Terra Sigillata

Sedona - NYT Jeff Topping 04.09.06.jpg

On October 8, 2009, paramedics responded to a 911 call at a mystical retreat being held at Angel Valley Spiritual Retreat Center in West Sedona, Arizona, a stunningly beautiful area known widely as a mecca for New Age enthusiasts. Eyewitness accounts compiled in this October 21 New York Times article describes what medics encountered upon arriving at a 415-square-foot “sweat lodge” on the center’s grounds:

Midway through a two-hour sweat lodge ceremony intended to be a rebirthing experience, participants say, some people began to fall desperately ill from the heat, even as their leader, James Arthur Ray, a nationally known New Age guru, urged them to press on.

“There were people throwing up everywhere,” said Dr. Beverley Bunn, 43, an orthodontist from Texas, who said she struggled to remain conscious in the sweat lodge, a makeshift structure covered with blankets and plastic and heated with fiery rocks.

Dr. Bunn said Mr. Ray told the more than 50 people jammed into the small structure — people who had just completed a 36-hour “vision quest” in which they fasted alone in the desert — that vomiting “was good for you, that you are purging what your body doesn’t want, what it doesn’t need.” But by the end of the ordeal on Oct. 8, emergency crews had taken 21 people to hospitals. Three have since died.

Participants paid $9,695 each to attend a “Spiritual Warrior” retreat led by Mr. Ray, an event that continues to be advertised on the website for James Ray International, Inc.

Yes, the 2010 event is still scheduled for September 18-23, 2010.

But I wouldn’t put up my ten grand just yet because an investigation of Mr. Ray is ongoing and the Yavapati County Sheriff’s Office has recently released the affidavit from a search warrant executed shortly after this tragedy.

This December 30 New York Times article displays the 33-page search affidavit and this January 3 Prescott News article has several photographs and an excellent distillation of the affidavit.

Many other news sources will provide you with details on the circumstances of the tragedy with eyewitness reports and you can read elsewhere of Mr. Ray’s appearances on The Oprah Winfrey Show.

But here we would like to discuss some of the pharmacology associated with the Sedona tragedy. Lynne LaMaster in the Prescott News notes that according to the search warrant documents, investigators were originally looking for:

“A saleable/useable quantity of unlawful drugs including but not limited to marijuana, methamphetamine and peyote, paraphernalia for packaging, manicuring, weighing, distributing, including but not limited to scales, baggies, grinders, bindles, envelopes, seals paraphernalia used to administer the drug, i.e., syringes, cotton swabs, alcohol swabs, spoons, razor blades, tubes.”


While investigators did not appear to find any overtly psychoactive substances, they did find a veritable cornucopia of prescription drugs, dietary supplements, and syringes, with prescriptions in the name of Mr. Ray. In fact, the amount of products found wouldn’t even fit in a typical cornucopia – a more accurate descriptor might be “suitcase full of supplements.”

But it wasn’t the supplements that caught my eye.

It was this letter from a Michigan doctor of osteopathy:

James Ray Crisler Rx letter from Prescott News.jpg

Dr. Crisler operates the website, allthingsmale.com, and offers in-clinic and online consultations. The frontpage of his site argues strongly that he is in the business of anti-aging therapies as shown lecturing to the American Academy of Anti-Aging Medicine and offering subscriptions to Life Extension Magazine. Further exploration of his website reveals that he specializes further in assessment of low testosterone levels, or hypogonadism.

Testosterone cypionate, hGH, hCG, Arimidex (anastrozole) and finasteride (sold previously as Propecia or Proscar, but now available generically). OK, that’s starting to make sense. Testosterone and human growth hormone (hGH) are anabolic agents. That is, they enhance the development of lean, skeletal muscle mass. The larger cocktail is a typical bodybuilding/anti-aging regimen that is also purported to enhance sex drive. But you might have some questions at first glance.

(For pharmacology students and professors, dissecting the endocrine pharmacology of this combination would make a great comprehensive qualifying examination question for graduate candidacy.)

  • Arimidex/anastrozole? Isn’t that used to treat estrogen-dependent breast cancer?
  • Finasteride? Isn’t that used to treat prostate cancer?

An endocrine pharmacology treatise

Testosterone cypionate is known as a “depot” form of testosterone that has a half-life of 5-8 days, sold as DEPO®-Testosterone in the US. Testosterone, the steroid hormone primarily responsible for secondary sex characteristics in men, is not active when taken orally because it is rapidly metabolized by the liver. Therefore, if one wishes to boost testosterone, it is commonly formulated into a gel or patch that slowly releases the hormone across the skin. But it is more effectively delivered by injection, usually into muscle. When combined with a fat-soluble compound like cypionic acid, the testosterone is slowly released from the injection site. According to a PowerPoint presentation available at Dr. Crisler’s website (here, 4.5MB), his regimen employs weekly injections of 100 mg testosterone cypionate.

When I was interviewed by Dan Harris for ABC World News Sunday two days ago, we discussed in footage that did not appear whether testosterone qualified as an “anabolic steroid.” The public normally thinks of ultrapotent, clandestine compounds as being the anabolic steroids used by athletes. But in purely pharmacological terms, testosterone is a steroid based on its chemical structure and it has anabolic, or tissue-building, activity. However, testosterone is an anabolic steroid that we make naturally, men and women.

Hence, testosterone is an endogenous anabolic steroid. When injected as testosterone cypionate, this would be called the exogenous supplementation of an endogenous steroid.

You can see why this description didn’t make it to the final news piece.

Arimidex (anastrozole) is classified as an “aromatase inhibitor.” You may not know that testosterone is the starting material for estradiol, the steroid hormone primarily responsible for secondary sex characteristics in women. Testosterone, which we all make from cholesterol as the starting material, is converted to estrogen by aromatase or CYP19, an enzyme that is highly abundant in the ovaries. When a woman is diagnosed with a form of breast cancer that required estrogen to grow, aromatase inhibitors are given to prevent the ovaries from making more estrogen from testosterone (Older drugs such as tamoxifen can also be given as they directly block the effects of estrogen on breast cancer cells themselves.)

We do not know if Mr. Ray was among the approximately 1% of breast cancers that occur in men. Former drummer of the rock band KISS, Peter Criss, is the most recently public of male breast cancer patients in the US.

However, it does not appear that Dr. Crisler is a board-certified oncologist, so there must be some other reason that he prescribed Arimidex to Mr. Ray. Men have some testosterone that gets converted to estrogen but usually it’s not enough to cause estrogenic side effects such as gynecomastia and testicular shrinkage. But when taking supplemental, supraphysiological doses of testosterone, the small amount of aromatase that men have will convert enough of it to estradiol such that they may experience some feminizing effects.

Finasteride prevents conversion of the testosterone to dihydrotestosterone or DHT, a form of the hormone that can cause benign prostatic hypertrophy, can promote prostate cancer, and is also partly responsible for hair loss. Hence, finasteride combats several side effects of testosterone supplementation. So, these testosterone injections can be combined with anastrozole and finasteride to maximize testosterone’s anabolic effect while minimizing “unsightly” side effects.

Human growth hormone (hGH) is a peptide normally produced in the pituitary gland that is also anabolic on its own and augments the muscle-building effects of testosterone.

Human chorionic gonadotropin or hCG is normally the hormone produced by the placenta during pregnancy and is the hormone detected in the urine by home and clinical pregnancy tests. Yes, men taking this hormone would give a positive pregnancy test.

Understanding why hCG might be given in this cocktail requires that we revisit the hypothalamic-pituitary-gonadal axis (HPGA). Gonadotropin-releasing hormone, or GnRH, is produced in the hypothalamus of the brain and signals that pituitary gland to synthesize and release several peptide hormones that each share a common subunit: LH, FSH, TSH, and hCG. LH, or luteinizing hormone, when released from the pituitary gland and causes the testes to create mature spermatozoa and release testosterone. However, when too much testosterone is produced, or too much is available from external injection, a negative feedback loop suppresses LH secretion. Suppression of LH over time will cause testicular atrophy. It is thought that providing hCG will provide more of the subunit shared with LH, restoring LH levels. I am not convinced that this actually occurs. Restoring LH also is purported to increase the conversion of cholesterol to pregnenolone, a precursor or building block of testosterone. Believe it or not, this is an oversimplification of the pathway but I hope that gives you an idea of the rationale behind hCG use.

There were also some other drugs found in Ray’s room at the lodge prescribed by other physicians that included that Diovan (valsartan), an antihypertensive of that competitively binds receptors for an endogenous vasocontrictor, angiotensin II, and an injectable relative of vitamin B12 called methylcobalamin. Although we don’t know for certain if Ray was taking the drugs prescribed by Dr. Crisler, investigators did at least find anastrozole and Genotropin brand of hGH, Propecia brand of finasteride, together with pregnenolone, the testosterone precursor. Also found were bags, suitcases, and pill boxes of energy supplements and amino acids. The complete litany of objects confiscated from his possession are detailed at the Prescott News website.

Behavioral effects?
As mentioned at the outset, one of the biggest reasons investigators were interested in any drugs that might have been in Ray’s possession was that there may have been psychoactive substances that could have impaired his judgment or that of followers/clients in the sweat lodge at the retreat. Ray was reported by several eyewitnesses as being aggressive and aloof, and even unhelpful when medics arrived at the sweat lodge. Dan Harris at ABC News asked me if I thought that Ray’s pharmacopeia might have contributed to his state of mind.

This is very difficult to do for a plethora of reasons, not the least of which because I am not a physician nor am I privy to what drugs he was actually taking or his basal personality characteristics. However, I am a pharmacologist and did train in endocrinology during my postdoctoral fellowship and can make some general comments.

A person taking any anabolic steroid regimen is prone to mood swings, anxiety, and aggressive behavior. A physician colleague also reminded me that some of the drugs on the search warrant could alone cause electrolyte disturbances that could be exacerbated by being in an enclosed area with hot stones where other people were vomiting and begging to get out after fasting for 36 hours. Specifically, testosterone can cause sodium retention and Diovan/valsartan can cause potassium retention. These ionic imbalances can certainly influence one’s state of mind and one can speculate that these imbalances would be made worse by fasting and dehydration.

Off-label drug prescribing
This case also raises some questions as to how these drugs were prescribed in the first place. Sources close to Ray told ABC News that the “practical mystic” was being treated for a hormonal imbalance.

It is peculiar why a man of Ray’s means living in Carlsbad, CA, would be prescribed drugs by an internet physician in Michigan rather than seeing a board-certified endocrinologist or urologist at one of the outstanding medical centers in southern California.

Nevertheless, Dr. Crisler appears to have done nothing illegal in prescribing this regimen to Mr. Ray. Physicians in the United States, whether they are MDs or DOs, are granted the latitude to prescribe any FDA-approved medicine for any indication they see fit. While it is illegal for drug companies themselves to promote “off-label” uses of drugs (i.e., indications for which the company has not received explicit FDA approval), a physician can legally prescribe a breast cancer drug to a man wishing to build lean muscle mass.

Recognizing the dead
Let us not forget, however, that this is a very sad case where three people lost their lives and nearly two dozen people were hospitalized. Press accounts of the sweat lodge incident and subsequent investigation suggest that blame and potential criminal penalties will fall where they may. The Camp Verde Journal noted in its 2009 roundup that:

Lawsuits have been filed by survivors, victims’ families and the Black Hills Sioux Nation, alleging Ray “committed fraud by impersonating an Indian,” thus violating the 1868 Treaty of Fort Laramie.

What we have offered here is a perspective on the pharmacology and toxicology of prescription hormone products and considerations of issues raised in publicly available documents and questions posed of us by the press. It is likely that several factors conspired to end up with this loss of life. As always, tragic events are what drive changes in laws and regulations.

Note: A correction and clarification were posted here on January 10.

Comments

  1. #1 John Curtis
    January 5, 2010

    What does the terrorist’s failed attempt to blow up a jetliner have in common with James Ray’s Sweat Lodge deaths?

    Unfortunately, while President Obama points to a “systemic” failure in airline security and vows to make changes in the entire system, no such action will result from James Ray’s behavior in Sedona that actually did result in the loss of life… unless we take action.

    It is easy to vilify Mr. Ray, however, the consequences of his actions are now in the hands of law enforcement and the judicial system. While he may go to prison, as the damning evidence piles up… what of the REST of the self-help “industrial complex!”

    Consider this, the field of self-help is an extremely unique sector in our economy. It’s an $11 billion dollar industry that is completely UN-REGULATED. There is… NO national organization, NO code of conduct, NO entrance exams, NO credentials, NO education requirements, NO ethical standards, NO means to sanction, NO spokesperson. How sustainable can a business be that characterizes the motto… Caveat Emptor (buyer beware!)?

    Therefore, absent a better idea… I respectfully submit to ANY and ALL interested parties that we (the consumers and producers of self-help) take action by establishing the Association of Self-Help Professionals or whatever name seems most appropriate.

    Time has come for the self-help field to further professionalize itself by taking a BOLD step in the aftermath of the tragedy in Sedona and the media circus that will surround the trial of James Ray. There are hundreds of examples of associations that have united individuals with a common interest to enhance their membership, protect the public and for the betterment of society.

    Absent such bold action, I predict that anyone associated with James Ray, The Secret and its Law of Attraction is spending countless hours and dollars in damage-control, trying to figure out how to “disassociate” from Mr. Ray without being painted as a charlatan with the same broad brush, and found guilty by association, in the “court of public opinion!”

    All that is lacking now is the motivation and leadership. If you consider yourself a self-help expert OR if you are a consumer of self-help products, I urge you to consider working together to turn the Sedona Sweat Lodge deaths into a legacy that salutes the work of the earliest self-help experts like Napoleon Hill, Norman Vincent Peale and Dale Carneige, honors the efforts of well-intentioned, self-help professionals of today and turns the deaths of those who died in the Sweat Lodge… Liz Neuman, Kirby Brown and James Shore into a legacy for the betterment of the self-help profession!

    Any help you can provide in this regard would be greatly appreciated!

    John Curtis, Ph.D.

    “The power of accurate observation is commonly called cynicism by those who have not got it” – George Bernard Shaw

  2. #2 Jack Darkes
    January 5, 2010

    It is simply not as clear as you propose that “A person taking any anabolic steroid regimen is prone to mood swings, anxiety, and aggressive behavior.” ANY regimen?Research suggests that personality and pre-existing trait dispositions (as well as state variables) relate to the behavior effects of AAS – even with doses larger than those in this story. (e.g., see Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men. O’Connor, Daryl B.; Archer, John; Hair, W. Morton; Wu, Frederick C. W. Physiology & Behavior. Vol 75(4), Apr 2002, 557-566.)

    I am not privy to his “personality” either, but as a clinical psychologist and researcher on substance use/abuse, I could probably make a few predictions about this person’s behavioral disposition given the description. I doubt that AAS were necessary for this manifestation of behavior.

    Is it always about blaming a drug?

  3. #3 DrugMonkey
    January 5, 2010

    Recognition that exogenous substances have behavioral, affective and so-called personality consequences is not “blaming” a drug. It is seeking an explanation for what occurred that takes into account the available knowledge.

  4. #4 Cosmic Connie
    January 5, 2010

    Thanks for posting this; it’s good to hear from someone with expertise in this area. The letter from Dr. Crisler was the first thing that caught my eye too, though my initial thought on seeing HCG on the list was that it was part of the mostly discredited Simeons weight-loss regimen popularized in more recent years by huckster Kevin Trudeau. Other “New-Wage” gurus and their followers have touted this weight-loss plan recently, so it wouldn’t surprise me if James Ray was a believer too. However, at least in the Trudeau incarnation of the plan, HCG is only used for a limited time, in conjunction with a 500-calorie-a-day diet. It doesn’t seem very wise, even for someone who fancies himself immortal, to be subjecting his body to something so radical during an extreme event such as the retreat in Sedona.

    On the other hand, if the HCG was indeed part of a cocktail along with the other items listed in Dr. C’s letter, then of course your speculation makes a lot more sense than my original guess.

  5. #5 Art
    January 5, 2010

    If someone told me that you could buy a chunk of unimproved desert, dig a hole and cover it with cheap tarps, force 50 people at a time to starve and remain unoccupied for days at a time, and these people would pay you most of $10k each for the privilege I would have called you crazy. Let’s see … 50 people at $10k each is … great Googly Moogly … it’s half a million dollars.

    Obviously “The Secret” is to find suckers with money and trade vapid inspirational slogans and physical hardship for great piles of money.

    Then again, I wonder how much he has left over once the lawsuits have done their work. He has enough money and connections that he won’t end up in jail. Assuming he doesn’t do anything really stupid, like smack a judge or try to shoot it out with the law, I suspect he will will play the victim card, the misunderstood but well meaning guy who allowed his metabolic condition to effect his judgment to an unintended and tragic end.

    If there is any risk of losing his fortune, and especially if incarceration might be the outcome, I think he will flee to Costa Rica or other warm and forgiving place that lacks an extradition treaty.

  6. #6 SaltyDroid
    January 5, 2010

    Thanks @Pharmboy :: that was awesome. I think you can eliminate from your analysis the possibly of exacerbated effects due to fasting and dehydration. Ray was surely well hydrated :: and well fed. The “spiritual journey” was for the marks … not for the shark. The shark also got all the oxygen that he needed by never moving away from the door … the marks on the other hand … not so much.

    Notice that one witness reported that James Shore was blue with dark lips. Did these people cook, or suffocate? Also there’s a mention in the warrant that carbon monoxide poisoning hasn’t been ruled out. Maybe some smarty pants over here at science blogs could help me understand that. Where would carbon monoxide come from in a situation like this?

    @DrCurtis :: I echo your cry that this incident be used to cast a harsh light on the “self help” “industry” as a whole. But I wonder if the underlying science is objective enough to keep an association from becoming a part of the problem over time. Bernie Madoff as the head of NASDAQ comes to mind. Associations have a dangerous tendency to become cartels.

    @Art :: You dramatically understate the horror. This wasn’t a one off event. James Ray was on the road 250 days a year doing shit like this {and charging prices like this}. People don’t just pay $10,000 {plus an additional $5,000 in hidden costs} to go to a lame event underneath cheap tarps. They were manipulated into that desert with shamefully aggressive, cult like, tactics. This event isn’t even the end of the up-sells. The big sell is the World Wealth Society … $60,000 … per year.

  7. #7 Jessie
    January 5, 2010

    Bill Cosby one had a routine about the effects of cocaine. he said it magnifies your personality. The punchline was “Yeah, but what if you are an asshole?” James is an arrogant, egotistical, meglomaniac. Magnified.

  8. #8 Tsu Dho Nimh
    January 5, 2010

    Some of the supplements whose labels were visible were of the “muscle -building” variety. Protein shakes,

    But yes, it’s a chemical portrait of an insecure male.

  9. #9 liz
    January 5, 2010

    Dr. Crisler’s license info:

    http://www.dleg.state.mi.us/free/piresults.asp

    JOHN KEITH CRISLER Osteopathic Medicine & Surgery Osteopathic – Educational Limited 5101014986
    Osteopathic Medicine & Surgery Osteopathic Physician 5101014986
    Pharmacy CS – 1 5315006069
    Pharmacy CS – 3 5315011408
    Pharmacy Drug Control – Location 5315012286

  10. #10 Ghnasi
    January 5, 2010

    COMMENT ON SWEATLODGE (inipi) DEATHS

    WHILE IN PERU I RECIEVED MESSAGE ASKING WHY PEOPLE HAVE DIED IN A SWEATLODGE IN SEDONA? I promised to post something about it when I returned.
    I have not recieved a degree as a water pourer. I have been endorsed by my elders. This is my opinion from experience and not that of anyone else, group or organization.

    The cause of death could possibly be any one or combination of the following.
    PREPARATION: Participants should be hydrating for at least four days before the lodge. Abstinence of sex including masturbation at least the day of the lodge and a day after (sometimes 4 days prior and post are recommended) With first timers it is often offered that they have a small drink of water after the second round.

    CHARGING a fixed fee for a sweat lodge is against the principle of tradition, this is not the way. ifts and donations are standard, a fair exchange is understood.

    All are welcome, the teachings are there and are revealed slowly, as quick as you can observe. The number one requirement is for you to show up, you will be welcomed.
    Not all will be revealed at first however if you keep showing up the teachings become apparent.

    EGO. It’s the personal duty of the Water pourer to lead in a non egoic way. Empathic connection with each and every participant. Self importance takes the back seat. An experienced water pourer (leader) knows when a participant is at their edge BEFORE the participant themselves realize.

    CONSTRUCTION of the lodge. It is important that the lodge itself can breath, that is , if plastic is used and it often is, the inner linings are blankets, canvas and non synthetic in makeup. The top or crown of the lodge needs to be porus, breathable, that means NO PLASTIC on the crown, blankets or duvets are excellent.
    Most importantly there are agreements that should be clearly stated before the first door is closed. (usually during or after the smudge before entering)

    WHAT ARE THE AGREEMENTS MADE BY PARTICIPATING IN A LODGE?
    Following are the four agreements that all participants should clearly understand before the first door closes in an Inipi (sweatlodge) ceremony.

    There is an agreement to a high degree of self honesty here.

    
1 If you are suffering within the lodge, return your focus to your intention or prayer.

    2 If suffering continues, focus your attention on your breath.

    3 If the above does not alleviate suffering, surrender and lay on mother earth (the ground) and breath the cooler air.

    4 If you are still suffering, say, “all my relations and/or open the door”.
 

    IT IS IMPORTANT FOR PARTICIPANTS TO KNOW THAT THEY ARE NOT BEING JUDGED, THAT THERE IS NO WEAKNESS IN DISCLOSING A CONDITION OR CALLING FOR THE DOOR IN THE SWEATLODGE.
    THESE ACTIONS ARE A SIGN OF PERSONAL POWER AND COURAGE. A SIGN OF BEING THE ONE IN CONTROL OF ONES OWN LIFE.

  11. #11 David N. Brown
    January 6, 2010

    Human chorionic gonadotropin or hCG is normally the hormone produced by the placenta during pregnancy and is the hormone detected in the urine by home and clinical pregnancy tests. Yes, men taking this hormone would give a positive pregnancy test.

    This reminds me of Cecil Jacobson, who gave women this stuff in his “fertility clinic”. I wouldn’t be surprised if this osteopath is running the same scam.
    As an AZ resident, this has been a big story in local papers. I’m not sure how much coverage it’s getting nationally. I hadn’t heard that this guy was on Oprah. I think the angle that deserves the heaviest treatment is comparing Jenny McCarthy to him!!

  12. #12 Calli Arcale
    January 7, 2010

    Notice that one witness reported that James Shore was blue with dark lips. Did these people cook, or suffocate? Also there’s a mention in the warrant that carbon monoxide poisoning hasn’t been ruled out. Maybe some smarty pants over here at science blogs could help me understand that. Where would carbon monoxide come from in a situation like this?

    The fire. You can get CO from any form of combustion where the fuel contains carbon. The lack of oxygen and the presence of steam can also facilitate formation of CO. So it’s not an unreasonable suspicion. (People do periodically show up at hospitals with CO poisoning from their fireplaces. It’s not just gas furnaces and car engines that you have to worry about.)

  13. #13 daedalus2u
    January 7, 2010

    Hemoglobin that has CO coordinated to it is still red. It is a slightly different shade than the red of oxyhemoblobin. Sometimes you can see the carboxymyoglobin in meat cooked in a gas oven.

    There are gas treatments of meat that use CO to help it maintain a red color. Nitrite treatment of meat gives it a red color too, from NO coordinated to the heme.

    What you get in blood from nitrite is methemoglobin (with Fe3+ instead of the Fe2+ of normal hemoglobin) It is dark in color and doesn’t carry O2.

    Dark lips are probably not from carbon monoxide but could be from methemoglobin. Those might be tricky to diagnose on autopsy because the samples need to be taken promptly and the right way.

    Acute muscle damage (from heat, dehydration, kidney failure, maybe even fasting) can release myoglobin into the blood stream which would complicate any color analysis.

    One of the problems of using extreme stress like this to induce altered mental states is that there is little margin for error. Euphoria is a symptom of near death metabolic stress. That is why people perform autoerotic asphyxiation. A near death metabolic state triggers a physiological state where the “safeties” of pain are turned off and you become euphoric, a euphoria that will allow you to run yourself to death. A useful feature if you need to escape by running from a bear where to be caught is actual death. Not so useful when someone tricks you into doing it for no good reason.

  14. #14 Tsu Dho Nimh
    January 7, 2010

    @12 … Calli, there was no fire inside the sweatlodge. Rocks were heated in a bonfire well outside the lodge and moved to the “fire pit” (really a hot rock pit) with a pitchfork. That search warrant was really early, and CO testing on the hospitalized participants revealed nothing unusual.

    It is possible that Ray dumped some incense or herbs on the rocks, which would have caught fire, because some accounts mention the rocks “flaring up”.

    They had all the ingredients for a physiological disaster:

    1 – Spent several days in long hours of strenuous activity in a very warm, dry climate and got low-level dehydration started. Sedona is deceptive. It’s lovely at that time of year, but bone dry.

    2 – Spent the previous 36 hours fasting and water-free in a very dry climate, getting them more dehydrated.

    3 – Broke their fast immediately before the sweatlodge, which didn’t give them enough time to get rehydrated.

    At this point we have 50+ dehydrated, exhausted people.

    4 – The $@#%!# idiot who built the sweatlodge (to whose specs?) covered the entire structure with waterproof tarps, ensuring minimal O2 exchange. (real sweatlodges are covered by wool blankets or a cotton canvas, not plastic sheeting)

    Limiting the O2 supply and increasing the CO2 induces a mild euphoria – it’s a cheap guru’s trick for making people think they are experiencing something special (spiritual auto-erotic asphyxiation).

    5 – The lodge was far larger than the usual, with 4x the usual number of people jammed into it. Real ceremonies might have a dozen people, but that’s an unusually large number.

    This made it impossible to monitor the condition of the participants … the usual arrangement is one row of people, sitting around the edge, with one person designated to making sure everyone is OK. Leaving if it gets too hot is not disparaged. Also, discreetly lifting the blankets to let in a small cool draft is allowed.

    6 – The *)&%^ idiot who was running the ceremony didn’t understand the role of water and the water pourer, and instead of scattering a small amount of water on the rocks (small increase in apparent heat) he reportedly dumped a bucket or so on them at a time, releasing huge clouds of steam.

    Now we have 50+ already-dehydrated people in an intensely hot, humid environment with limited O2 supply … and one greedy SOB telling them to push beyond their limitations and stay in the killing fields.

  15. #15 Jeton
    January 7, 2010

    to Drug Monkey:

    taking into account the available knowledge to understand a tragedy should not become a pretext for absolving an obviously reckless individual of his guilt.

    James Arthur Ray will have a very powerful incentive to cast some or all responsibility for his actions upon his doctors, and anyone else he can, so that he may possibly escape full culpability for this horror. However, his case will also become an unfortunate vehicle for others to advance their own unrelated agenda, which this pseudonymous writer appears to be doing here.

  16. #16 New light
    January 7, 2010

    First of all you guys need to get out the of stone age of
    HRT and seperate steroids use from physiological dosages of TRT. We have been using Dr J protocol with all of our patients with high success rate with resolving depression, emotional disgulation, weight issues, diabetes, insulin resistance and the list goes on and on. First of all the HCG diet is a bunch of crap as it has been proven clinical time and time again to be so. All it is detox diet which alkalizing the body and gives your body a temporary rest to “reset” and to clean the crap out from typical american diet. HELLO PEOPLE Arimidex is now the number on prescribe drug for males dealing with excess estrogen issue. Wake up and smell the coffee that Adex can be used to reset the hypothalamus due to excessive estrodial due to obesity, and other genetic issues with in the cytochrome p450 enzyme. All one has to do is go to pub med to see this from several numerous studies. First of all you NOT in the right mind you pay 10 grand to run out in the desert like some nomad hoping to find spiritual bliss while living off the land dehyrating your self. That is just completely insane non medical sound. Serves you right for getting sick. Any medical DR would probably report you to the looney bin for even partaking on such an idiotic adventure. Dude i think you been having a bad trip or something. You people need to get your facts straight because all of Dr Crisler methods have been used in 10,000’s of cases as well as my self with excellent success rate. The only time people are in danger is if they are idiots and do not listen to the Dr’s advice. Right there that is the main reason this person got in trouble and God knows what other recreation drugs he was doing on top of the “legally” prescribe and physiological dosages of hcg, adex and testosteone. Dr J reputation far exceeds many of the people that you have mentioned on here. Dr J is a member of a4m and has set many current standards in HRT today and is on the cutting edge of HRT. Come on people time to open up and see the light. For some reason you do not get the concept vs phyisiological dosages vs steroid dosages. Look at the new research that low testosterone is an epidemic across the united states due to the toxins we consume from our food water and air we breath. Instead of pointing fingers to the one of the well respected medical in the field of HRT why not point the finger to the Gov’t for putting the hormones and pesticides in our food causing it in the first place. When I read this article I almost pissed my self laughing at the lack of medical experience and common sense. This may have been true 40 years ago in the 1960, but we are in a new decade. Shag time and hippies are over

    peace out.

  17. #17 Abel Pharmboy
    January 7, 2010

    @16 New light – Please let me be clear: I have no personal issues with Dr. Crisler. The reference to him came from the letter confiscated by authorities from Mr. Ray’s lodge room. This post was stimulated by the fact that most medical professionals using any of the drugs on this list would almost never have a reason for doing so. It is clearly a bodybuilding regimen.

    The point I wished to make is that as odd as this list may seem outside of the bodybuilding and anti-aging communities, Dr. Crisler has every legal right to prescribe such drugs. However, drug companies are prohibited from advertising drugs for uses that are not expressly approved by the US Food and Drug Administration.

    The organization you note, a4m or the American Academy of Anti-Aging Medicine is quite popular with osteopathic physicians and one cannot argue with much of its diet and exercise recommendations. However, their approach to hormonal supplementations is not embraced by those in the field of the study of aging. (Biogerontology 2006; 7:279-85)

    I still find it odd that if Mr. Ray truly had a hormonal deficiency as his sources claimed to ABC News, why did he travel halfway across the country to seek out a bodybuilding/anti-aging doctor rather than a board-certified endocrinologist in southern California. Hence, I am simply noting that Mr. Ray’s claim of a hormonal deficiency is irregular in this context.

    There is no scientific evidence for the existence of a low testosterone epidemic in the United States.

    First of all you NOT in the right mind you pay 10 grand to run out in the desert like some nomad hoping to find spiritual bliss while living off the land dehyrating your self. That is just completely insane non medical sound. Serves you right for getting sick.

    While I still have great compassion for the people who died and those who may have been held in the sweat lodge against their will, a version of your thought has crossed my mind.

  18. #18 DLC
    January 8, 2010

    Gee, dehydrate yourself for a day and a half, and then overheat yourself in an atmosphere where clean air will be limited. The stress on your body will be enormous. I’m surprised that more people didn’t die.

  19. #19 smitty4
    January 8, 2010

    John Crisler, DO is FAR from being just an, “internet physician in Michigan!” Dr. Crisler ‘s cutting edge protocols are being used worldwide. Sure he has a webpage. So what? That does not diminish his skills at what he does. It just makes his practice more accessible to men who have medical issues and need help. I don’t know why you find it so strange that a man would travel to see a physician who is preeminent in his field. Would you find it strange if he had cancer and decided to travel to see a physician at the Mayo Clinic?

  20. #20 Sister of KS Brother
    January 8, 2010

    “Testosterone cypionate is known as a “depot” form of testosterone that has a half-life of 5-8 days, sold as DEPO®-Testosterone in the US. Testosterone, the steroid hormone primarily responsible for secondary sex characteristics in men, is not active when taken orally because it is rapidly metabolized by the liver. Therefore, if one wishes to boost testosterone, it is commonly formulated into a gel or patch that slowly releases the hormone across the skin. But it is more effectively delivered by injection, usually into muscle. When combined with a fat-soluble compound like cypionic acid, the testosterone is slowly released from the injection site. According to a PowerPoint presentation available at Dr. Crisler’s website (here, 4.5MB), his regimen employs weekly injections of 100 mg testosterone cypionate, about double the manufacturer’s recommendation for treating clinical hypogonadism.”

    Did you ever consider that Mr. Ray may have Klinefelters Syndrome?

  21. #21 PC
    January 9, 2010

    Hey idiot.

    Maybe the reason people come in from all over the world to see Dr Crisler is because he is RECOGNIZED AS THE BEST IN THE WORLD AS AN ANTI AGING DR.

    Have you ever considered the fact that a majority of physicians are simply behind in the times, and unable to help a majority of their patients in their quest for physical health as they age?

    Have you been to a traditional Dr lately?

    Seriously. Your complete ignorance on the subject is glaring and obvious to ANYONE with any knowledge in the subject.

    I would be happy to tear apart your arguments further, but I feel as though I have sufficiently owned you for now.

  22. #22 PC
    January 9, 2010

    LOL. The very fact that you do not know that arimidex is now the number one drug to treat excessive estrogen levels in aging males, pretty much seals the deal for me.

    Why even argue with someone who is so clearly behind.

    Shame on you Dr, shame on you, for not doing more research before you wrote this atrocious article, full of misinformation.

    You are a shining example of the incompetence that exists today with many Dr’s which is WHY PEOPLE do not go down the street to their local MD, and instead spend thousands to fly to Michigan.

  23. #23 Katzenjammer
    January 9, 2010

    This is a seriously misinformed piece – I don’t even know where to start. Not that I have the time. Even your response to New Light is replete with claims that are bizarre in the extreme.

    Do you normally proffer such a menagerie of wildly untrue assertions? If so, I’ll remember not to read your blog for the simple reason that you don’t know what you’re talking about, but pretend otherwise. It’s just the sort of willful arrogance and pretense to knowledge that characterizes many of the drones in the medical-pharmaceutical industrial complex.

  24. #24 Phil
    January 9, 2010

    Dr. John is the most anti-steroid Dr. in the country. He is not a Internet Doctor -people have to either and see him, or have their local doctors ask him to consult.

    I am sorry but your full of it for saying this I don’t like to get in to crap about stuff like this but tell it like it is.

    I am a men that is Hypopituitary and I am on every hormone med. that my pituitary does not make. I help men with info about Hypogonadism on the web and I know Dr. John Crisler If I were him I sue you for this junk about him.

  25. #25 Abel Pharmboy
    January 9, 2010

    Ah-ha, PC and Katzenjammer, I see that this post made Dr. Crisler’s forum at musclechatroom.com under, “Wow. I’m speachless [sic].”

    As I’ve said, I have no issue with Dr. Crisler. My intent was to describe the pharmacology of these drugs. If you choose to seek out Dr. Crisler to use these drugs, you have every right to do so.

    However, what we tend to do here in our open forum is to not begin our discussions with, “Hey idiot.” Perhaps the reason that neither of you know where to start is, perhaps, that you actually really don’t know where to start.

    My readers and I welcome any discourse based in facts. I am certain that Dr. Crisler is famous based upon the large number of referral hits I am receiving from bodybuilding discussion forums (90 hits from mesomorphosis and 42 hits from musclechatroom) but PUTTING THINGS IN ALL CAPS is the Internet equivalent of yelling and doesn’t make anything more true. For example, by what measure is he “recognized as the best in the world as an anti aging Dr?” Moreover, the only reference that says the #1 use worldwide for Arimidex is in TRT is Dr. Crisler’s own PowerPoint presentation. I welcome any references in that regard.

    In the absence of any substantiations, PC, the only thing you seem to have owned is your own ignorance.

  26. #26 PC
    January 9, 2010

    Couldn’t agree more with the above posts.

    The very fact that he does not grasp the fact that arimidex is now used to treat high estrogen levels in males (which, BTW, is one of the leading causes of prostate cancer), seals the deal.

    Dr, your clearly out of your league here. Shame on you.

    Here, let the experts at Harvard Medical School own you even more. – http://www.hno.harvard.edu/gazette/2004/02.05/10-testosterone.html

    Would you like further ownage? Here we go. I found this study in less than 15 seconds.

    # Gruntmanis U, Braunstein GD. Treatment of gynecomastia. Curr Opin Invest Drugs 2001; 2: 643–649.
    # Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol 2002; 167: 624–629. | Article | PubMed |
    Buzdar AU, Riobertson JFR, Eliermann W, Nabholtz J-M. An overview of the pharmacology and pharmacokinetics of the newer generation aromatase inhibitors anastrozole, letrozole, and exemestane. Pharmacol Pharmacokinet 2002; 95: 2006–2016. | Article |
    Taxel P et al. The effect of aromatase inhibition on sex steroids, gonadotropins, and markers of bone turnover in older men. J Clin Endocrinol Metab 2001; 86: 2869–2874

    LOL, love to hear your reply.

    Here is a better idea. How about when you are clearly uninformed about a topic, you gladly do some more research, and perhaps prevent your foot from going in your mouth even further

  27. #27 leigh
    January 9, 2010

    PC, you apparently also spent approximately 15 seconds reading all those articles, given that they are either irrelevant to the point you seem to be trying to make, or contrary to it.

    try reading comprehension sometime, i hear it’s really helpful in the fine art of not coming off like a sanctimonious prick.

  28. #28 a
    January 9, 2010

    Doesn’t Dr. Crisler own http://www.MuscleChatRoom.com?

  29. #29 silphion
    January 9, 2010

    Great reverse engineering exercise, thanks, and great aplomb in your replies.
    Good job PharmBoy

  30. #30 B
    January 9, 2010

    Pharmboy,

    HCG is used by those who require testosterone replacement therapy to help maintain whatever testicular function existed prior to testosterone replacement. This is important because the testicles produce much more than just testosterone. If HCG is not used the testicles will atrophy and stop functioning.

    http://calendar.hsl.washington.edu/dspace/bitstream/2012/52/1/JCEM_2005_Low_Dose_Human.pdf

    With just a little bit of research you would have found that HCG is routinely used along with testosterone cypionate for testosterone replacement therapy. Your misinformation does nothing but harm those who need to find a doctor who actually knows what they are doing in regard to testosterone replacement therapy.

  31. #31 Abel Pharmboy
    January 9, 2010

    B, thanks for the comment because we don’t disagree at all on the function of hCG in the regimen.

    The second and third sentence(s) of the paper you cite says that the Leydig cells of the testes rely on LH and FSH for production of testosterone. I wrote above that hCG provides the alpha-subunit that is common to LH, FSH, TSH, and hCG. Therefore, hCG maintains normal testicular function because testosterone alone would suppress LH secretion. The second paragraph of the introduction explains this point.

    So since we agree, I do not understand where you see harm.

  32. #32 B
    January 9, 2010

    I see harm because you keep stating that he was on a “bodybuilding” regimen with no real proof. When the fact is that all of these medications are very common for a TRT protocol, including the use of Arimidex and HCG.

    Many hypogonadal males convert to much testosterone into estradiol regardless of their testosterone levels. That being the case, they need to use an aromatase inhibitor to control the conversion of testosterone into estradiol. I would guess that he was probably using a very, very small dose of Arimidex to keep his estradiol within the normal range.

    I see harm because without knowing the doses of each medication that he was taking, your saying he was using the drugs for bodybuilding or muscle enhancement is pure speculation.

    I see harm because there are far too many doctors who are clueless in regard to TRT and tens of thousands of men all across this great country suffer because of it. Your speculation regarding the protocol prescribed by a reputable doctor does nothing but harm on many levels.

  33. #33 SKEEBZ
    January 9, 2010

    Pharmboy,
    Its amazing how far from the truth you are. Good fictional article though.

  34. #34 ts
    January 9, 2010

    I think that it is important to point out that ALL of Dr. Crisler’s patients are routinely tested to be sure that all hormone levels are optimized and fall within normal physiological levels. The acronym HRT stands for Hormone REPLACEMENT Therapy. His patients are simply replacing what is not being made by natural means. If a patient tests outside of the normal range, whether it be low or high, the dosages are adjusted accordingly. The fact that it is a bodybuilding regimen is false. If a male with healthy testosterone levels were to take the small dosages of testosterone that are prescribed, his own endogenous levels of test would shut down and he would be left with… normal levels! A bodybuilder would typically take 5-10 times the amounts that are prescribed in addition to several other PEDs.

    The frustration on the part of the posters (myself included) most likely comes from the fact that Dr. C has changed many of his patients lives with his protocol. Reading your article, and the all too familiar questioning of why anyone would prescribe arimidex for HRT, sounds like every other doc that is in the dark about HRT and subsequently unable to help their patients lead normal lives. I have actually shown his protocol to two of my doctors, who were so impressed after doing some research, that they are now using the same.

    To reiterate, Dr. C is not an internet doctor. As you are aware, treatment is very much individualized and he fears that readers would take his treatment advice as their own. He makes it a point to NOT give individual treatment advice over the internet.

  35. #35 JES
    January 9, 2010

    I saw a similar article in National Enquirerer while i was checking out a the grocery. Which by the way, i had a conveyor belt full of bodybuilding foods. (had five times the amount of meat checked out by a normal male)

  36. #36 PalMD
    January 10, 2010

    @ts:

    Any doctor who is willing to prescribe medication to a patient that they have never once physically examined in person is practicing unethical, bad medicine and should be de-licensed and perhaps fined/jailed, depending on available legal remedies.

    It is never OK to treat a patient that you have never seen. It would likely be different if a doctor had seen a patient, examined them, gone over lab tests and established a diagnosis (that other experts would agree with on the whole) to later refill or change a prescription. But to not examine a patient and simply treat a number (especially a dubious one) is unwise, unethical, dangerous, and foolhardy.

    The fact that some of his “patients” like their treatment is irrelevant. If I, for example, were to offer morphine to anyone who requested it I would be very popular—and potentially in big trouble.

    One should wonder why a doctor would charge for services not normally billed by physicians. For example, what if you want to know your lab results? My office would simply send you a copy if you requested them. Would his? For free? Is he really some sort of extraordinary doctor providing a legal and ethical and needed service that somehow the rest of us have failed to do?

  37. #37 ts
    January 10, 2010

    @PalMD Where did you get from my post that Dr. Crisler doesn’t require his patients to come to his office for a physical examination? This is required of all of his patients. And he does go over test results and provide those results by request.

    I agree that the fact that his patients like their treatment is irrelevant. As I stated above, we are all tested and our protocols adjusted accordingly to maintain levels within normal physiological ranges. If you were to offer morphine to anyone who requested it, yes you would be in trouble. Just as if Dr. C were to offer these drugs to anyone who requested them, he would also be in trouble. Did you even read my post or did you just pull certain parts out and start making assumptions?

    Have you done any research on Dr. Crisler’s practice? Or are you making these wild allegations based on the author’s irresponsible journalism?

  38. #38 LL
    January 10, 2010

    In the interest of disclosure I will say that I am a patient of Dr. Crisler. I do not speak for him so these are just my observations.

    It is unfortunate for Dr. Crisler that he is being associated with this “new age guru” that (allegedly) killed a bunch of people in a sweat-lodge. The implication is that he was doing something unethical yet legal by prescribing the medications in question. That being said, it is understandable given that many medical professionals are not familiar with their use in TRT.

    It should be noted that Dr. Crisler is a very vocal anti-steroids presence in his practice and online. He is well known in the bodybuilding community as one of the few doctors that is able to help those that have destroyed their hormones through steroid abuse. This will be clear if you review his online forum. Users are prohibited from any discussion related to steroids or obtaining medications without a prescription.

    I will also note that Dr. Crisler no longer prescribes HGH and has not done so for some time. Mr. Arthur’s letter shown above is quite old. Dr. Crisler moved from the Abbot Rd. facility multiple years ago.

    I would encourage the author of this article to spend a few days researching Dr. Crisler at his online forum (Musclechatroom.com). It will become clear that the only thing he is guilty of is working in a field that most medical professionals are not familiar with. That and probably choosing an unfortunate name for his forum.

  39. #39 LL
    January 10, 2010

    @PalMD

    Unfortunately you have made many assumptions in your reply.

    As TS mentioned, Dr. Crisler requires all of his patients to see him in person. His initial visit is done at his office and involves a comprehensive interview and physical examination. Mine lasted over 2-hrs.

    You asked if he provided lab reports. They are free if you pick them up in his office. There is a $5 charge to have them faxed to you.

    You also asked “Is he really some sort of extraordinary doctor providing a legal and ethical and needed service that somehow the rest of us have failed to do?”

    I can only answer for myself. I felt terrible for over 3-years. I saw multiple doctors that were unable to help me. Dr. Crisler was the only one that was able to diagnose my “simple” problem of low testosterone. I take testosterone and HCG weekly now and feel as if my life has been given back to me. I’m not a bodybuilder and don’t look like one.

    As I mentioned in my post above, if you were to spend some time reviewing Dr. Crisler’s online forum it would become clear that he is not involved in anything unethical.

  40. #40 A Fellow Academic
    January 10, 2010

    Your statement that Crisler’s protocol, “employs weekly injections of 100 mg testosterone cypionate, about double the manufacturer’s recommendation for treating clinical hypogonadism.” is not only inflammatory and suggestive of inappropriate dosing, but it is incorrect.

    Quoting from the insert provided with Testosterone Cypionate (200 mg/ml) manufactured by Watson Pharma, “For
    replacement in the hypogonadal male, 50-400 mg should be administered every two to four weeks.” This dosing could be as high as 200 mg/week.

    The current guidelines of the American Association of Clinical Endocrinologists (AACE) for the treatment of hypogonadal males calls splitting the above dose and administering it at intervals shorter than two weeks.

    You have done a disservice to hypogonadal males whose lives have been improved by various hormone replacement protocols
    intended to replace what our bodies make poorly by lumping us with bodybuilders illegally seeking supraphysiologic levels of anabolic steroids. Your attempt to sensationalize this issue is distasteful and unworthy.

  41. #41 PalMD
    January 10, 2010

    Sensationalize? Step back for a second. Some guy in AZ may have diverted medications prescribed for him—hardly the doctors fault, under most circumstances, unless the doc was prescribing amounts so in excess of normal that he should presume some sort of diversion.

    However, when you are treating someone from a distance, you acquire extra ethical expectations regarding the care of your patient. It is not “normal” to treat people from a distance outside an established telemedicine program. That doesn’t make it illegal per se, but makes it questionable.

    The treatment of male hypogonadism does not normally require seeking out a long-distance consultation, and if it did, I would expect someone to consult an endocrinologist, not a generalist. I am qualified to treat male hypogonadism, and when I run into trouble, I consult an expert, not “some guy on the internet” who is willing to allow a patient to purchase medications from him and to send them a long distance.

    Really, step back for a minute folks and you will see how far outside the realm of usual practice this is.

  42. #42 Abel Pharmboy
    January 10, 2010

    @A Fellow Academic – My source for the dosing guideline was from DEPO-Testosterone brand of testosterone cypionate made by Pfizer. For clarity, I have removed from the post the statement, “about double the manufacturer’s recommendation for treating clinical hypogonadism.”

    If you re-read the post and follow this explicit clarification post, you will see that I have made a clear distinction between anabolic steroids used for bodybuilding and use of the endogenous anabolic steroid testosterone for male hormone replacement therapy.

  43. #43 Geoff
    January 10, 2010

    I ran that HRT protocal by another Dr. friend of mine.His conclusion was that anyone taking that drug combination would more than likely grow a prehensile tail and shoot intermitent laser beams from their eyes.I took this with a grain of salt since his PhD. is in art history and he thinks HRT is a subway line in New York.I think I shall henceforth look to established experts in their fields for my information.

  44. #44 LL
    January 10, 2010

    @PalMD

    What you fail to realize is that Dr. Crisler is considered an expert in his field by many. The fact that you are not familiar with him and dismiss him as “some guy on the internet” does not change this.

    He has a typical brick and mortar practice with typical in-person office visits. Some patients are out of state and conduct most visits over the phone. They are still subject to the same frequent bloodwork from approved labs like Quest Diagnostics.

    I find it comical that you (and the author of the article) are willing to form opinions based on little to no information. You obviously are not familiar with Dr. Crisler’s work which is easily accessed on his forum.

    We don’t even know if the deceased person was a current patient of Dr. Crisler. His letter doesn’t appear to be dated and comes from a facility that Dr. Crisler moved from multiple years ago. We also don’t know what quantities were prescribed of each medication. Why is there an assumption that unethical “steroid” type quantities were being used?

    What makes his work outside the realm of usual practice is the fact that most “experts” as you call them are painfully behind the times when it comes to TRT practices.

    As I previously mentioned, spend a few days reviewing his online forum. I would be interested to hear your opinion based on something other than an old letter with no details.

  45. #45 PalMD
    January 10, 2010

    I’m sorry, LL, I wasn’t aware that he was an expert. Under which medical boards is he certified?

  46. #46 PalMD
    January 10, 2010

    Let me clarify: Crisler is a licensed DO in the state of Michigan. He says he is a family physician, but he is not listed as being board certified by the American Board of Family Medicine. There exists an American Osteopathic Board of Family Medicine which is less widely recognized and whose database is not searchable.

    He also does not appear to be board-certified in endocrinology, the subspecialty that deals with hypogonadism.

    By way of disclosure, I’m an internist, board-certified by the ABIM.

  47. #47 LL
    January 10, 2010

    @PalMD

    As I mentioned, I do not speak for Dr. Crisler. I am only offering my opinions / experience.

    His online forum has enough information to keep someone busy for days. Why not form your own opinion rather than relying on blog postings? Better yet, why not ask him yourself in his forum? My experience is that he is open to any question that is posted in a non-inflammatory manner.

  48. #48 PalMD
    January 10, 2010

    I don’t have any questions for Crisler. What I’m suggesting is that it is unwise for patients to seek care from a non-specialized dude in a far-away place for a complicated medical diagnostic and therapeutic problem rather than seeking someone local and well-qualified. I suspect part of the allure is that people like Crisler tell patients what they want to hear, rather than the bland uncertainties of real medicine.

  49. #49 Tsu Dho Nimh
    January 10, 2010

    @32 … if you look at the rest of the items found by the police, it’s loaded with the usual things consumed by 50-something guys who can’t stand the thought of getting older. Protein shakes, various energy ‘boosters”, etc.

  50. #50 Tsu Dho Nimh
    January 10, 2010

    @44 said, “We don’t even know if the deceased person was a current patient of Dr. Crisler. His letter doesn’t appear to be dated and comes from a facility that Dr. Crisler moved from multiple years ago.

    Read the article … that letter was carried by the not-dead James Arthur Ray, the guy whose stupidity about physiology killed three people in Sedona, AZ., to justify his having injectables and syringes. Maybe he forgot to ask for a new one.

  51. #51 LL
    January 10, 2010

    @Tsu Dho Nimh

    My bad on the letter – I thought it belonged to the dead guy. The fact that it belongs to the kooky not dead guy doesn’t change anything regarding my comments. The letter is old and we don’t know if he is a current patient of Dr. Crisler. Nor do we know the dosage of the medications in question. The fact that one of his patients appears to be a nutcase has no bearing on him or TRT in general.

    Most of the discussion here is typical blog fodder from uninformed people. Dr. Crisler is well known in the TRT field. Information on him is readily available and he is accessible by the general public via his forum. In his forum there are many documents, interviews and presentations that explain his protocol.

  52. #52 MonkeyPox
    January 10, 2010

    …such as his formal qualifications for be proclaimed an “expert”?

  53. #53 V
    January 10, 2010

    This Dr does not like steroid use and treats real condtions as well as patients.
    With how this artice was writen it really makes things sound bad however this Dr prescribes medications that are used for a lagitimate purpose and medical condition.
    Other Dr’s and endocrinologists have even turned to this good Dr for questions.
    A lot of family practioners as well as many other Physicians treat conditions such as these.
    Also the letter above looks old and does not even have a date to it, has it been verified as current and true.
    This Dr has treated patients that have suffered chronic bilateral orchitis as well as conditions of atrophy of the organs for various reasons among other real medical conditions.
    Not all Dr’s can agree with each other, however many see Dr Crisler as a knowledgable Dr to ask for help sometime as he understands how to help is patients and does not cater to any kind of sterod abuse as described in the article above attacking the Dr.

  54. #54 RN
    January 10, 2010

    The above letter could be a very old letter, it does not appear to even have a visible date left on it.
    Also how do you know who is to blame it may have nothing at all to do with the Dr.
    Things like this could happen to any Dr.
    Many nurse practioners, Physician assistants as well as other Family Practice Physicians as well as General Prctice Physicians treat conditions where they need to prescribe hormones such as Testosterone and other medications that are much needed by a patient to treat a lagit condition.
    Where was the information in thie article obtained and how?

  55. #55 NA
    January 10, 2010

    Why can you just not let this rest, why does evryone make such a big deal out of something little.
    Anyway this Dr does not even prescribe HGH at this time, that letter would have to be anchient.
    Also a branch of Family Practice Osteopath Physicians exists that is not searchable from the posts.
    Why argue when an autopsy and ful investigation will be done.
    Why be hitting the Dr and each other to argue over something that has not yet been proven.

  56. #56 Dr Weed
    January 10, 2010

    In CA Drs prescribe many various drugs that are not prescribed or even legal in all states.
    The article even says Dr Crisler did nothing wrong please correct me if so.

  57. #57 nyob
    January 11, 2010

    I would like to comment on PalMd’s post first. I was searching for years for a local doctor to treat me. I had fatigue, prostate issues, sore nipples. Should I have searched other than DO’s, Urologists, Endocrinologists in my area? How many years should I have let this go on? Should I have taken more depression meds I had severe side effects from beacause it wasn’t what I needed? I even went as far as compiling a quarter inch thick report on the effects of high estrogen in men to give to doctors. None would even try to lower my estrogen or even read it at all. I was on the phone calling medical centers and different doctor offices about treating high estrogen in men too. My calls were never returned.

    You can get Testim or Androgel. That’s about it. Forget about the rest of the hormones that get affected. The Endo I went to gave me Testim and said come back in 6 months. A coouple months more of laying on the couch hardly being able to work I went again. He said my total Testosterone level was fine now. He wasn’t worried abouth the high estrogen. When I asked what I should do about the fatigue and sore nipples he didn’t even answer.

    My prostate issues were so bad I had to pee every 15 minutes at times. It would take me a couple minutes to get very little out. I ended up having surgery for it. Recovery takes forever! Then guess what? The symptoms were returning like they do for everyone else that doesn’t die from old age first. My hormones were still out of whack. Thank god I found Dr.Crisler in time to balance things out for me. The issues have greatly diminished and I won’t have to go a second round of that nightmare. I don’t have to lie on the couch from fatigue every time I do anything at all. Life is pretty much back to normal.

    Now to put the good doctor and the death of an old patient together is unbelievable. I had to wait a day to write this so I wouldn’t say things I would regret. The letter should be taken off the post. This whole topic should be deleted! It isn’t even his office address on the letterhead that’s posted. Also if I can’t get something to keep treating my testosterone conversion to estrogen because the OP thinks it is just for breast cancer I will be back to square one with my problems.

    I may be back to write more I have to get to work. I am just real frustrated about this whole topic.l

  58. #58 MonkeyPox
    January 11, 2010

    The Crisler groupies are just sad. I feel great pity for them.

  59. #59 B
    January 11, 2010

    MonkeyPox, you should not feel pitty for anyone. His patients are getting some of the best medical treatment available!

    Do some research. You obviously know nothing about male HRT.

  60. #61 neurospasm
    January 11, 2010

    what i find interesting is that the original post was about james ray and how people followed him blindly, some to their deaths. some of crisler’s patients demonized ray’s followers as idiots in comments on the allthingsmale thread linked to here that now seems closed or scrubbed. while not as extreme as what happened with ray, crisler’s followers are showing here how similar things can happen in another setting. i agree with #58 monkeypox – i feel great pity for them.

  61. #62 tahoegeminii
    January 21, 2010

    we have some damage control comments in here from the “good Doctors” staff obviously-#53,55, 57 and 59-sorry about your jobs but really you knew you are working for a drug pusher or quack-whatever–the reason that this little problem just won’t “go away” is that PEOPLE DIED DO TO ANOTHERS BAD AND DRUG ALTERED BEHAVIOUR and JUDGEMENT-people who had paid way too much and trusted way too much in this chauvinistic, egotistic petty tyrant-hopped up on testosterone and steroids-OMG!-I hope it never goes away I hope JAR’s skin is tacked to the freakin barn wall along with his quack medical and core staff-they all KNOW WHAT THEY ARE DOING_IT IS EXTORTION-it is feeding off the misery and insecurity of others for you own personal profit with no regard to the safety and well being of your VICTIMS-no punishment is enough for the “new age” Jim Jones we have inherited in James Ray-like heads on posts-this guy needs to stand as a warning to the charlatans , quacks and snake oil vendors all trying to create their own religion to make billions(like L. Ron Hubbard) and they get to play god-the avenging angels with be glad to dissect your carcasses

  62. #63 tahoegeminii
    January 21, 2010

    To the people that say this is the only doctor to help them-Sigmund Freud was a great administer and promoter of Cocaine as a cure all to depression mood swings energy loss-everything and the kitchen he claimed Cocaine cured-this is the father of modern physcology-HE WAS TERRIBLY WRONG-HE prescribed and addicted many of his patience and if he would not have admitted his mistake and taken the stance this quack is taking would have been put in prison-Sigmond Freud the Cocaine addict-my point being-Heroin makes you feel great too! why don’t you have the good doctor just maintain you on heroin the rest of your life-you’ll feel great and think his is just the best-you feel good cause your are drugged up-in 10 years the side effects will give you cancer or kill you-In that ten years however the drug companies and the doctor can make a pile of cash on you and all the drugs they get you to buy and consume-it is called being a cash cow–funny thing about cash cows is that the cow is always the one defending the guy bleeding him dry-cows really are stupid

  63. #64 Gator
    January 30, 2010

    It’s highly unlikely that “Able Pharmboy” holds a degree in anything. He has no clue about medications or how they might be to treat the endocrine system. A capable pharmacologist knows not only the primary indication for a medication, but also understands the alternative uses in the treatment of disorders. Pharmboy, you quote reading you found in the PDR, showing you’re a fool.

    The medications on this list are not particularly useful “musclebuilding” steroids. They might be used for recovering the HPT axis that is damaged from steriod use. They are also useful for treating hypogonadism of other causes, such as diabetes, obesity, opiate use and alcoholism.

    Treating the consequences of steroid use is one of Dr. John Crisler’s key competencies. There are very few in this country who have these skills. Treating male hormone issues for other causes is also a core competency. There are only a few physicians in the country who can and will treat the male hormonal problems, particularly when it becomes more complex than prescribing Androgel. All of these medications are appropriate in this application. Of course a real pharmacologist would know this and wouldn’t slander a physician he doesn’t know and has never met.

    Able Pharmby, your accusations and implications are slander.

  64. #65 Abel Pharmboy
    January 31, 2010

    @Gator – Re-read the post. I understand completely about off-label uses of the drugs. I raised the rhetorical questions for readers who will most often associate, for example, Arimidex with breast cancer.

    There is no slander here. As I noted above, Dr. Crisler and any physician is within their right to prescribe any medication for any indication they wish. The legal restrictions are on the pharmaceutical companies themselves – they may not promote a drug for off-label uses.

    Contact me offline if my degrees are of legitimate concern to you. And kindly read my “About” page to understand why the proper spelling of my pen name is “Abel.”

  65. #66 GirlyMan
    January 31, 2010

    “There is no slander here.”

    @Abel – I agree there is no slander here.

    @My Hypogonadal Brethren – This guy seems eminently reasonable to me. And, apart from this particularly contentious post, I kinda like his blog. Since he is not (yet) on TRT, Dude just didn’t appreciate the muck he was wading into. I’ll reserve my contempt and scorn for less reasonable people, like those worried about “souls”, e.g.

  66. #67 Ken Weiss
    June 12, 2010

    I am not a doctor, but rather a student of the Law of Attraction. In Ray’s book Harmonic Wealth, he describes incidents where he lost his focus and faith in the LOA, and subsequently lost his wealth. By realigning with the law of attraction, he regained his wealth.

    How anyone could leave a building while others languish inside to die, is criminal.

    Joe Vitale, Bob Proctor and other leaders in the LOA movement would not subject people who paid 10 grand to a cockamamie sweat lodge scam.

    This incident taints a legitimate movement as a bunch of kooks.

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