Many of you may have seen the WFAA evening news story on 5-24-10. It was about the Ft. Worth Police Dept. advocating a wellness program including possible testosterone replacement for its officers. Our Clinic was inappropriately referred to as a reference. Her is a copy of an email sent to the reporter Sherry Slater:

Dear Mrs. Slater:
 
My name is Jeff Wasserman MD. I am Board certified by the American Board of Anesthesiology, the American Board of Pain Medicine, and the American Board of Anti-aging and Regenerative Medicine. I am one of the founders, and Medical Director of Dallas Healthy Aging Institute (DHAI).
 
I was rather shocked this evening to see the story "Fort Worth police chief promotes hormone therapy" on the evening WFAA news with Dallas Healthy Aging Institute referred to as a reference for the story. Not only were our physicians not contacted for comment, but a statement was attributed to us that we did not make nor support.
 
Your story incorrectly stated DHAI feels testosterone replacement is likely to cause "Men to become angry". I am not aware of any staff that made that comment to any of your representatives, nor can I find that written anywhere on our website? If I am mistaken here, please correct me.
 
In fact, we are VERY MUCH in support of bio-indentical testosterone hormone replacement therapy (HRT) for middle-aged and elderly men who have signs and symptoms of testosterone deficiency with documented low serum levels. We rarely see even minor side effects. The endocrinologist in your report from UTSW Medical Center gave his opinion that men receiving replacement often get a "high" from HRT and get "addicted". I couldn't disagree more, and after 6 years of routinely prescribing HRT, I can honestly say I have never seen that occur. I also have never witnessed, or gotten complaints of increased aggression from patients when the medication is prescribed correctly, and for appropriate deficiency states.
 
Many middle-aged and elderly men develop evidence of testosterone deficiency including frequent fatigue, muscle wasting, inability to lose weight, low self-esteem, poor memory, low bone density, and reduced libido. This "Andropause", when accompanied by documented low testosterone levels, frequently responds dramatically to testosterone HRT by various techniques as many of our patients can attest. There are also hundreds of studies supporting the use of testosterone replacement for documented deficiency.
 
Not only do I frequently prescribe testosterone replacement for patients in our wellness clinic (male and post-menopausal females), but as an anesthesiologist and Pain Medicine physician I routinely prescribe bio-identical testosterone for male patients with chronic pain frequenly on opioid medications which have been shown to lower testosterone levels and cause concommitant signs and symptoms.
 
I want to emphasize that testosterone is a controlled substance due to its history of being used for reasons other than for appropriate clinical indications. It should only be prescibed by providers trained in recognizing deficiency conditions, utilizing various treatment options, and monitoring response to therapy.
 
Please retract the misquoted statement "on air", and on the website.
 
If you would like to know more about our Clinic and appropriate indications for HRT, please do not hesitate to contact us by phone at (214) 559-4325 or email at Jwasseman@DHAclinic.com. I appreciate your attention to this matter.

Jeff Wasserman MD
Cell (214)886-2108

I haven't made a blog entry for a while...forgive me DHAI patients.

I have been asked by many patients about pantethine. In particular, may people ask "is this the same thing as pantothenic acid (Vitamin B5)?". If only it were, as Vit B5 is very inexpensive, but alas, pantethine is very different, and for that matter more effective and expensive. Very little pantothenic acid gets converted into pantethine, so to get all the beneficial effects one must take pantethine directly.

Positive benefits reported from pantethine include improvements in lipid metabolism, imrpoved brain health, and detoxificatiion to name a few.

Pantethine lowers LDL ("bad") lipoprotein cholesterol and triglycerides, while at the same time increasing HDL ("good") cholesterol 10-20%. It also increases proteins within the membrane of HDL lipoproteins called Apo-A1 which has added health benefits. Raising HDL levels can be difficult, but aerobic exercise, alcohol in moderation, triamterenes (type of Vitamin E), statin drugs/red yeast rice, and estrogen/progesterone can also have positive effects on HDL levels as well.

Pantethine increases Co-enzyme-A levels and which is used to produce ATP and cellular energy improving a wide variety of metabolic functions. It increases brain-derived neurotropic factor (BDNF) and nerve cell survival and function, and helps to metabolize alcholol and other body toxins.

Typical daily dose of pantethine is 800-1200 mg/day. It is often combined with other beneficial cardiovascular supplements such as niacin, triamterenes, resveratrol, policosanol, and plant sterols.

I use it especially in patients with very low HDL levels, especially women where studies have shown low HDL levels to be a more significant cardiovascular risk factor than in men.

A study published in the March issue of the Journal of Clinical Endocrinology & Metabolism, suggest that IGF-1 may prove a useful biomarker for predicting cancer risk. It showed that adults.

The study included 633 men, aged 50 and older, whose IGF-1 levels were measured between 1988 and 1991. During 18 years of follow-up, men whose IGF-1 levels were above 100 nanograms per milliliter at the start of the study were nearly twice as likely to die of cancer as those with lower levels of the hormone.

First off, I would add that growth hormone (HGH) therapy should only be used in patients with documented clinical and lab relative HGH deficiency. That being said, since we routinely measure IGF-1 (insulin growth factor-1) on all new patients, it is my empiric experience that only a small minority of men between the ages of 50-65 have IGF-1 levels < 100! Incidentally, these men often suffer from significant muscle wasting, fatigue, low sense of well being, and other symptoms associated with low IGF-1/GH levels. This raises the difficult question of the need to compare risks/benefits for any therapy where the risk of a severe adverse event is extremely low, versus obvious benefits for a suffering patient.

I question the validity of this retrospective study based upon my empiric experience and knowledge of statistics, and agree that MUCH further study needs to done on this topic before drawing and definitive conclusions that would change clinical practice.

I do agree however that any patient who starts HGH therapy after documented clinical/lab/challenge-test deficiency should be made aware of all risks (proven and theoretical)>

This week, there was mention of a law suit against suppliers of 10 common brands Fish Oil. The suit claims the products have higher than acceptable levels of PCBs, which are proven carcinogens. The PCB's first get inside the food of the source fish, then with repeated exposure build to higher levels. It has been known for some time that fish oil supplements can contain PCBs which are ubiquitous throughout the environment.

At DHAI, we ONLY use fish oil supplements that are molecularily distilled to reduce the risk of exposure to mercury, lead, cadmium, and PCBs. Many of our products are also pharmaceutical grade that include another level of testing to confirm the lack of unwanted contaminants.

Previous studies have shown green tea to have many beneficial properties, including reduction of cancer risk. It also has been shown to be beneficial to cardiovascular health and reduce the risk of diabetes among other things.

 A recent study from the American Journal of Epidemiology, September 15, 2009, showed that drinking 5 or more cups of green tea per day led to > 40% reduction in risk of blood and lymphatic tumors. This confirms the results of other previous studies that have looked at green tea's ability to reduce cancer risk for other tumors as well.

A new study found that vitamin D decreases the risk of dying in patients diagnosed with colorectal cancer. According to the American Cancer Society, there will be an estimated 106,100 new cases of colon cancer, 40,870 new cases of rectal cancer and 49,920 deaths from colorectal cancer in 2009. Currently, the risk of a person developing colorectal cancer in their lifetime is approximately 1 in 19. Previous research has shown that increased serum vitamin D levels decreased the risk of developing colorectal cancers.

In this new study, researchers investigated whether decreased serum vitamin D levels were associated with an increased risk of death in patients already diagnosed with colorectal cancer. One thousand seventeen subjects with colorectal cancer diagnosed between 1986 and 2004, were evaluated for serum 25-hydroxyvitamin D3 levels and then followed to assess mortality rates.

The results of the study showed that higher levels of 25-hydroxyvitamin D3 was associated with a significant decrease in the risk of death associated with colorectal cancer as well as a decrease in overall mortality risk. Furthermore, the study found that the subjects with the highest serum 25-hydroxyvitamin D3 had 50 percent less risk of mortality due to colorectal cancer compared to the subjects with the lowest 25-hydroxyvitamin D3 levels. In addition, compared to the subjects with the lowest 25-hydroxyvitamin D3 levels, those subjects with the highest 25-hydroxyvitamin D3 had a decreased risk of overall mortality of 38 percent.

The researchers concluded, “Higher predicted 25-hydroxyvitamin D3 levels after a diagnosis of colorectal cancer may be associated with improved survival. Further study of the vitamin D pathway in colorectal cancer is warranted.”

Reference:

Ng K, Wolpin BM, Meyerhardt JA, Wu K, Chan AT, Hollis BW, Giovannucci EL, Stampfer MJ, Willett WC, Fuchs CS. Prospective study of predictors of vitamin D status and survival in patients with colorectal cancer. Br J Cancer. 2009 Sep 15;101(6):916-23

The three-year survival rate was about three times higher for active 85-year-olds compared with those who were inactive. Getting less than four hours of exercise weekly was considered inactive; more than that was active.

The results "clearly support the continued encouragement of physical activity, even among the oldest old. Indeed, it seems that it is never too late to start," the researchers wrote in the 9/14/09 Archives of Internal Medicine, which published the study.

They noted that exercise reaped benefits even for previously sedentary 85-year-olds; their three-year survival rate was double that of inactive 85-year-olds.

 At DHAI, we recommend a patient specific combination of both aerobic and resistance training to improve cardiovascular health and endurance, muscle mass, and bone density. Besides the obvious benefits, these also reduce the risk of falls and associated injuries.

LONDON (AFP) – Healthy people taking a daily dose of aspirin to prevent heart attacks may be doing themselves more harm than good, according to a new study by British scientists. Researchers found that the risks of bleeding from taking aspirin were such that its routine use in healthy people "cannot be supported" -- although they did not dispute its use in patients with a history of vascular problems.

 This appeared on the internet today released after this latest study in a European cardiology journal. The risk of cardiovascular disease was not reduced in the study patients, but there was a significant risk of bleeding complications in those taking aspirin.

 My recommendations at this current time are that unless you have a personal history of cardiovascular disease other than mild hypertension, or have a very significant family history of cardiovascular disease at an early age, I would not take aspirin on a routine basis.

 Jeff Wasserman MD

Once again, yet another "sub-study" from the Women's Health Initiative (WHI) study that reported in 2002 about the risks of estrogen/progestin replacement in women. PROBLEM is, the hormones used in the study are not bio-identical, they are pills instead of transdermal creams, and they were given in relative high doses than what most practitioners use today to reduce menopausal symptoms and the risk of osteoporosis.

Premarin (conjugated estrogens) contains > 80 different estrogens obtained from pregnant horse urine. Several of these have been shown to be toxic and cause cancer. Medroxyprogesterone is synthetic and a women's body has no natural receptors for it. The WHI results indicated that medroxyprogesterone was even more dangerous than conjugated estrogens.

Other studies using bio-identical hormones, many of these still on-going, have repeatedly indicated they have an improved safety profile compared to synthetics.

 Oral estrogens go through the liver after ingestion, and this "first-pass" effect likely increases the amount of blood-clot proteins as well as other metabolites not found with the use of transdermal skin creams. Again, studies seem to indicate that transdermal use of hormone replacement therapy is safer, and the practitioner should always use smallest dose proven effective for the individual for the shortest period of time. Thus compounded transdermal cream dosing can made for each individual.

At DHAI, we use only bio-identical hormone replacement therapy when indicated. We use compounded formulations from experienced and reputable pharmacies, and we tailor-make each prescription for each patient.