels. Gonadotrophin levels rise during aging (Feldman et al 2002) and testicular secretory responses to recombinant human chorionic gonadotrophin (hCG) are reduced (Mulligan et al 1999, 2001). This implies that the reduced production may be caused by primary testicular failure but in fact these changes are not adequate to fully explain the fall in testosterone levels. There are changes in the lutenising hormone (LH) production which consist of decreased LH pulse frequency and amplitude, (Veldhuis et al 1992; Pincus et al 1997) although pituitary production of LH in response to pharmacological stimulation with exogenous GnRH analogues is preserved (Mulligan et al 1999). It therefore seems likely that there are changes in endogenous production of GnRH which underlie the changes in LH secretion and have a role in the age related decline in testosterone. Thus the decreases in testosterone levels with aging seem to reflect changes at all levels of the hypothalamic-pituitary-testicular axis. With advancing age there is also a reduction in androgen receptor concentration in some target tissues and this may contribute to the clinical syndrome of LOH (Ono et al 1988; Gallon et al 1989).
Epidemiological data has associated low testosterone levels with atherogenic lipid parameters, including lower HDL cholesterol (Lichtenstein et al 1987; Haffner et al 1993; Van Pottelbergh et al 2003) and higher total cholesterol (Haffner et al 1993; Van Pottelbergh et al 2003), LDL cholesterol (Haffner et al 1993) and triglyceride levels (Lichtenstein et al 1987; Haffner et al 1993). Furthermore, these relationships are independent of other factors such as age, obesity and glucose levels (Haffner et al 1993; Van Pottelbergh et al 2003). Interventional trails of testosterone replacement have shown that treatment causes a decrease in total cholesterol. A recent meta-analysis of 17 randomized controlled trials confirmed this and found that the magnitude of changes was larger in trials of patients with lower baseline testosterone levels (Isidori et al 2005). The same meta-analysis found no significant overall change in LDL or HDL cholesterol levels but in trials with baseline testosterone levels greater than 10 nmol/l, there was a small reduction in HDL cholesterol with testosterone treatment.


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We know it can be somewhat intimidating entering into a new environment, but we are glad that you are interested in visiting our church. To help you get to know us and give you a glimpse of what you can expect, we have answered some general questions about our church and what we do.
9:15 am - Early Service
10:00 am - Adult Bible Study
10:50 am - Main Worship Service
9:30 am - Children's Meetings
3085 Grand Prairie Road SE, Albany OR
Our early service starting at 9:15 am begins with singing a few hymns. After the singing the children go to their classes at 9:30 am. Then the person incharge of the service prays, reads a few Bible verses, provides a mission story, which is either a video or read story, and gives a 10-15 min talk. After that people go to one of our three adult Bible Studies.
The children's classes provide singing, stories, Bible lessons, nature lessons, topic discussions, and crafts. Children should be picked up at 10:40 am.
Our adult Bible studies either use a weekly Bible study guide or a religious book. There is a teacher that leads the class through discussions of the topic for the week.
At 10:50 am we come together in the sanctuary for our main worship service. This service is composed of announcements, singing, scripture reading, prayer, offering giving, children's story, music, and a sermon.
We also have a fellowship potluck meal on the second and forth Saturday of each month. If you are visiting, you are welcome to come eat and visit with us without bring anything.

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Rumours this morning suggest that DICE General Manager Patrick Back is to part ways with the studio. Having worked with DICE on Battlefield Bad Company 2, right through to Battlefield 1 last month, perhaps he is just stepping down, or is he seeking other challenges?
The rumour comes from a source of PlayStation Lifestyle, who say that "It's said Bach is leaving to spend more time with his family, but it's unclear whether he's leaving for another studio, or forming one of his own. Bach, for his part, will have Battlefield 1 as the last game on his resume as a DICE employee."
[UPDATE] It has since been confirmed that this rumour is true, following an email sent out by EA on the matter.
"Patrick Bach has been a great colleague to many across DICE and EA for almost 15 years. We thank him for all of his contributions, especially to our Battlefield franchise and community, and wish him all the best on his next adventure."
– Patrick Söderlund, EVP, EA Worldwide Studios
"I've had an epic ride at DICE and EA, filled with amazingly creative and passionate people, and unforgettable experiences with our player community. I'll certainly be playing Battlefield 1 for a long, long time to come, and I look forward to seeing what's next from the incredible team at DICE."
– Patrick Bach
Here, Patrick Bach talks to Geoff Keighley on Youtube Gaming in June, about Battlefield 1.
It's not unheard of in the games industry for creators and writers to jump out of the industry and pursuing different career paths or other, calmer ventures.
We at 4-One Gaming would like to wish Patrick Bach the best of luck on his next adventure too, and in the meantime, thank you for the great games in your time!


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Kitchen Ideas. Thursday , March 01st , 2018 - 06:47:03 AM
Many communities have a 'Parade of Homes' where the local builders demonstrate their skills in building homes. Walking through these show homes will give you a good feel of what different ideas and concepts look like in actual settings. You can also see many different styles of kitchens and ideas on display in home improvement centers and cabinet makers' showrooms. Pictures are great to find kitchen ideas, but experiencing real kitchens gives you a better feel for the actual finished concept.
Now that you've chosen your design, you need to choose your appliances! A grill or smoker is a necessity. You'll need to decide if you want a gas or charcoal grill, and what type fits best in your budget. Grills can range from very affordable to very expensive. Other kitchen ideas include sinks, refrigerators, extra burners and more. Some people opt to put in a refrigerator beneath their prep area. Adding extra gas burners can help you prepare a well-rounded meal. Whether or not you need burners depends on how much you anticipate using your outdoor kitchen.
If you are remodeling your old kitchen, you may be somewhat limited in the design options available to you. This may be especially true if your house is older and your kitchen space is smaller. This is where consulting with a kitchen designer can be very beneficial in helping you pull together the look that you want for your kitchen. You can show the designer your portfolio of kitchen ideas, and together you can design your dream kitchen. The designer will have the experience to steer you toward the design features that will work well together, and which ideas need to be discarded. After seeing which kitchen ideas you prefer, a good designer will introduce you to ideas that you may not have considered to compliment your basic ideas. A kitchen designer will be able to maximize the efficiency of your kitchen by creating the best layout within your existing kitchen space, or maybe rework your available space to make your kitchen more functional.
Believe it or not the best place to start is with you and your family. Make a list of those things that you feel you will most need in your outdoor kitchen and then list those things that you think will be beneficial. For example, most families agree a good grill is a must at backyard, but do also want to make breads, pies and pizza out of doors? If so then you are going to want a wood burning oven as well. You might even want to include an open fire pit for guests to gather around, a dining set and of course cabinets and counter tops.
If you decide on an island, there are more decisions to make. You can have one custom made for you, or you can use a pre-fabricated island. Customizing your outdoor kitchen can allow you to go more upscale with granite, slate or other unique materials. Pre-fabricated islands are less expensive and come in a variety of configurations and finishes. Be sure to choose materials that will hold up well in your climate.
Whatever you decide on for your personal kitchen, you're sure to enjoy many hours cooking and entertaining. Your family and friends will enjoy your efforts and you'll be the favorite host once they discover your beautiful kitchen.
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This is our listing of scheduled investigations and events. See when the NWA Ghost Connection will be in a haunted house near you!
"The soul of man is immortal and imperishable – Plato
If you know of a location you'd like to see NWA Ghost Connection visit, let us know in the comments box below.
- We are helping a few local realtors with cleansing homes for sale that have potential Hauntings. If you're a realtor and need our help to make that sale please email us.
- Its Time we have our YouTube page updated with our investigation of The Historic Clayton House. Search NWA Ghost Connection and check us out.
- As of 03/29/2017 NWA Ghost Connection has adopted a grave in Bentonville, AR, from the year 1908. We are in the process of resealing the above ground tomb and finishing it with a clear coat to protect it from weather wear. NWA Ghost Connection is dedicated to giving back to our community. See our Adopt a Grave page for updates.
- NWA Ghost Connection will doing a commercial soon we will keep you updated for more on this. We want to bring awareness to NW Arkansas about hauntings so stay tuned.
- NWA Ghost Connection will be setting up a time at a public library to do some questions and answers for those interested. We will post as soon as the date is set.
- Children Of The Grave 2 was released in April 1st 2012, I am extremely excited my daughters are in this great documentary(See Below). Stay tuned for updates. http://childrenofthegrave2.blogspot.com/
- NWA Ghost Connection did some filming with the Booth Brothers and Twintalk Entertainment for the documentary "Children of the Grave" seen on the Sci-Fi Channel. Also filming with them is Missouri Paranormal Research "MPR". All filming took place at the First Annual Arkansas Ghost Hunters Conference. Thank you to Saint and Phillip Booth. We love you. View the Children of the Grave clip on YouTube: http://www.youtube.com/watch?v=BayeIwyGslk
- Our Research section has been updated with some interesting information in the Unknown Phenomena page.


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Because smartphones are everywhere, the demand for new and creative apps is increasing in popularity more than ever before. Between Google's Android and Apple's iPhone market, people are using countless apps everyday. And, most of them are selling right and left. Taking the time to develop and sell a smartphone app may be worth your while since it's a very lucrative way to earn money online. The apps cost almost nothing to actually develop and don't involve any shipping or storage costs, which works to expand your overall profit margin. Well performing apps can make thousands in ad revenue each month for their creators, making them another great passive income strategy.
Every year more people shop online than ever before. Customers have grown to love the convenience of buying online, and new online stores are constantly opening to meet the demand. If you've ever thought about starting an online store of your own, now is a great time to get started. Don't worry— it's not as hard as you might think. In fact, with the right eCommerce platform on your side, you can have your whole business up and running in no time.
Sure, there are plenty of businesses offering social media consulting services, but you can stand out from the crowd by focusing primarily on networks that are still gathering steam with businesses. Facebook and Twitter are still the top networks, but businesses tend to struggle the most with more visual platforms like Instagram, Pinterest, Tumblr and Snapchat. All of these platforms have huge audiences, but many businesses don't realize how big they really are, how effective they can be and how to make them work for their niche. Snapchat has more than 158 million users per day, according to Business Insider. Instagram has more than 500 million daily active users, according to Statista, and Pinterest has more than 200 million.
The PENNY HOARDER℠, ℠, and ℠ are service marks of Taylor Media Corp. Other marks contained on this website are the property of their respective owners. Taylor Media Corp. is not licensed by or affiliated with any third-party marks on its website and they do not endorse, authorize, or sponsor our content except as noted herein. Please read our Privacy Policy and Terms of Service.
Work remotely for a call center. Because many call center jobs are location independent, finding work in this field is an easy way to earn some money from home. Dozens of sites list job openings for call-center representatives, including Freelancer.com and SimplyHired.com. Meanwhile, you should check local job listings for openings and opportunities as well.
19. eBay – Of course you can't read an article about making money online that doesn't mention eBay. You can start an eBay store and get serious about it or you can just sell some stuff to declutter your home. Either way, I've made my fair share from selling on eBay and it's still a popular way to earn money. If you decide to start an actual eBay store, you'll want to find a drop-ship business like Doba that will store and ship items straight to your customers so you don't have to deal with an inventory.
Every successful business has an automated sales funnel. Yet, so many businesses are completely unaware of the power of an effective funnel. Sales funnels provide automation in the sales process. They help you build a relationship with your audience and develop a bond with the consumer. There are plenty of tools you can use to build a sales funnel, but the world's most successful businesses often create custom-coded funnels.
Sites like Cookening, EatWith, and MealSharing are to restaurants what Airbnb is to hotels. Sign up as a host to earn dough by cooking and serving meals to guests in your home. It's up to you what you want to cook and how many people you can accommodate. Cooks are paid directly through the site, so no cash ever changes hands. The earning potential for becoming a cooking host is $50-$100 per meal.
Research Pricing (And Set Fair Starting Prices): Before setting prices for each item, research your local Craigslist website and (if possible) nearby yard sales to get a sense of how to price them. Remember that many buyers will try to haggle – so set prices a bit higher than your bottom dollar, but not so high that you'll scare off first bids. 10% to 15% is a good rule of thumb. Consider bunching low-value items, such as old CDs, into lots of five or 10, or offer x-for-$y deals.
According to Carter, who's company provides coaching trading guidance to over 350,000 customers around the world, one of the best ways you can actually make money in options is to buy at the money calls 15 days before earnings are released and them the day before earnings are released. The excitement and anticipation around earnings typically drives up the price providing consistent winners, while holding through earnings is pretty much a crapshoot.
You can earn above average rates of return because peer-to-peer lending eliminates the bank function. That means that you participate in nearly the entire interest rate being paid by the borrower, rather than the less than 1% that you will typically earn on certificates of deposit. And you can reduce your risk by investing in slices of hundreds of different loans.
One factor that you must be aware of though is that Care.com is a peer-to-peer arrangement. That means that you will be in direct competition with other pet sitters in your area. You must price your services competitively in order to get business. Once you begin to develop a list of regular clients, you will be in a better position to raise your rates. This will be particularly true as you get referrals from those customers.
If you're a fitness buff and have the right combination of charisma and business sense, working as a part-time online personal trainer can be both physically and financially rewarding. Once you build up a reputation and client base for yourself, it could easily turn into a full-time endeavor for you. Check out this interview with several fitness blog owners who are making a living online, from MonetizePros. As well, I'd recommend checking out this resource if you want to take this business idea seriously and get started with a business plan for your personal fitness trainer business today.
Expert sales funnels often start with a free offer, also called the lead magnet. By delivering value in the lead magnet, you're creating trust with the consumer. In the next step, you'd usually find what's called a self-liquidating offer or a trip wire. These are insatiable deals that are hard to pass up, often for $7 to $47. The front-end offer is usually found beyond that along with one-time offers to help boost the lifetime value of the customer and the average cart value.
Once a site or blog is created and optimized for SEO (search engine optimization) purposes, the search engine marketing (SEM) begins. The potential for earning income in this area is literally through the roof if you know what you're doing. An expert in SEO management is responsible for successfully marketing a website and can choose to promote it in a variety of ways.
Just be sure to put a lot of care into your product listings. Everything from the titles you use, to how effective the description is at convincing potential buyers your product is better than the rest, and even taking care to shoot high quality product photos can have a dramatic impact on your sales. I recommend using photo editing tools like Fotor, which gives you the ability to edit your images, create captivating graphic designs and more.


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Merck, Samsung Bioepis Win Biosimilar Approval
Source: Business Wire
Sep 08, 2015
Merck and Samsung Bioepis announced the approval of a biosimilar version of Amgen's immunology medicine Enbrel by the Ministry of Food and Drug Safety in Korea.
The Korean approval of biosimilar Brenzys is the first product approval under Merck's collaboration with Samsung Bioepis. Samsung Bioepis is a joint venture between Samsung and U.S. biotech Biogen.
Brenzys is indicated for the treatment of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and psoriasis in adult patients. Merck plans to launch the biosimilar in South Korea by the end of this year or early 2016.
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text: 1 127 ColourOrange Frame NumberUnknown Stolen FromEast Midlands, Leicestershire Stolen WhenBetween 11pm Thursday 6th dec and 7:30am Friday 7th dec Bike Description Bike is completely stock. Small scratch on the right sticker on the forks. Theft Description Stolen from Tesco park road in Loughborough whilst I was working nights, the lock was cut straight through. 1 127 Contact Bikes Owner Share on Facebook Tweet on Twitter Recently Stolen Bikes Ammaco Holland 19/26 dutch bike 30 mins agoCarrera bicycles Hellcat 38 mins agoVoodoo Bizango 1 hour agoSpecialized Allez Sport 2 hours agoElectra Amsterdam Original 3i 2 hours ago Recent Posts The Inseparability of Cycling & Parking 2 years agoInternational allies in the global fight against bike thieves 3 years agoFive smart takes on bicycle security 3 years agoMetropolitan Police Release Stolen Bike Data 3 years agoI've found my bike.... what next? 3 years ago


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@gregr I agree. There needs to be a way to release tuners. The current menu system works well for that. Although having a translucent guide with channel in the background would be cool, it kind of would be redundant with the favorites menu accessible with a swipe down. Especially for people using antennas, who are getting ABC, NBC, CBS, Fox, CW, and PBS. All of the channels fit nicely in the favorites menu, which is available while the current channel is playing. The guide is only useful for planning future programming.
Play current channel while on grid
I would love to see this. It's the feature that I miss most having switched from Verizon Fios boxes to the HDHomeRun Prime with AppleTV. Other than that great app, hope to see this feature soon.
Would love to see this!
I'd like this feature too. Actually the was Directv Now does it is the guide gets superimposed over the currently viewed channel. You still get a full screen of guide but you can see the currently viewed channel (and audio) as well.
I read that tvOS 11 may include a PIP feature, which might make doing a guide/video combo a bit easier. Though I assume you would need to use the built-in video player in order to take advantage of it.
It's a shame that hardware decoding is limited on the ATV to H.264 progressive, because having to decode most video in software is probably the main reason why there aren't enough resources left to do other interesting things like a guide overlay, etc.
Any updates on this feature request?
I'm a new channels ATV user and would love to be able to to pull up the full epg grid while continuing to view the channel I'm watching.
I also want this feature. Does not seem to be a difficult ask, the favorites are shown by sliding down and the stream continues unless you choose a new channel. .
slightly transparent guide with audio +1
agree. essentially any option to browse the epg grid (and select a new channel to change) while the current channel still playing.
same behavior as swiping down and showing the favorite channels, except showing he guide grid and allowing the user to select which channel to change.
Feature Request - PIP & Background Audio Stream
Another vote for this feature (on Android TV however)…
After dumping cable boxes which had a PIP/audio stream, and going to the Channels app, my wife immediately called out that she much preferred having the audio stream continue playing. She found it jarring to have audio and then go to none (especially if she had fallen asleep and I was still watching TV, the abrupt volume change would wake her up, whereas a constant volume didn't disturb).
I also prefer at minimum the audio feed as then you can "monitor" whats going on in the current channel and decide whether you really want to change or not when surfing.
Please implement this feature. This is huge!!! +1
Just curious for some that have posed this new feature question. Are we talking the ability to keep playing the current channel while viewing the guide (which is what I vote for), or are we talking the ability to see the content of the channel that is currently highlighted in the guide?
What I think would be cool, is if the playing channel continues without leaving the current screen and some action (I am sure this might be one of the challenges) brings up the guide. The action that brings up the guide either minimizes the playing video or superimposes (I don't think I would be a fan of this option) on top of the playing video with translucent guide (hard to see but kinda cool), or the video you are watching shrinking down to size in one (less viewed) corner of the guide.
I think if we can at least get sound playing in the background to start many would be very very happy. I am coming from Nvidia Shield and the built in google channels app keeps the channel playing while you view the guide. When the sound cuts off while viewing the guide in channels it is very jarring.
Just wanted to bump this thread up and see if there was any progress in getting a transparent guide that would overlay live tv?
If this is NEVER going to happen, can the devs make a sticky saying so and let's move on?
Just trying Channels DVR as a potential replacement for my old Windows 7 Media Center + extenders. So far, so good.
My wife's biggest complaint is that there is no audio from whatever we are watching (live tv or DVR) when browsing through the Guide.
It looks like users have been asking for this for years. @tmm1, any chance of it ever happening?
We're going to take a stab at it this year. There are a ton of technical challenges with how the app works that make it complicated. It's not as trivial as "make the video show on the guide"
For those that request this, what are you actually after?
Do you just want it because that's how traditional cable boxes worked? Or is there a more specific thing you're after?
"Make the video play on the guide" is a result, not a problem solving feature. If we knew more about the problems you were trying to solve, we could possibly solve it another way.
Your feedback would be really useful!
For me the use case would be watching one show and being not completely into it and looking to see if anything better is on but not wanting to miss anything of the first show in case I don't find something better to watch.
This is basically it for me too. It's more the option to look around with the guide similar to putting something in PIP on my iPad and then checking out the Channels forums...
Thanks for the quick reply. For me, if the audio just continued in the background, that would be a great start and would definitely improve the WAF in my home.
When watching a live show, and a commercial comes on, we often surf the guide to see if anything else is on. Just hearing the original station's audio provides a clue as to when it is time to stop checking out the guide and return to the show (if nothing better was found! )
I would imagine that keeping just the audio feed without trying to make the guide transparent, or shrinking the video into a small window, would be fairly simple. But as a developer, I realize that what appears simple may also be much more challenging depending on how the app was designed.
Again, thank you for your consideration of this enhancement. We are really enjoying Channels DVR. I am amazed at how quickly Channels is able to tune a station and begin displaying video. Incredibly smooth on our Apple TVs.


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The government has thrown the farming community to a pit
Monday, 20 July 2015 - 9:29
Former President Mahinda Rajapaksa said that the country's farmer community had been rendered helpless.
The former President said so while addressing a people's rally held in Galgamuwa in Kurunegala yesterday.
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