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Hormones, Metabolism, Aging, and Men s Health function but hypothyroidism may impede many vital functions In addition, by increasing the level of SHBG, hyperthyroidism decreases the level of FT, which could impact sexual function Few studies have reported on the prevalence of sexual dysfunction in men presenting with thyroid dysfunction Veronelli et al [329], using the IIEF-5, found that prevalence and severity of ED were signi cantly higher in men with both hyperthyroidism (10/13, 77%, including two severe and two moderate cases) and hypothyroidism (30/55, 55%, including four severe and 11 moderate cases), than in 109 control men of the same age (33/109, 30%, including no severe and only three moderate cases) In 48 men with hypo- or hyperthyroidism, Isidori et al [330] found ED in 64% and 15%, respectively (associated with hypoactive sexual desire and retarded ejaculation in most of the hypothyroid patients), and premature ejaculation in 7% and 50%, respectively After return to normal levels of serum thyroid hormones for eight to 12 weeks, the prevalence of premature ejaculation fell from 50 to 15% in the hyperthyroid patients, while that of retarded ejaculation was reduced by half in those with hypothyroidism The mean ejaculation latency time doubled in the former and signi cantly decreased in the latter, suggesting the possibility of a direct involvement of thyroid hormones in the physiology of ejaculation In 38 patients referred for ED and found to be hypothyroid, Baskin [331] reported that erectile function returned in the majority following thyroid hormone substitution Conversely Wortsman et al [332] did not observe any sexual improvement following thyroxin treatment in a short series of ED patients with primary hypothyroidism In conclusion, a majority of the patients with thyroid dysfunction have some form of sexual dysfunction, which may improve following normalization of the thyroid hormones Some studies have reported on the prevalence of thyroid dysfunction in men presenting with ED Among 600 ED patients preselected (since sent to endocrinologists by urologists who suspected an endocrine cause), Baskin found hypothyroidism in 6% [331] Earle and Stuckey [20] found only two patients with hypothyroidism in 1455 men consulting for ED (no bene t of hormone therapy on sexual function) The prevalence was somewhat higher in.

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Synchronization in my opinion seems often misunderstood Essentially, this feature is relevant when a transit AS (one that passes traffic for which it is neither the source nor destination) chooses not to use a full iBGP mesh Hence, if routers A, B, C, and D were connected in series, consider that only A and D are iBGP peers and are providing transit between multiple ISPs For this to work, an IGP would have to have full prefix awareness, or said another way, the IGP table and the BGP tables would need to contain the same routes Hence, it could be said that the tables would need to be synchronized For protection, the BGP routers will not advertise a prefix outbound via eBGP to other AS s until their internal IGP table has the prefix installed This means that likely the other IGP routers in the domain also have the prefix and thus traffic will not be black holed In practice, no one does this! Redistributing 100k routes into an IGP is not a good thing :) All transit providers fully mesh with iBGP (with the exception of traffic engineered cores over MPLS) Synchronization is thus always turned off In fact, Juniper does not even offer a synchronization knob

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incomes, for example Hotel REITs operate in a more volatile environment and will tend to see greater fluctuations in the returns they can deliver Shopping centres also offer a measure of stability, but will provide a return that reflects the strength of the retail sector Don t take the word trust literally! The trust s assets remain subject to the trends influencing the sector in which they operate These trends will have an impact on their operations, profitability, and, in turn, the amount of the distributions you receive In extreme cases, if the operating business of the trust performs poorly, a distribution may not land in your lap at all On the other hand, as witnessed in when stock markets dove in late 2008, an otherwise solid REIT may be discounted by the market regardless of how well its real estate is performing because the units of the REIT are seen as just one more equity

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the series of Bodie et al [19], but the 2240 otherwise unselected ED patients were all more than 50 years old (hypothyroidism in 39% and hyperthyroidism in 1%, based on serum TSH values; no indication of the effects of speci c endocrine therapies on sexual function) In another Italian study of men with ED, plasma TSH concentrations were signi cantly lower in men who also had premature ejaculation, and premature ejaculation was two-fold more frequent in men with ED and suppressed plasma TSH, again suggesting a possible relationship with hyperthyroidism [333] However Waldinger et al did not nd any relationship between premature ejaculation and thyroid dysfunction in a cohort of 620 men with premature ejaculation [334] In conclusion, although few objective data is available, the prevalence of thyroid dysfunctions does not seem clearly increased in the patients consulting for sexual dysfunction, and routine determination of thyroid hormones is not justi ed in this population unless symptoms of thyroid disease are present

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