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In vitro studies suggested that ERα or ERβ translated mechanical forces into prosurvival signals in osteocytes and osteoblasts, independent of estrogens.65 Estradiol was shown to prevent osteocytes apoptosis and enhance the production of transforming growth factor-alpha which inhibits osteoclastic bone resorption.66 Thus, estrogens converted from testosterone in male could contribute to the anabolic action of osteocytes. The remaining 5% is produced by the adrenals by the conversion of dehydroepiandrosterone.15 Testosterone is bound by sex hormone-binding globulin (SHBG) and albumin with strong and weak bonding in blood subsequently.16 Effects of testosterone on the body are mediated by its local conversion to 5α-dihydrotestosterone by peripheral tissues, which has a greater affinity for androgen receptors (ARs).17,18 The patient commences use of these devices approximately one week after surgery and continues daily for a period of months to years. 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Gaullier et al. decided to not only evaluate the effectiveness of CLA on weight loss, but to see if either CLA-triacylglycerol or CLA-FFA is more efficacious than the other. Along with other weight related endpoints, this study also evaluated the effects of CLA on sagittal abdominal diameter (SAD) as abdominal obesity has been linked with the metabolic syndrome. At the end of 12 weeks, the results demonstrated a decrease in body fat mass (BFM) of 1.73 kg in the group receiving CLA 3.4 grams (P ≤ .05) and a decrease of 1.3 kg in the group receiving 6.8 grams (P ≤ .05). In regards to weight loss, CLA is believed to work by promoting apoptosis in adipose tissue. If a dietary supplement appears to be unsafe after being marketed, the FDA can then decide whether or not to have the product removed from the market. In addition, health care costs are approximately 42% higher for obese patients when compared to normal-weight patients . 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