Several times a month, I encounter infertile couples in whom the male is on testosterone treatment by injection, pellets, or gel. Most of these males are unfamiliar with the adverse effects and side-effects of testosterone treatment. Quite frequently, the couple is infertile because of significant reduction in sperm performance directly due to testosterone treatment.
Here is how testosterone treatment harms sperm: the testicles produce two major commodities- sperm and testosterone. When testosterone is given to a male, the brain, specifically the pituitary gland that regulates testicular production of sperm and testosterone, gets a signal that there is adequate amount of testosterone. Consequently, the pituitary gland shuts down its production of hormones that stimulate testosterone and sperm production. Sperm production then shuts down and infertility due to male factor ensues. This harmful effect of testosterone on sperm production is temporary but may last 3-12 months after stopping testosterone treatment.
In this age of improved communication and the search for immediate gratification, “Low-T” commercials are abound. Symptoms of low energy and low libido, common with the rapid pace of modern life, often drive males to their doctor’s office to seek diagnosis, then treatment, of presumed low testosterone. When low blood level of testosterone is confirmed, the simple solution is testosterone treatment.
Here are some of the pros and cons of testosterone treatment:
1. “Easy fix”- rather than changing lifestyles that are harmful to testosterone production, especially obesity, taking testosterone may result in improving immediate issues (low libido, fatigue) and a false sense of well-being but harm in other areas (prostate health; cardiovascular health; fertility).
2. Reduced male fertility- many physicians prescribing testosterone do not ask beforehand about conception attempts by their male patients. Many male patients do not realize that testosterone treatment may harm male fertility, at least temporarily, and unknowingly harm the couple’s attempts to have a child.
3. Prostate health- testosterone treatment may result in prostate enlargement and possibly with small increased risk of prostate cancer. Prostate enlargement may lead to bothersome urinary symptoms and increased frequency of visits and urological procedures.
4. Cardiovascular health- especially with high doses of testosterone, there is an increase in blood clots in the lower extremities and lungs; and worsening of cholesterol levels (which may result in increase in heart attacks and strokes).
5. Cost and inconvenience: testosterone treatment is costly, and requires daily application of gel or frequent injections.
1. Improved feeling of well-being and stamina
2. Improved libido, reduced erectile dysfunction
3. Improved bone density
4. Increased muscle mass.
So what’s wrong with feeling better? Not much, unless it comes at the expense of long-term health risks! One should strongly consider weight loss and increased exercise instead of testosterone treatment- this may accomplish improvement in stamina and well-being, possibly also with increased libido and sexual performance, along with greater success in conceiving.
Measles has been spreading in the United States at a rate that worries health officials, with 102 cases so far this year in at least 14 states.
Most infections are linked to an outbreak that began in Disneyland in December, almost certainly started by someone who brought the disease in from another country. A “smattering” of other imported cases have also occurred, according to Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.
Measles was eliminated from the United States in 2000, meaning that the infection no longer originates here. But worldwide, there are still about 20 million cases a year; in 2013, about 145,700 people died of measles. Travelers can bring the virus into the United States and transmit it to people who have not been vaccinated.
Measles spreads through the air and is among the most contagious of all viruses; in past epidemics, it was not uncommon for one patient to infect 20 others. Some 90 percent of people exposed will get sick (unless they are immune because they have had measles already or have been vaccinated). The virus can hang suspended in the air for several hours, so it is possible to catch measles just by walking into a room where an infected person has recently spent time. Inhaling a tiny amount of viral particles is enough to cause illness.
The disease is cause for particular concern because it can have severe complications, including pneumonia and encephalitis, which can be fatal. Those who survive encephalitis can wind up with brain damage. Measles can also cause deafness. And even without complications, the virus makes children very sick, with high fevers, a rash and sore eyes. Painful ear infections are also common.
Here are some commonly asked questions about measles and the vaccine that prevents it.
Q. Has the United States been particularly hard-hit?
A. Many relatively wealthy countries are having worse outbreaks. Virtually all of continental Europe has been undergoing a large outbreak since 2008, with more than 30,000 cases in several years.
France, which gets more tourists than any other country, had 15,000 measles cases in 2013, with at least six deaths. About 95 percent of the cases were in people who had never been vaccinated or had not had both recommended doses.
In the United States, vulnerable communities have had outbreaks in the last few years, including Orthodox Jews in Brooklyn and the Amish in Ohio. But vaccination rates are also relatively low in some wealthy, liberal neighborhoods. The Seattle suburb of Vashon Island is believed to have the lowest vaccination rates of any health district in the country.
Who is most at risk of becoming seriously ill from measles?
Babies and young children who have not been vaccinated are most vulnerable, and most at risk for dangerous complications.
“Even in developed countries like the U.S., for every thousand children who get measles, one to three of them die despite the best treatment,” Dr. Schuchat said during a news teleconference last week. In the United States from 2001 to 2013, 28 percent of young children with measles needed to be treated in the hospital.
In pregnant women who have never been immunized or never had measles, the disease increases the chance of premature labor, miscarriage and having a baby with a low birthweight. People with leukemia and other diseases that weaken the immune system are also at risk of severe illness from measles.
The best protection for high-risk people, Dr. Schuchat said, is a high rate of vaccination in everyone else, so the disease cannot gain a foothold and start spreading.
Is the measles vaccine safe?
There is no evidence that the vaccine causes harm. Research in 1998 linking it to autism was proved fraudulent and was retracted. Children may briefly run a low fever — an increase of about 1 degree Fahrenheit — after the shot and may develop a mild rash.
When should children get the measles vaccine?
They need two shots, one when they are 12 to 15 months old, and another when they are 4 to 6 years old, according to the C.D.C. The injections contain a mix of vaccines to prevent measles, mumps and rubella.
Experts evaluated the advice given on medical talk shows, and the results were surprising.Many Americans get their health advice not from their doctor, but from daytime television. But how good are those recommendations?
Reporting in the BMJ, Canadian researchers analyzed two medical TV talk shows—The Dr. Oz Show and The Doctors—and found that only 46% of the recommendations on The Dr. Oz Show and 63% on The Doctors were supported by evidence. 15% of advice given on Oz and 14% of advice on The Doctors contradicted the available published evidence in journals.
“The bottom line message is for people to be really skeptical about the recommendations made on these medical television shows,” says study co-author Christina Korowynk, associate professor of family medicine at the University of Alberta. “They should look for more balanced information to be presented, and understand that they need all of that information in order to make an informed decision.”
They measured 80 major recommendations made on the two shows from January to May 2013 against evidence gleaned from published studies in medical databases. They looked at both consistency—how much the conclusion was supported by the studies—and believability, which included the quality, number and type of study.
On average, Korownyk’s group found that both shows mentioned how the advice might specifically help a person in only about 40% of the recommendations, and they mentioned the amount of benefit, another aspect of useful health advice, in less than 20% of recommendations. (Harms were mentioned in less than 10% of the recommendations, and costs in less than 15%). She says that without such information on how much benefit and harm a particular recommendation might have, it’s hard for people to make informed choices about whether the advice is right for them.
Korownyk and her colleagues aren’t the first to cast doubt on the quality of advice given on the shows. In June a Senate subcommittee heard testimony from Oz on false advertising of weight loss claims and Sen. Claire McCaskill queried the doctor about the statements he made on the show. “I do personally believe in the items that I talk about on the show,” he said at the hearing. “We have to simplify complicated information. We have to make the material seem interesting and focus on the ‘wow’ factor.”
Representatives for The Doctors said in a written statement to TIME: “The Doctors was never contacted about the study or the article. Our producers and doctors all do their due diligence to make sure information provided on the show is sound, relevant and timely—often debunking the myriad of medical myths that abound in the media and across the internet.”
Members of The Dr. Oz Show wrote: “The Dr. Oz Show has always endeavored to challenge the so-called conventional wisdom, reveal multiple points of view and question the status quo. The observation that some of the topics discussed on the show may differ from popular opinion or various academic analyses affirms that we are furthering a constructive dialogue about health and wellness.”
Korownyk acknowledges that the exact impact of television health advice isn’t clear, since the study didn’t investigate how many of the recommendations people adopted and whether they had an effect on their health. But the advice is clearly reaching people. “What we’d love to see is a process on these shows where the evidence is reviewed in a critical manner, and presented in a balanced, objective way so the audience can understand,” she says. “As physicians, we are moving toward that, and we’d love to see the broader television personalities doing the same sort of thing.”
(Based on “The Truth about Gluten”, Consumer Reports, January 2015)
Fad? New health prophesy? Gluten, a protein found in wheat, barley, and rye, has recently been targeted as the source of all dietary evil. Even though less than 7% of Americans are truly gluten-sensitive (with some variation of Celiac Disease), many others claim significant relief from various troublesome physical and mental symptoms by adopting gluten-free diet.
Gluten-free diet may be poorly balanced and devoid of important nutrients. When considering such diet, one must be aware of the following:
1. Gluten-free diet may be less nutritious: A true gluten-free diet may be low in certain nutrients (e.g. folic acid and iron) and may lead to increased consumption of sugar and fat.
2. Potential increased exposure to Arsenic: Rice-containing gluten-free diet may have increased amounts of inorganic Arsenic, a carcinogen.
3. Weight gain: Despite common misconceptions about the weight-reducing properties of gluten-free diet, the reverse may be true- weight gain due to increased sugar and fat content in such diet.
4. More expensive: Approximately double the cost of regular diet.
5. Serious health conditions may be missed: Certain anemias and gastrointestinal conditions may be missed. Many people who are not truly gluten-sensitive may feel better on gluten-free diet in the first few weeks or months, either due to placebo effect or due to reduction in certain carbohydrates (e.g. fructose) that may be the original source of troublesome symptoms.
6. You might still be eating gluten anyway: Approximately 5% of “gluten-free” foods actually still contain gluten.
Gluten-free diet may still provide relief from troublesome mental and physical symptoms in people who are not truly gluten-sensitive but care must be exercised to avoid compensatory increase in calories (especially from sugar and fat) in gluten-free diet. One must ascertain that nutritional deficiencies, especially iron and folic acid, are avoided. Other diets that are less expensive and laborious may achieve the same effect.
Glenn Beck used to be a very sick man. Last week he revealed that he has suffered through years of debilitating physical symptoms—intense pain in his extremities, an inability to speak, vision loss, and severe chronic insomnia. He feared for his career, and even his life, until he was diagnosed and treated for adrenal fatigue and other unspecified disorders. Beck says he’s now on the road to recovery.
I’ve never met Glenn Beck, nor listened to him for more than a few minutes at a time. In fact, I didn’t realize Beck was still working until a Slate colleague sent me an article about his health revelation. As a fellow human, I’m genuinely pleased that his health has improved, but I’m very concerned about the story he’s telling.
Let’s start with one of Beck’s diagnoses—adrenal fatigue. You have two thumb-sized adrenal glands sitting atop your kidneys. They produce many of the hormones you know by name, including testosterone and adrenaline. Like any other part of your body, the adrenal glands can malfunction. The accepted scientific term for most of these problems is “adrenal insufficiency.” The autoimmune system, for example, sometimes attacks the glands, suppressing production of cortisol. The result is Addison’s disease, which can cause muscle fatigue, weight loss, nausea, and a host of other symptoms. Acute cases can be fatal, especially in young people.
Adrenal insufficiency, however, must be kept separate from adrenal fatigue. Immunologist James Wilson coined the latter term in 1998 to describe a syndrome caused by prolonged stress overburdening the adrenal glands. The symptoms supposedly include extreme fatigue, a general sense of unwellness, and what Wilson calls “gray” feelings.
Wilson is prone to overstatement. He boasts of three doctoral degrees, but two of them are in the scientifically dubious fields of chiropractic and naturopathic medicine. He claims that adrenal fatigue affects millions of people around the world, but provides no credible data to support that statement.
Wilson also says his book on adrenal fatigue has been “received enthusiastically by physicians.” Not exactly. The Endocrine Society—the world’s largest association of people with formal, legitimate training in the treatment of adrenal disorders—says that adrenal fatigue is “not a real medical condition.” The group goes on to say that the diagnostic tests are “not based on scientific facts or supported by good scientific studies,” and that some of the supplements prescribed for the disorder, which include extracts of human glands, have not been adequately tested for safety. The statement concludes by urging patients “not to waste precious time accepting an unproven diagnosis.” Endocrinologists apparently do not beat around the bush.
Robert Vigersky, a past president of the Endocrine Society, says that the adrenal glands perform in precisely the opposite manner that Wilson suggests: “When you’re under stress, the adrenal glands increase output of cortisol and related hormones, and they don’t fatigue. They continue to produce those stress hormones.”
The clinic that diagnosed and treated Glenn Beck also deserves a mention. The Carrick Brain Centers were founded by “chiropractic neurologist” Ted Carrick, who, like James Wilson, has questionable credentials. His Ph.D., for example, comes from a for-profit university that now operates exclusively online. Carrick has made wild claims about restoring patients’ eyesight and hearing. He also claims to bring people back from comas. If extraordinary claims require extraordinary evidence, you’d think Carrick would have a series of massive, randomized, placebo-controlled, double-blind studies to prove his results. In fact, he has nothing but anecdotes. Yale neurologist and noted quackery hawk Steven Novella sums the situation up nicely: “Chiropractic neurology appears to me to be the very definition of pseudoscience—it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it.”
Glenn Beck says relatively little about how he was diagnosed with and treated for adrenal fatigue. The treatment included electrical stimulation, hormonal supplements, and being whirled around in some sort of gyroscope.
If this is all nonsense—as I believe it is—then why is Glenn Beck feeling so much better? Here’s one possibility: He made a bunch of life changes that are known to treat a wide range of disorders. He slept. He ate healthier foods. He exercised and went through physical therapy. Those are reliable first-line treatments for everything from high blood pressure to diabetes to some mild psychological disorders. If Beck benefitted from a miracle cure, these lifestyle changes were it.
There’s a particularly irksome layer to Beck’s story that shows how quacks sell themselves to patients. If his account is to be believed, it appears that some of Beck’s treatment providers spent as much time stroking his ego as treating his ailments…
Data sources: David Ropeik/Harvard University, National Weather Service, World Health Organization, Northeastern University Laboratory for the Modeling of Biological and Socio-Technical Systems, National Geographic, United States Census Adam Cole and Ryan Kellman/NPR hide caption
Health officials are saying it. Scientists are saying it. Heck, even many journalists are saying it: “The risk of Ebola infection remains vanishingly small in this country,” The New York Timeswrote Wednesday.
But what does that mean? Are you more likely to be struck by lightning or catch Ebola?
It all depends on what you do for a living and where you travel. For instance, three of us from NPR are spending 10 days in Monrovia, Liberia, to report on the outbreak. What’s our chance of catching the virus?
So far in the U.S., we’ve had too little data to calculate a real risk. But we can do some back-of-the-napkin math to give some perspective.
Up until now, two people have caught Ebola in the U.S. Both were nurses in Dallas, who cared for Thomas Eric Duncan, the Liberian man who was diagnosed with the virus.
*Mercury poisoning facts by John P. Cunha, DO, FACOEP
“Mercury is a naturally occurring element that is found in air, water and soil. A highly toxic form (methylmercury) builds up in fish, shellfish and animals that eat fish. Fish and shellfish are the main sources of methylmercury exposure to humans.
Mercury exposure at high levels can harm the brain, heart, kidneys, lungs, and immune system. High levels of methylmercury in the bloodstream of unborn babies and young children may harm the developing nervous system, making the child less able to think and learn.
Symptoms of methylmercury poisoning may include impairment of peripheral vision; disturbances in sensations (“pins and needles” feelings); lack of coordination; impairment of speech, hearing, walking; and muscle weakness.
Elemental (metallic) mercury primarily causes health effects when it is breathed as a vapor where it can be absorbed through the lungs. Symptoms include tremors, emotional changes, insomnia, weakness, muscle atrophy, twitching, headaches, disturbances in sensations, changes in nerve responses, and performance deficits on tests of cognitive function. Higher exposures may result in kidney effects, respiratory failure and death.”
Consumer Reports, in its October 2014 issue, presents information about mercury in the fish we eat. It also advances the argument that the recent guidelines of the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) regarding how much fish is healthy to eat, especially by women and children, may lead to the consumption of too much mercury. The latest federal proposal is to increase the amount of fish eaten by women who are pregnant or trying to get pregnant to 8-12 ounces per week. Nevertheless, certain fish contain higher amounts of mercury than others, and meeting these fish consumption guidelines may lead to excessive amount of mercury intake.
The following is a list of fish based on mercury content:
Highest mercury fish (to be avoided by pregnant women, breast-feeding women, and children: Swordfish, shark, King Mackerel, gulf tilefish, marlin, orange roughy
Moderate mercury fish (whose consumption must be limited): Grouper, Chilean seabass, bluefish, halibut, sablefish (Black Cod), Spanish mackerel, fresh tuna.
By MICHAELEEN DOUCLEFF (NPR) June 30, 2014 6:34 PM ET
The American College of Physicians said Monday that it strongly recommends against annual pelvic exams for healthy, low-risk women.
In fact, the intrusive exams may do more harm than good for women who aren’t pregnant or don’t have signs of problems, a group of doctors wrote in the Annals of Internal Medicine.
When we heard that news here at Shots, we were happily surprised. No more stirrups? No more stripping down below the waist or hearing those dreaded words: “Now, you’re going to feel a little pressure”?
Sounds great! I’m canceling my annual visit now.
Not so fast. Not all doctors agree about these new guidelines…
Don’t cancel your regular visit with your gynecologist. If you are healthy and without symptoms, you can see your doctor every 2-3 years rather than annually, though. Many women use their gynecologist as their only primary care physician. The conscientious and thorough gynecologist can be just as effective and knowledgeable as an internist or family physician. Better yet, many non-gynecologist physicians have no clue how to perform an adequate gynecological examination or a Pap smear or even a rectal examination!
As a physician who performs many annual physical examinations, let me let you in on some professional “secrets”:
1. The likelihood of finding a serious medical condition during a physical examination on a patient without symptoms (asymptomatic) is incredibly low.
2. The most important aspect of a periodic examination of an asymptomatic patient is in educating her about preventive care and inquiring about family history of serious illnesses rather than finding a serious medical condition.
3. The physical examination’s most important aspects are blood pressure, weight (and BMI), examination of the skin, thyroid, breasts, pelvic (and Pap smear where necessary), and rectal examination (when necessary). The rest (including head, neck, lung, heart, abdomen, and extremities) is simply less important in asymptomatic patients.
4. So, if you are an asymptomatic, healthy female, skip your internist or family medicine physician (unless you find one that can perform an adequate examination below the belly button…) and see your gynecologist (unless he/she do not adequately address preventive medicine issues and do not examine you above the belly button).
5. During an examination, I always examine the neck and abdomen, and listen to the heart and lungs in addition to the more crucial elements (thyroid, skin, breasts, pelvis) despite extremely low likelihood of finding anything of importance in a healthy, asymptomatic patient. When you professionally and tactfully apply the hand touch, patients often feel reassured that their physician is both thorough and caring.
6. There is a famous story about a physician who owned a horse. Being a true scientist, and tight in the pocket, he decided to gradually reduce the horse’s feed (wishing to save on expenses and relying on the lack of scientific evidence that a certain amount of feed is vital for his horse’s survival.) The program worked elegantly, but then the horse died… I personally would feed this horse a regular diet and skip the psuedo-scientific, misguided advice of the American College of Physicians…
Women have choices in contraception, from pills and injections to intrauterine devices and the NuvaRing. But when women discuss birth control with their doctors, they may not be getting all the information they want, a survey finds.
Doctors tend to think it’s most important to discuss how to use contraceptives and which methods are most effective at preventing pregnancy, according to the poll, which was published in the journal Contraception. Women, on the other hand, are often more concerned about safety, side effects and how the contraceptives work.
Researchers surveyed 417 women, aged 15 to 45, and 188 health care providers. The women were either using contraceptives or interested in using them. While 41 percent of them ranked questions about safety as one of their top three concerns, only 20 percent of the doctors thought discussing safety was a top priority. That may be because providers know that for a healthy woman, contraceptives are usually safer than pregnancy, the study says. But women may still worry about complications caused by hormonal birth control, like blood clots, though they are relatively rare.
Those considering permanent contraceptive option may be worried about safety as well. Recently, the safety of Essure, a device that’s permanently inserted into the fallopian tubes to block them, came under question when a number of women who used it complained about pain, hemorrhaging and headaches.
“The main takeaway is really that it’s very important for providers to speak about what’s most important to women,” says Kyla Donnelly, a reproductive health researcher at the Dartmouth’s Institute for Health Policy and Clinical Practice, who led the study.
Yet providers don’t always know what what’s most important to their patients, she tells Shots. “And doctors are increasingly having to manage very short consultation periods.”
These results aren’t the final word — the participants were mostly white, and they had to have Internet access in order to complete the survey. But it does show that doctors and patients aren’t always on the same page.
Donnelly says she’s working with other researchers to developing guides — called option grids — to help health care and patients discuss contraceptives. “That way providers can feel supported with the right information.”
Endocrine disruptors are chemicals that interrupt the processes of natural hormones and have been previously implicated in affecting human reproduction. Now, these chemicals – which can be found in household and personal care products – have been shown to affect sperm function, potentially impacting fertilization.The research team, from the Center of Advanced European Studies and Research in Germany and the University Department of Growth and Reproduction in Denmark, published the results in the journal EMBO reports.
The researchers from this latest study note that EDCs are present in everything from food and textiles to drugs and household products, including plastic bottles, toys and cosmetics.
Currently, the European Commission is reviewing its policy on EDCs, and their plans from last year sparked a debate between endocrinologists and toxicologists on how to regulate such chemicals.
Though proving adverse effects of EDCs on humans has been difficult with a lack of acceptable experimental systems, lead study author Timo Strünker, from the Center of Advanced European Studies and Research in Germany, says their study “provides scientific evidence to assist forming international rules and practices.”
With a new bioassay developed by the researchers, they were able to rapidly test hundreds to thousands of chemicals for potential interference with function of human sperm.
EDCs prompt changes in sperm swimming behavior
They explain that for their study, they tested about 100 chemicals and found significant results that suggest endocrine disruptors may lead to widespread fertility issues in the Western world in a way that has not been identified until now.
The team’s findings reveal that about one third of these chemicals showed adverse reactions. Researchers found that certain ECDs in household products, such as toothpaste and sunscreen, affected human sperm function, potentially impacting fertility.
Some of these chemicals include ultraviolet filters such as 4-methylbenzylidene camphor (4-MBC), which is used in some sunscreens, and Triclosan, an anti-bacterial agent used in toothpaste.
“For the first time,” says Prof. Niels E. Skakkebaek, leader of the Danish team, “we have shown a direct link between exposure to endocrine disrupting chemicals from industrial products and adverse effects on human sperm function.”
They looked specifically at how these chemicals affected the CatSper ion channel, which they explain is a calcium channel that controls sperm motility.
Applied at concentrations they measured in bodily fluids, the team says EDCs directly open the CatSper channel, increasing calcium levels in sperm and changing their swimming behavior. The investigators say this also triggers the release of digestive enzymes that help the sperm to break through the egg.
Additionally, EDCs make sperm less sensitive to progesterone and prostaglandins, which are two hormones released by cells around the egg.
The team says their findings illustrate how EDCs disturb the mechanisms underlying fertilization by prompting changes in swimming behavior, hampering sperm navigation and interfering with penetration into the egg’s protective coat.
The authors conclude their study by writing:
”Here, we provide a direct link between exposure to EDCs and potential adverse effects on fertilization in humans. About 800 omnipresent man-made chemicals are suspected to interfere with the endocrine system. To this day, the majority of these potential EDCs have not been evaluated for their action in humans.”
“More than other hormones, testosterone goes up and down throughout the course of the day, and it’s highest between 8 and 10 in the morning,” he says. “What this means is you can give someone a ‘false’ low testosterone level if you measure it in the afternoon.”
So the test should be done between 8 and 10 am, Tamler says. And it needs to be done twice, on different days, to confirm results.
If levels are low, Tamler says there are a number of reasons why that could be. “The most common reason for low testosterone in my practice, I find, is obesity,” he says. That’s because fat tissue, especially abdominal fat, can turn testosterone into the female hormone estradiol.
That transformation has two effects, Tamler says. First, there’s just less testosterone in the body. And second, the extra estradiol disrupts signals to the brain that stimulate testosterone production, telling the body not to produce more testosterone.
When obese men had weight loss surgery and lost about 40 pounds, their testosterone levels doubled in just one year, Tamler found in a recent study.
Diabetes and sleep apnea can also cause low testosterone and should be treated first, he says, before going on hormone therapy.
If it turns out that patients have none of these problems and their testosterone levels are truly low, then doses of the supplement need to be carefully tweaked in order to make sure it doesn’t cause production of too many red blood cells, which can lead to deadly blood clots.
“The amount of red blood cells in circulation can go up very high, and that can mean the blood does not flow as smoothly as it should and that can give you troubles,” Tamler says. Clots can cause heart attacks and strokes.
People on testosterone therapy need to be re-evaluated every six months, Tamler says, to check on red blood cell production, blood pressure and estradiol.
Men seek it out to combat low energy and decreased sex drive. Prescription testosterone has become so popular that so-called ‘low T’ clinics are becoming common sights in cities and suburbs.
The number of testosterone prescriptions written in the U.S. more than tripled in the last decade. But researchers suspect that much of the testosterone dispensed at low T clinics isn’t tracked, since it’s often bought with cash. This unfettered flow of testosterone—officially a controlled substance—has raised concerns among doctors who specialize in hormonal problems.
“In most doctor’s offices, you don’t see a big shingle over their door saying, ‘Get your testosterone here!’ ” saysDr. Edward Karpman, a board certified urologist and the medical director of the Men’s Health Center at El Camino Hospital in Los Gatos, Calif. Karpman says low T clinics aren’t in the business of treating the complex medical problems that often masquerade as low energy and decreased sex drive. Those can include sleep apnea, depression and, perhaps most importantly, heart disease.
“Any man who presents, especially in his 40s and 50s, with new onset erectile dysfunction is at an increased risk for cardiovascular disease and even heart attack or myocardial infarction,” says Karpman.
Hormone treatment itself isn’t without risk: a recent study of more than 55,000 men found a doubling of heart-attack risk among older men who used testosterone. Younger men who had a history of heart disease had a higher incidence of non-fatal heart attacks. In addition, men who are on prolonged high-level testosterone replacement therapy can experience testicular shrinkage.
Yet even as calls for closer scrutiny of the treatment intensify, the clinics continue to draw in men like Greg Lucas. At 25, Lucas was single and a rising star at a Dallas software company. But he didn’t quite feel right – his energy, his sleep, his libido were all lagging. He was having trouble managing his weight, too.
His symptoms sounded a lot like those described in an adfor low testosterone. So Lucas decided to do what the ad recommended: talk to his doctor.
“His first response was, ‘OK let’s do a blood test and see where you’re at,’ ” recalls Lucas. “Following that, my blood test returned a rating that was in the normal range for the lab and he said that was fine.”
Lucas protested: His levels, after all, were in the bottom 5 percent of normal – that seemed out of step for a 25-year-old man. Lucas was seriously overweight, and his doctor advised him to diet and get more exercise.
The problems persisted, though, and Lucas pressed his doctor for the next three years or so about testosterone treatment. Each time, got the brush off.
Lucas did manage to start exercising at a gym, but he wasn’t losing much weight. Then a coach mentioned that testosterone treatment could be the answer to his mothballed mojo and suggested he get a second opinion at a low T clinic. He went online and ended up calling a clinic in Dallas. He was impressed. Finally, it seemed, someone was listening.
“They did a blood test and found my testosterone level to be even lower that the last time I had it tested, and they said, ‘We would absolutely recommend that you start treatment right away,’ ” Lucas says.
Lucas says the testosterone therapy changed his life: he lost weight and got his energy back. He only wishes that his regular doctor would treat him for low T, so that his insurance would cover the bills.
Despite Lucas’s positive experience, the risks and health benefits of long-term testosterone therapy are not well understood. The Food and Drug Administration is reassessing the safety of testosterone products. A spokesperson reiterated the agency’s own guidelines: None of the products approved by the FDA should be prescribed unless low testosterone is associated with a medical condition.
Anawalt calls the low T clinics “sex hormone factories” which promote all the potential virtues and great myths about how testosterone may solve all problems. “They’re really out to prescribe as much testosterone as they possibly can, and it’s not clear that all these practices are completely safe,” he says.
But there’s also no evidence the clinics are not safe. State medical boards typically investigate only when patients file complaints, and there hasn’t been an outpouring of accusations against the clinics. But a review of physicians working for a number of low T clinics found that very few specialized in urology or endocrinology. Instead, one doctor at a Chicago clinic and another in Fort Lauderdale were anesthesiologists; in Houston, an allergist; in Phoenix, an osteopath; and in Washington, D.C., an obstetrician-gynecologist.
“There is some hope that state or federal governments will start to crack down and regulate unscrupulous prescription of testosterone to men, and perhaps they will review the practices of these clinics,” says Anawalt.
The clinics themselves say they’re legitimate medical practices. Dr. Bill Reilly is the chief medical officer at Low T Center, one of the largest chains of low T clinics, based in Southlake, Texas. His company has 45 offices and some 35,000 patients. Reilly says patients must have a diagnosed medical condition.
“Our number one complaint at Low T is, ‘Why won’t you treat me?’ We just don’t see a patient, ‘Hey, here you go. Here’s some testosterone,’ ” Reilly says. “They go through a complete history, physical, thorough evaluation. We go through their symptoms.”
Reilly says some 15,000 men have been turned away from his clinics with no treatment because they don’t meet the medical definition of low testosterone. And those with sleep apnea or high blood pressure or other serious illnesses are encouraged to see their family doctor. Before joining Low T Center, Reilly was a joint surgeon. He doesn’t believe medical training in urology or endocrinology is necessary to do the job well.
“You don’t need to be an endocrinologist. You don’t need to be a urologist,” says Reilly. “We’re all doctors. And we study more about testosterone than they do. We basically follow the national endocrinology guidelines.”
Reilly says the growing criticism from others in the medical community is perhaps just ignorance and fear of competition. After all, Low T Center expects to more than double its number of sites in the next year, reaching perhaps as many as 70,000 patients.
When TV huckster Kevin Trudeau stood in a packed federal courtroom to make one final sales pitch Monday, he hardly resembled the tanned, dapper figure seen hawking miracle diets and natural cancer cures on so many late-night infomercials.
After spending four months in jail for contempt of court, Trudeau’s trademark jet black coif was thin and gray. His usual tailored suit was replaced by rumpled orange jail clothes. Even his typical air of defiance had turned to contrition, a change he said washed over him during his sleepless first night in custody.
“If I ever write a book again, if I ever do another infomercial again, I promise no embellishment, no puffery and absolutely no lies,” Trudeau told U.S. District Judge Ronald Guzman in a remorseful tone. “I know going forward I will be a better person.”
But the judge wasn’t buying a word.
Moments after Trudeau’s plea for leniency, a visibly irritated Guzman sentenced the best-selling author to 10 years in prison, citing Trudeau’s decades-long history of fraud and calling him “deceitful to the core.”
“He has treated federal court orders as if they were mere suggestions…or at most impediments to be sidestepped, outmaneuvered or just ignored,” Guzman said in handing down an unusually lengthy prison term for a contempt conviction. “That type of conduct simply cannot stand…”
“He is a habitual liar and a fraudster,” Assistant U.S. Attorney April Perry said.
As a result of the size of the fraud and Trudeau’s two previous felony convictions, federal sentencing guidelines called for 20 to 25 years in prison, a range that Guzman said he thought was “appropriate.” However, he eventually agreed with prosecutors who said a 10-year term was sufficient since — unlike in many fraud cases — no one who bought Trudeau’s book was financially ruined.
Trudeau’s attorneys argued that prosecutors vastly inflated the amount of harm done by Trudeau’s misleading infomercials, saying many buyers were satisfied with the weight loss book.
In his lengthy statement to the court, Trudeau said he has been “completely wiped out” financially and that he and his wife Nataliya Babenko, 26, are “effectively homeless.” He said his time at the Metropolitan Correctional Center has changed his perspective and led him to realize he had made many errors. While he wouldn’t wish incarceration on anyone, the experience has wound up being “one of the best, most positive things in my life,” Trudeau said.
“In the past four months I have been stripped of all ego, defiance, arrogance and pride and for that I am thankful,” Trudeau said as he stooed at a lectern and read from typed notes.
But Judge Guzman was unimpressed, noting that in his three decades of fraud, Trudeau had taken on more than a dozen different aliases and even used his mother’s Social Security number to perpetrate a scam.
“That doesn’t happen by accident, and it doesn’t happen by good intentions,” the judge said. “It is a reflection of a person’s character.”
by Charles Ornstein March 19, 2014 (NPR, ProPublica)
An internal review by the University of Illinois has found that an advertisement in which a university surgical team endorsed a pricey surgical robot violated school policies.
Though the team acted “in good faith,” concluded, the episode pointed to the need for clearer rules and stronger enforcement.
The review by the university system’s vice president of research followed criticism of the ad for the da Vinci surgical robot that ran in The New York TimesMagazine in January. It featured a dozen members of the surgery team at the University of Illinois Hospital and Health Sciences System above the headline: “We believe in da Vinci surgery because our patients benefit.”
While surgical leaders at the Chicago hospital viewed their appearance in the ad as “free publicity” for their program, the review said, some outsiders saw it as promoting a commercial product. Paul Levy, the former chief executive of the Beth Israel Deaconess Medical Center in Boston, wrote a saying their actions violated hospital policies. ProPublica .
The review found that staff members were not paid for appearing in the ad and that “there were no fraudulent attempts to hide any associations between faculty and Intuitive Surgical.”
But the review also found that policies were broken. “Based on discussions with individuals involved in the advertisement, neither the Office for University Relations, which works with the campuses to ensure consistent application of the University’s image and messages, nor the Ethics Office, was consulted regarding the participation of UIC employees in the advertisement,” said the report, which is dated March 15 but was released publicly yesterday. “Additionally, approval was not solicited from the Chief Operating Officer of the Medical Center as required by internal policy.”
The review found that the policies governing conflicts of interest were “complicated and inconsistent.”
Two doctors in the ad disclosed to the university in January, after the ad ran, that they had received “$5,000 or more aggregate income from and/or have greater than $5,000 investment or equity” in Intuitive. A third doctor reported a relationship with Intuitive but said it was valued at “none or less than $5,000.” All three had previously said they had no relationship with the company in 2013-14.
Questions have been raised about the value of the da Vinci system.
A linked to surgery with the robots are going underreported to the U.S. Food and Drug Administration. And the American Congress of Obstetricians and Gynecologists said in a : “There is no good data proving that robotic hysterectomy is even as good as — let alone better — than existing, and far less costly, minimally invasive alternatives…”
Flipping through The New York Times magazine a few Sundays ago, former hospital executive Paul Levy was taken aback by a full-page ad for the da Vinci surgical robot.
It wasn’t that Levy hadn’t seen advertising before for the robot, which is used for minimally invasive surgeries. It was that the ad prominently featured a dozen members of the surgery team at the University of Illinois Hospital and Health Sciences System. “We believe in da Vinci surgery because our patients benefit,” read the ad’s headline.
“While I have become accustomed to the many da Vinci ads, I was struck by the idea that a major university health system had apparently made a business judgment that it was worthwhile to advertise outside of its territory, in a national ad in The New York Times,” Levy, former chief executive of Beth Israel Deaconess Medical Center in Boston, told me by email.
As Levy scanned the ad further, he noticed that at the bottom the ad bore a copyright for Intuitive Surgical Inc., the maker of the da Vinci system. It included this line: “Some surgeons who appear in this ad have received compensation from the company for providing educational services to other surgeons and patients.”
Ads for prescription drugs and medical devices are common, and some feature physician testimonials about why they believe the product works. Physicians also deliver promotional talks for drug and device makers, something we’ve covered extensively in our series.
But a whole hospital department? Levy wondered: Was this kosher?
“I was stunned that a public university would allow its name and reputation to be used in that way,” he wrote. “The next day, I did a little research on the university’s own website and confirmed that my initial reaction was correct: The ad violated the University’s code of conduct and administrative procedures, and likely state law.”
Da Vinci robotic systems aren’t cheap. The Wall Street Journal reported last year that they can , and questions have been raised about their value. The American Congress of Obstetricians and Gynecologists said in a : “There is no good data proving that robotic hysterectomy is even as good as — let alone better — than existing, and far less costly, minimally invasive alternatives.”
Levy, whose blog is called , began writing a series of posts about the ad. The first, called , ran on Jan. 22. “The University has allowed its reputation to be used in a nationally distributed advertisement produced and owned by a private party, in benefit to that party’s commercial objectives. This is not consistent with ‘exercising custodial responsibility for University property and resources,’ ” it said…
A large study has found substantial risks in prescribing testosterone to middle-age and older men for a variety of ailments. One part of the study found that testosterone doubled the risk of cardiovascular disease in more than 7,000 men who were 65 years old or older, essentially confirming findings in previous studies. The other part found that testosterone almost tripled the risk of heart attacks in a group of more than 48,000 middle-age men with previous histories of heart disease. The harm in both cases occurred within 90 days of receiving the prescription.
The new study — conducted by researchers at the University of California, Los Angeles; the National Institutes of Health; and Consolidated Research — analyzed prescription records from a large database of insurance health claims around the country. In a striking comparison, it found that drugs used to treat erectile dysfunction, such as Viagra and Cialis, which are often prescribed for similar purposes, did not increase heart risks.
The study, published last week in the online journal PLOS One, provides the most compelling evidence yet that many American men have embarked on a perilous course of overtreatment. Testosterone is clearly indicated to treat abnormally low levels of the hormone because of genetic or pathological causes, a condition known as hypogonadism. But a huge upsurge in prescriptions in recent years suggests that testosterone is now being prescribed to men who are simply reluctant to accept the fact that they are getting older. In many cases, doctors are prescribing testosterone without even ascertaining whether a patient’s testosterone levels are actually low or whether he has a medical condition that justifies it.
The reason seems clear. Drug companies have shamelessly pushed the notion, to doctors and to the public, that their testosterone-boosting product can overcome a supposed disease called “low T,” which is characterized by feelings of fatigue, loss of sexual drive, depressed moods, an increase in body fat and decrease in muscle strength, among other symptoms.
If you read my note below regarding a Google search producing false information about me, please be advised that I am no longer considered a “pregnancy termination clinic”, as a recent Google search implied. Whether it was my very strong protestation to Google in a recent phone conversation (with an actual human being) or my “disclaimer” below, Google actually removed this erroeous listing. Phew…
Still, let’s reflect about this incident for a moment. If you have a blog and express your opinion or simply relay objective, neutral information about a topic, Google may draw its own conclusions about your interests and occupation using its own twisted logic and create a profile of you that could be entirely false. I strongly suspect that such was the case regarding my medical practice. Scary! If you are a blogger, please check that information about you on the Web is correct. You may be discussing the moon and the stars one day and find yourself depicted as an astronaut by Google… Check it out!
Whether it is due to Google’s twisted logic (crossing the term “abortion” with “clinic” based on my postings) or due to malicious tampering, my practice has been labeled an “abortion clinic” if you cross “OKC” with the term “abortion”.
This isFALSEand every effort to correct this travesty is currently being madeby me and IT authorities.I do NOT perform abortions and have never done so.My personal opinion regarding abortion plays no role in my medical practice.
Please contact me if you have any questions regarding this issue but pass along this information to anybody who expressed concern about this false information.
By KIM JANSSEN AND MITCH DUDEK Staff Reporters (Chicago Sun Times) November 12, 2013 3:20PM
He lied and lied and lied.
But after years of living high on the hog as a best-selling author and smooth-talking pitchman, Kevin Trudeau’s fate was sealed Tuesday afternoon in about the time it takes to watch one of his fib-filled weight-loss infomercials.
A federal jury needed less than 45 minutes to find that Trudeau, 50, of Oak Brook, was guilty of criminal contempt of court when he “willfully misrepresented” the contents of his diet book, “The Weight-Loss Cure ‘They’ Don’t Want You to Know About” in three TV ads broadcast in 2006 and 2007.
Though Trudeau shamelessly claimed the book “is not a diet, is not portion control, is not calorie counting” and was a “simple” way to quickly lose up to 100 pounds or more, it in fact required a punishing 500-calorie daily limit; daily injections of a prescription hormone banned for use in diets; multiple colonic irrigation sessions, and strict adherence to dozens of bizarre and quackish rules, evidence showed.
The verdict likely signals a decisive turning point in the government’s decadelong battle to reign in the previously convicted credit card fraudster. In 2004, he agreed to a court-sanctioned deal with the Federal Trade Commission, promising not to make bogus claims about his books.
Trudeau — who portrays himself as a fearless anti-government and anti-food industry campaigner with access to a suppressed “cure” for obesity — has long insisted he’s being unfairly targeted for speaking out.
But his latest conviction comes on the back of an earlier finding that he was in civil contempt of the 2004 court order. U.S. Judge Ronald Guzman told him Tuesday that it’s just further proof that he “lacks respect for the court and the court’s orders.”
Ordering Trudeau taken into custody. Guzman warned he faces a “probable” prison term when he is sentenced, noting that Trudeau — who’s accused of hiding his true wealth in an attempt to dodge a $38 million court fine in a separate but related case — poses a flight risk.
The verdict prompted tears from some of the Trudeau supporters who packed the courtroom, one of whom later compared Trudeau to Nelson Mandela. But Trudeau showed little emotion as he gave up his possessions and was led into custody.
He winced, however, when prosecutor April Perry used her closing argument to sarcastically repeat his TV claim that the book requires “no potions, pills or powders.” Then she shook the collection of packaged supplements that the book actually called for like a set of maracas.
Trudeau’s attorney, Thomas Kirsch, pointed to disclaimers in the ads and to sections of the book in which Trudeau parroted his TV statements as evidence of his “good faith.”
But Perry said the only disclaimer that would have protected Trudeau would have read, “Everything Kevin Trudeau says is a big fat lie.”
Criminal contempt has no maximum sentence, meaning Trudeau faces anything up to life behind bars when he is sentenced, though a far shorter prison term is more likely.
New guidelines would double the number of Americans on cholesterol-lowering drugs.
Dr. Sanjay Gupta of CNN wondered on Twitter whether we are “waving the white flag” when it comes to helping Americans avoid heart disease. Dr. Eric Topol, a cardiologist and chief academic officer of Scripps Health, tweeted that the doubling of patients on statins, which can lower cholesterol by up to 50%, was “not good.”
But the American Heart Association and the American College of Cardiology remained convinced that the 2002 federal recommendations for when to start people on the drugs needed to be updated. About 33% of U. S. adults have high cholesterol, and less than half are receiving proper treatment, despite the fact that elevated cholesterol levels double the risk of heart disease, the number one killer of adults in the U.S.
Under the new guidelines, people without a history of heart disease can start taking statins if they have a 7.5% higher risk of developing heart problems or stroke in the next 10 years, based on their cholesterol levels, blood pressure, weight, gender, race and smoking status. (You can calculate your 10-year risk here. Warning: it’s a little complicated.) That’s a dramatic change from the 20% higher risk that previous guidelines advised.
The new advice also recommends statins for anyone with type 1 or type 2 diabetes, regardless of whether they have additional heart disease risk factors, between the ages of 40 and 75 years old. Diabetes carries a higher risk of heart disease, in part because of the changes in cholesterol levels.
The lower threshold for statin prescriptions is certainly welcome news for their manufacturers; the drugs have been among the most prescribed class in the U.S. in recent years, and in 2013, rosuvastatin (Crestor) topped the list, earning AstraZeneca $5.4 billion in sales, according to IMS Health.
But the dramatic shift also has some heart experts nervous about how the guidelines will translate in doctors’ offices around the country. For those with a history of heart disease, there is little debate about how beneficial statins can be in preventing second events; studies show that the drugs can significantly lower risk of death from heart events. But for healthy individuals who may have some risk factors for future heart trouble, doctors have always been reluctant to prescribe medications when so much of heart disease is preventable, with proper diet and exercise. “For people with no history of heart disease, but who are trying to prevent heart disease, there is already a tremendous amount of overuse of statins in my view in this country,” says Topol. “So my concern is that the new guidelines will lead to potentially even more promiscuous use of these statins than already exists.”
And as unscientific as the target numbers were, at least they provided patients with a goal, and motivation for changing their diet and exercise habits to lower their cholesterol and potentially reduce their dose or get off their statin medications entirely. “I have worries about how to motivate patients when they don’t have numbers as goals,” says Dr. Steven Nissen, department chair of cardiovascular medicine at the Cleveland Clinic. “The targets served a purpose for sure even though they weren’t scientific.”
But since the last federal guidelines for cholesterol treatment were issued in 2002, two things have happened. First, all but one of the currently approved statins came off patent, so the cost of the medications has plummeted; a three-month supply can cost as little as $10.
Second, more studies have emerged indicating the various ways that statins can help the heart. Not only do the drugs restrict cholesterol production in the liver, but they can also lower levels of inflammation, a process that researchers now believe is the final player in the several-act play that is a heart attack, by aggravating unstable plaques in heart vessels that then send clots to constrict blood flow.
And last summer, a team at Harvard Medical School published the most comprehensive analysis on the safety of statins to date. Based on 135 studies submitted by manufacturers of all seven statins to the Food and Drug Administration to earn approval for their medications, the scientists found that compared to placebo pills, statins raised the risk of diabetes by just 9%; other side effects, including muscle pain, cancer and changes in liver enzymes were not statistically significant.
So while most heart experts welcome the fact that cholesterol-level targets are no longer used to determine who should and shouldn’t be on statins, they need to be convinced that the new calculator will be a better tool for making that decision. “It will be a huge educational challenge,” says Nissen. “How do you now tell patients and doctors that you don’t need to know your [cholesterol] numbers any more, that it’s not about getting to a specific goal? Now it’s you either take a statin or you don’t. Everything else goes out the window.”
The new recommendations inch closer to the idea of putting everyone on a statin, a controversial scenario that a few bold scientists have proposed in recent years. As I reported earlier this year:
Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, recommends that everyone over 40 should discuss statins with their doctor, even if they haven’t had heart problems or are at increased risk for heart disease or diabetes. He says that inflammation is driving a number of aging-related conditions, both in the body and brain, and since studies have shown that statins are a powerful way to dampen the inflammatory response, more people might be living longer if they take advantage of statins. Rory Collins, an epidemiologist at Oxford University, caused an uproar last year when he addressed the European Society of Cardiology with a talk entitled, “The Case for Statins In a Wider Population,” and argued that more people should be availing themselves of the medications, just as they do aspirin.
Nissen notes that the guidelines are guidelines, and not binding, although many primary-care physicians may turn to then for help in determining how best to treat their patients.
For doctors who don’t quite know what to do about the new advice, Nissen suggests having discussions with their patients to make individual decisions about whether they need statins. Depending on how high that individual risk is, both doctor and patient can reach some consensus on whether they are comfortable with using statins.
And the recommendations don’t replace diet and exercise, still the best ways to avoid heart disease. It’s just that they aren’t as easy for patients as popping a pill.