White Coat Underground

Dr. Crisler, I fear for your medical soul

Yesterday I wrote a piece expressing some concerns about a physician’s practice featured in the news recently. Dr. John Crisler is a self-described anti-aging and men’s health physician. A couple of my concerns regarded his prescribing practices and his possible practice of distance medicine.

From closer perusal of his site it would appear that he may not require the use of his pharmacy, but he does charge his patients to send prescriptions to pharmacies other than his own. It’s not unreasonable to charge patients for the use of your time, but I feel very uncomfortable with what amounts to penalizing patients for preferring to choose their own pharmacy.

The next issue regards standards of care. In my last piece I wrote about being uncomfortable with the practice of clinical medicine long-distance when it is not significantly more beneficial than seeing a local doctor. Dr. Crisler has a consent form that explains some of his practices in more detail. It contains some curious content:

I hereby agree and authorize John Crisler, DO PLLC (abbreviated from now on as
“ATM”) to treat me for high serum estrogen levels and/or low endogenous testosterone
production, which is expected as a consequence of anabolic/androgenic steroid use.
Alternatively, I may be applying for Hormone Replacement Therapy. I understand that I
am contracting with ATM for treatment of these two specific conditions only, and that
any other medical problems I may experience now, or in the future, must be diagnosed
and treated by my own physician.


That’s just weird. Usually, we use a general consent to treatment, but here he seems to be acknowledging that he is: 1) doing something medically strange, and 2) exempting himself from diagnosing or treating anything else. I wonder how this is feasible. What if a patient develops liver problems or blood clots from the therapy? Is Crisler really not obligated to diagnose these conditions and treat or refer the patient as needed? I would find that hard to believe.

I understand that ATM may, at its discretion, accept a physical examination by my own PCP or medical specialist (or his/her agent) in lieu of a physical examination personally conducted by an ATM physician. If such is the case, I am agreeing that such a physical examination will be sufficient for the purpose of being treated by ATM, and that any
errors or omissions as a result of this agreement are in no way the fault of ATM.

I find this very difficult to understand. He is saying that he can treat a patient by relying on a third party physical exam and that he is not at fault for and mistakes.

So Crisler prescribes/sells medications based on on a physical exam done by someone else. That makes him sound more like a pharmacist than a doctor. But he claims to be acting as a doctor, and doctors have different ethics than pharmacists. Even with a signed release, it is not ethical to tell a patient, “I may not examine you, and I may rely on data provided by your doctor, and if it turns out something was wrong, it’s not my fault.” Patients have high expectations of us, and they expect us to use our skills to help them and to take responsibility for our work. If a resident of mine were to say, “I gave him that much potassium because the ER said his potassium was really low,” my resident would potentially be in a world of trouble (not to mention the patient’s own flat-line issue).

I agree it is my personal decision to use anabolic/androgenic steroids (for AAS Consults) and that ATM does not condone their usage. ATM has not given me any advice on how to use steroids, except to help protect my health or warn me of their possible side effects. I will not ask ATM for advice on how to use anabolic steroids, or for help in designing a steroid cycle.

This, in a word, is bullshit. If you are a pharmacist and are simply dispensing a medication, then this is fine. But if you are a doctor, prescribing a medication comes with certain responsibilities, and includes a tacit recommendation for its usage.

But my favorite part is this:

I understand that by signing this agreement I am giving up the right to sue ATM, its doctors, anyone connected in any way with ATM, or the pharmacy(s) which fulfill
ATM’s prescriptions FOR ANY REASON WHATSOEVER, FOREVER.

I have no idea if what Crisler does is legal or not, but in my opinion, it is extremely unethical.

Comments

  1. #1 catgirl
    January 11, 2010

    If such is the case, I am agreeing that such a physical examination will be sufficient for the purpose of being treated by ATM

    I find it especially odd that he is requiring the patient to determine whether he (Crisler) has enough information to do his treatment. How is a layperson supposed to know what the doctor needs?

  2. #2 qetzal
    January 11, 2010

    PalMD,

    I think the part about not asking for advice on using anabolic steroids or designing a steroid cycle refers to the kind of steroids men might take for bodybuilding.

    As I understand it, if you’re a male bodybuilder who’s taking anabolic steroids to increase muscle, and you’ve got low testosterone and/or high estrogen a consequence, Crisler will prescribe drugs to treat those side effects. He won’t offer any advice on using the bodybuilding steroids themselves, except maybe to warn you of their possible adverse consequences.

    However, I’m not entirely sure, since his release is not well worded, and since testosterone itself is a steroid.

    Even if I’m right, one could question the ethics of his approach. One one hand, he’d be profiting by treating the side effects of improper drug use. On the other hand, it’s arguably analogous to giving sterile needles & syringes to drug addicts. Of course, Crisler apparently makes a substantial profit from his practice, while needle exchanges are usually not-for-profit activities.

    Note that I agree with many of your other concerns.

  3. #3 PalMD
    January 11, 2010

    If my patient tells me they are taking anabolic steroids and having side effects, I will counsel them to stop, not add more potentially dangerous medications to the mix.

  4. #4 Nomen Nescio
    January 11, 2010

    I agree it is my personal decision to use anabolic/androgenic steroids (for AAS Consults) and that ATM does not condone their usage. ATM has not given me any advice on how to use steroids, except to help protect my health or warn me of their possible side effects. I will not ask ATM for advice on how to use anabolic steroids, or for help in designing a steroid cycle.

    rephrasing this from the doctor’s viewpoint, and being perhaps a tad bit cynical:

    “you wanted these drugs, so i’m giving them to you. but i don’t condone your taking them, and will tell you nothing about how to use them safely, unless i can see you doing something so obviously stupid that i’d be liable for your death or permanent injury maybe. if you ask me about these drugs, i will not answer. now here’s your drugs.”

    is that about the gist of it? because if so, i’d expect more service — and assistance! — out of my pharmacist, never mind my physician.

  5. #5 HGGirl
    January 11, 2010

    Even pharmacists are supposed to answer questions…there really is no excuse for this.

  6. #6 TGAP Dad
    January 11, 2010

    I must again note that “doctor” Crisler claims a D.O. for his medical education. Once again, my mind draws a correlation between an osteopathic medical education, and bullshit quackery. I have had personal experience with several D.O.s, none of which gave me medical advice or treatment worth the paper their pseudo-degrees were stamped on. It’s because of an osteopath, who treated me as a two-year-old, that I lack the full use of my right thumb.

  7. #7 Katharine
    January 11, 2010

    Indeed.

    Looking at the normal curriculum of osteopaths from a handful of osteopathic medical schools, it is crap compared to MDs.

    From the American Osteopathic Association website:

    “Osteopathic medical students also learn the art of osteopathic manipulative medicine, a system of hands-on techniques that help alleviate pain, restore motion and influence the body’s structure to help it function more efficiently.One key concept osteopathic medical students learn is that structure influences function. Thus, if there is a problem in one part of the body’s structure, then function in that area will also be affected.”

    If this does not scream quack, I don’t know what would ever scream quack.

  8. #8 Dan
    January 11, 2010

    Yes, he is a DO. No, Osteopathic medicine isn’t “quackery.” I think that the individuals who post inflammatory comments about Osteopathic medicine and medical education in particular simply don’t have a clue. Also, to the comment about being treated, as a two year old, by an Osteopathic Physician causing him to loss use of his thumb. Rubbish, you were two, you’ve been fed anger by your parents and haven’t a clue what medicine in general and osteopathy in particular means.

    Anyway, get off of DO’s they are practicing PHYSICIANS too!

    Paramed

  9. #9 Calli Arcale
    January 11, 2010

    DOs vary widely. I’ve met ones who were very responsible. (One even performed the c-section which delivered my second child. Not that I had much choice; you get the OB on call for that sort of situation, whoever it might be.) I’ve also encountered DOs who were so far into woo they wouldn’t know a clinical trial if it bit them on the behind. In all fairness, I’ve known MDs who were like that too. (Some of them get profiled on Respectful Insolence…)

    In my experience (warning, anecdote ahead!) DOs seem somewhat more commonly associated with quackery than MDs. But nowhere near as much as DCs, and I do not know whether my observation is reflective of reality, nor whether some areas have stronger quackery associations than others. May depend on the licensing requirements of specific states.

  10. #10 Scott
    January 11, 2010

    I am a student at a DO school right now, and I have noticed that there seem to be more DOs who condone quackery like acupuncture and “herbal remedies” and such than MDs. This does piss me off, as someone who actually takes science seriously. I think it should the American Osteopathic Association’s job to crack down on these people, because they surely aren’t doing anything for the reputation of DOs (or for the well-being of their patients). But then again, the AOA doesn’t seem to want to do anything that requires taking a stand.

    As far as quackery is concerned, I think 18th century DOs who believed that manipulation was the only acceptable treatment were quacks, since they mindlessly shrugged off things like drugs, vaccines, surgery, etc. However, Osteopathic Medicine has grown up as a profession and realized that hey, drugs and such do in fact work (however, there is this weird deification of A.T. Still–the founder of osteopathic medicine–that makes DOs look like cultists).

    As for me, I plan on going into primary care, and luckily my school, MSU College of Osteopathic Medicine, is ranked #7 according to the US News and World Report (for reference, Harvard is #15).

    Anecdote alert: I did a preceptorship at a three-doctor family practice under a DO who chooses not to do manipulation, while one of his MD partners was fond of homeopathy (only under “certain conditions,” she maintained). This isn’t meant to say that MDs are quacks, just that no medical degree program is automatically quack-free.

  11. #11 neurospasm
    January 11, 2010

    Thanks for digging into his consent form. This guy is a complete and utter weasel. What kind of doc has the chutzpah to not only draft these terms, but then put them online for everyone to see? Is this for real? It seems to me like one of those contrived cases on bioethics violations that we get in our annual training that are so ludicrous that they couldn’t be real.

  12. #12 Pascale
    January 11, 2010

    First, I don’t believe you need to fear for this d00d’s soul, cause he sold it long ago.
    Second, I know many, many competent DOs. One treated me for torticollis (crick in the neck) when I was about 5. IV benadryl whacks this condition quickly, but his gentle neck manipulations worked out the spasm faster (and with less trauma to me) than starting an IV. Anecdotal, but true.
    Yes, a number of DOs are attracted to woo, but so are a number of MDs. And 20 years ago, when nontraditional students couldn’t get into MD school, the DO route was their only option. One I remember had a PhD in biochemistry, but was considered “too old” for medical school. A lot of smart late-bloomers from the ’70s wouldn’t be practicing without osteopathy. And they have been some of the best docs with whom I have worked.
    Just don’t get me started on chiropracters…

  13. #13 PalMD
    January 11, 2010

    Most DOs who graduated in the last 20 years or so have done the same training as their MD counterparts. Many do standard MD residencies.

  14. #14 Chris
    January 12, 2010

    Indeed, one of the first pages I found countering the anti-vaccine information was from an instructor at a DO program many years ago:
    http://www.pathguy.com/antiimmu.htm

  15. #15 Voice of reason
    January 12, 2010

    Hi everyone,

    Short introduction, I’m a male with low testosterone levels.
    I’m not even from the US, I found all these discussions on your blogs few days ago after looking up “testosterone” in Google News.

    I’ve read most of the comments about John Crisler in last 2 days.

    I’ll try to bring up a few points and keep it relatively short.

    1. You are right to express some of your concerns about Dr Crsler practices.

    2. Even if his marketing practices might be dubious, that wouldn’t mean that his TRT practices are dubious as well.

    3. It seems to me that it is – unfortunately -true, that worldwide, a lot of the endocrynologists are not experienced in treating hypogonadism properly, simply because they lack the newest knowledge in that area or just don’t have enough experience in treating such patients.

    4. Despite Dr Crisler being not an endocrynologist, I can see how he can be indeed very knowledgeable, even more than 98% of endocrynologists, on TRT issues.

    5. It is a fact that hypogonadism exists. A man with low testosterone will often experience symptoms (now, don’t tell me to list all of these symptoms to you, I assume they should be obvious or easy to google…). It’s also known that increasing his testosterone to optimal levels will often eliminate these symptoms. Hell, the Endocrine Society has proper guidelines on TRT therapy in males below and around the 300 ng/dl range. Considering the above, it should be quite obvious to all of you, that

    a) when a doctor/endo tells a patient his levels around the 300 ng/dl are normal, he is wrong, even more when the patient is not old yet…
    b) satisfaction from a therapy can be easly felt by the patient, if his testosterone increaseses from say, 280 to 650. You just can’t deny that, can you? Hence, the testimonies would be useful actually.

    Again, I understand some of your concerns about Dr Crisler.
    However, it seems to me he’s doing mostly genuine things in his therapy.
    Also, come on, the consent form is poorly worded perhaps, but when he’s referring to ‘steroid use’ in t, he’s talking about illegal steroids, not the medical testesterone he prescribes.

    One more thing, did you read his guidelines on TRT?
    You are right that they are not to be seen in Pubmed, indeed.
    However, could you provide me with an published article describiing TRT guidelines? I’m not sure if such exist, although I’d hope to be wrong.
    Anyway, since you all have access to Pubmed (most likely), could you link me some article written by an endo, presenting guidelines for succesfull male TRT.. or a publication which would show how the guidelines by Dr Crisler are wrong? Keep in mind, TRT is not only about raising total testosterone from 300 to , say, 600, it’s also about monitoring all these other hormones, especially estrogene, in Dr Crisler TRT guide he also talks about preventing testicular antrophy or fertility issues.

    This is truly a genuine question, I’d be very curious to read an article of similar lenght on male TRT, to the guidelines of Dr Crisler (to be clear, I’m not talking about a study discussing all the risks or benefits or TRT, i’m talking about a published article, or a guideline in any other form, written by an endo, describing the best measures for proper, safe, and most effective TRT administration? Or would Dr Crisler be the only one bothering to write it, while most of the endos just prescribe Androgel, measure the testosterone again in some future, and then just stick to the therapy?

    anyway, I’m 30 years old from Europe, my T is around 300.
    I hope to increase it naturally by weight loss, diet, exercise, lack of stress, perhaps weight training in future, Zinc and magnesium supplementation at low-mid doses for a while etc,. I’d hate to go on TRT at this age, however, I cant deny that I’m suffering from some of the symptoms of such a low level at this age and I didn’t really like how most of you have been diminishing the role of low T levels in a man.

    regards

    PS i said I’d keep it relatively short….. oh well ;)

  16. #17 Nomen Nescio
    January 12, 2010

    one more anecdote for the grist mill: my primary care physician is a DO, with a sheepskin from Michigan State. he’s never so much as mentioned any form of quackery or woo to me, but has provided quality medical care each time i’ve seen him. for what it’s worth.

  17. #18 Calli Arcale
    January 12, 2010

    Voice of reason: thank you for offering your personal experience. It is brave to do so, given the public attitudes towards hormone replacement.

    That said, just because a doctor is good at treating hypogonadism doesn’t mean he never does any wrong or that one should not be skeptical out of concerns for the emotions of his patients. Most doctors who end up disciplined treated the majority of their patients perfectly well; they would never have been successful as a physician otherwise. I can think of a few cases in point: doctors who had scads of very satisfied patients who were treated responsibly, and a handful who were grossly mistreated. This is usually the case for doctors who get disciplined for unethical prescribing of narcotics, and the documents displayed above do suggest that this doctor may be attempting to cover his behind legally which suggests he is indeed doing something unethical and is aware of the fact. Most likely he treats most of his patients well. And I suspect he also enables unsafe anabolic steroid use in others.

    I don’t doubt that hypogonadism is real. I don’t doubt that some men suffer serious ill effects from declining testosterone levels. I think such men should be treated. But that is not what this thread is about; it’s about a doctor who may be using legitimate treatment of hypogonadism as a cover for unethical activity. We’ve seen it with chelation and HBOT and treatment of precocious puberty; I don’t see why TRT would be immune to this sort of exploitation.

  18. #19 Donna B.
    January 12, 2010

    A lawyer once told me that you can’t actually sign away your right to sue someone for negligence on their part. Of course, IANAL so I could have misinterpreted him (or he was wrong).

    What his waiver will accomplish is a reluctance to sue when/if something goes dreadfully wrong.

  19. #20 qetzal
    January 12, 2010

    Voice of Reason:

    Thanks for the well-considered comment. I agree with many of your points. However, I will take issue with this:

    b) satisfaction from a therapy can be easly felt by the patient, if his testosterone increaseses from say, 280 to 650. You just can’t deny that, can you? Hence, the testimonies would be useful actually.

    Testimonials are useful for showing that patients believe a given treatment made them better. That’s arguably useful for indicating that the treatment may be worth looking into in more detail. It’s absolutely NOT useful for deciding if the treatment really works.

    Over at Science-Based Medicine there’s a post about “The Water Cure,” which basically amounts to drinking lots of water and eating sea salt. There are testimonials that claim The Water Cure works for diabetes, Parkinson’s disease, Alzheimer’s disease, cystic fibrosis, epilepsy, lupus, multiple sclerosis, and on and on.

    Hopefully you’ll agree that it’s essentially impossible for water + salt to cure all those diseases. Yet there are testimonials from people who (apparently) believe exactly that.

    My point is to illustrate that testimonials tell us essentially nothing about treatment efficacy. People are adept at convincing themselves of all kinds of things, and are happy to provide testimonials to that effect, even when they’re clearly and objectively wrong.

    That’s not to say that Crisler’s patients are wrong to think his treatments helped. Crisler’s treatments may or may not work better than what most endo’s would prescribe. Unfortunately, his patients’ testimonials have almost no value in judging that.

  20. #21 bikemonkey
    January 12, 2010

    *cough*MarkMcGwire*cough*

  21. #22 asdf
    January 12, 2010

    qetzal, you said

    Testimonials are useful for showing that patients believe a given treatment made them better. That’s arguably useful for indicating that the treatment may be worth looking into in more detail. It’s absolutely NOT useful for deciding if the treatment really works.

    So how do you tell if a treatment “really” works? What criteria would you accept as proof that a treatment works? Would you only accept a double blind placebo study as proof that a particular treatment works? Even then, a particular treatment won’t work for everyone because everyone will respond somewhat differently to hormonal manipulation. What then? Another double blind placebo study with some different protocol to prove that it works also?

    I’m just trying to understand what would be accepted by the regulars of this blog as “proof of treatment”.

  22. #23 PalMD
    January 12, 2010

    That’s a very good question, and complex.

    The use of exogenous testosterone for the treatment of male hypogonadism is fairly well accepted based on available studies. That’s just the beginning. When starting an individual patient on a previously validated treatment, there are laboratory parameters and subjective parameters to follow. Different conditions are different.

    For example, if I have a diabetic patient with proteinuria, the data from RCTs and other studies show that ACE-inhibitors will reduce proteinuria and slow decline in kidney function. Therefore, when I screen diabetics for protein in the urine and find it, i almost always start them on an ACI-I. I monitor the patient’s progress by lab parameters since there are no subjective criteria for this one. I also monitor patients for the rare but not terribly rare side-effect of chronic cough and the very rare side effect of angioedema. I would not feel comfortable doing this through the mail.

    With testosterone treatment for male hypogonadism, there are pretty good lab parameters that can be followed, but as with many conditions, a real, face to face follow up is wise. For example, if you have a patient on testosterone, it is recommended that a digital rectal exam be done fairly frequently (usually 3,6, and 12 mo after starting therapy, along with PSA).

  23. #24 Karl Withakay
    January 12, 2010

    “I understand that by signing this agreement I am giving up the right to sue ATM, its doctors, anyone connected in any way with ATM, or the pharmacy(s) which fulfill ATM’s prescriptions FOR ANY REASON WHATSOEVER, FOREVER.”

    This seems to be so unenforceable as to jeopardize the enforceability of the entire consent form unless the was a separability clause.

    So you can’t sue the ATM janitor if they sideswipe your car while at the supermarket, and you can’t sue the non-ATM pharmacy if they accidentally give you heart medication instead of an antihistamine on a non-
    ATM prescription if they’ve ever filled an ATM prescription for you?

    Another question for a lawyer: A non ATM pharmacy filling an ATM prescription is a third party not involved in the execution of the consent form; how can the form bind the signer to not suing the pharmacy that has no contractual involvement?

    The consent form alone destroys any credibility Crisler or ATM can claim to have.

  24. #25 daedalus2u
    January 12, 2010

    This is a BS bogus release. It may provide some protection for Crisler in a court of law, and may intimidate the people he malpractices on, it is highly unethical and violates (or should violate) just about every ethical and best practices guideline. This is exactly the kind of thing a pusher of illegal drugs would do. How is this different? It isn’t.

    I think that by defining his scope of practice this way, he is not acting as a “medical doctor”, and is not prescribing within a “medical doctor’s” scope of expertise or with a “medical doctor’s” ethical and medical obligations to his/her patient. Just for trying to practice like this he should lose his license to practice medicine. There are minimum standards and this doesn’t meet them.

  25. #26 asdf
    January 12, 2010

    PalMD, so you are basically saying that the only one who can prove successful treatment is the doctor providing the treatment, and then they are only proving it to themselves.

    Then only real differences I see in Dr. Crisler’s documents and the one published by the Endocrine Society’s clinical guidelines is that Dr. Crisler also pays more attention to estradiol and other hormones that will be affected by treatment such as DHEA and pregnenolone.

    I can understand your concerns regarding the long distance treatments, but if he does require his patients to see him in person once per year and they are seeing their PCP regularly like they are supposed to anyhow, I’m not seeing the problem there.

  26. #27 justice is blind
    January 12, 2010

    Since PALMD is a practicing internist, he should know not to throw stones if one lives in a glass house. Virtually any reputable physician can be examined and defamed under a magnifying glass by any jerk with a blog, as has been done here in a most unjust and despicable manner. Who will be next to throw under the bus? For a few extra hits on the blog meter, perhaps you will be next.

  27. #28 MonkeyPox
    January 12, 2010

    “Defamed”? Really? Evidence?

  28. #29 qetzal
    January 12, 2010

    asdf:

    First, let me be clear that I’m not an MD. I’m a PhD biologist with a background in biotech drug development, including early stage clinical trials. Consequently, I think I have a better understanding of the standards of scientific & clinical evidence than most people (though not necessarily better than many commenters here). But I’m far from an expert in clinical evidence.

    As I understand it, Crisler supposedly has a treatment regimen that is better than the “standard” treatment one could expect to receive from a conventional endocrinologist. Some people have claimed that the testimonials on his website are evidence of the superiority of Crisler’s treatment, but I’ve already explained why that’s wrong.

    What would be good evidence? As PalMD says, it’s a complex question. One issue is how we know if a given treatment is working for a specific patient. In that case, I’d agree that the treating MD is really the only one in a position to “prove” efficacy, and he’s only proving it to himself and his patient. And even if he does prove (to his own satisfaction) that his treatment worked, he hasn’t proved that it worked better than if the patient had followed the standard treatment.

    I’m more interested in the question of whether Crisler’s treatment really works better in general. In other words, how would Crisler prove to other MD’s that his treatment works and that they should adopt it? That’s the sort of thing that might ideally be addressed in an RCT. Short of that, I think one would at least like to see a well-documented case series that describes in detail the patients being treated, what their previous treatments were, what aspects of their diseae were poorly managed at the start, exactly what the novel treatments involved, and exactly what the clinical results were that suggest improved results. Such a case series would need to be published in a reputable medical journal, where other experts in the field could see it, evaluate it for plausibility, attempt to reproduce it in their own practice, etc.

    That’s about the minimum I’d want to see to believe that Crisler’s treatment might actually be better than the standard treatment. Testimonials, radio interviews, and pieces in Healthy and Fit Magazine definitely don’t cut it.

  29. #30 Orac
    January 12, 2010
    I understand that by signing this agreement I am giving up the right to sue ATM, its doctors, anyone connected in any way with ATM, or the pharmacy(s) which fulfill ATM’s prescriptions FOR ANY REASON WHATSOEVER, FOREVER.

    I have no idea if what Crisler does is legal or not, but in my opinion, it is extremely unethical.

    Promises not to sue for malpractice are not legally enforceable, as far as I know, and requiring them is completely unethical.

  30. #31 Dr. John Crisler
    January 12, 2010

    While I have been the subject of Internet attacks over the years—from nitwit steroid users to Doper Doctors I have gone after—I have yet to see one as vicious as this. It’s amazing what people will post, hiding behind their computer monitors, under an assumed name. What troubles me is that it is from someone who is supposed to be a colleague. If you just would have called me, I would have been happy to clear up your misconceptions—before you libeled probably the most anti-steroid doctor in the country.
    First, the comments posted here insulting Osteopathic physicians are mind-numbingly ignorant, especially in this day and age. They say lots about the individuals posting them, and absolutely nothing about the Osteopathic profession.
    Osteopathic medical students learn all their allopathic counterparts must learn—plus about 25% more. Their board exams are twice as long. And while I refuse to disparage my MD brothers and sisters, Osteopathic physicians not only practice every specialty of medicine, we also regularly score much higher when compared to MD’s for patient satisfaction. Perhaps that is because we tend to practice in a more holistic and family-oriented manner. We are also more likely to seek cures, and less to simply write prescriptions. But there are certainly good physicians, and bad ones, on both sides.
    Everything we do at my office has been rigorously scrutinized by legal counsel and regulatory body. Therefore there is absolutely nothing unethical, immoral or illegal about anything we do. My profile is far too high to be doing anything I shouldn’t.
    For the record, I have never prescribed an anabolic steroid, not even once. Further, I am proud of the fact you could not produce example of a physician doing more to fight the spread of anabolic steroids over the years. There are literally tens of thousands of words published by me on the Internet, portions of every lecture I have given, and countless hours counseling patients regarding the hidden dangers of excessive hormonal manipulation. I also regularly assist Law Enforcement as they crack down on dopers and Doper Doctors. That is why this blog is so profoundly ridiculous.
    And very single patient I have has either been seen by me personally, or served on a consultation basis, as is done every day all over the country. Some of the verbiage from my website is meant merley to facilitate that process, whether you understand it, think it’s ”weird” or not. By the way, thinking something is “weird” is certainly not excuse for libel.
    Do you treat patients for the COPD and emphysema that smoking brings? Well then, by your logic, you support tobacco use! These steroid guys will one day finally quit. And on that day I want them to be in the best state of health possible. That way they will be less a drain on our precious medical resources. Of note, while I do not care if a single steroid user ever darkens my door again, I only have a small handful of patients using these days (again, with Controlled Substances not of my doing). In fact, it was precisely the clinical experience gained treating those guys which taught me how the Endocrine system works, as one must come to know the excesses of a thing to truly understand its middle ground.
    I have never called myself an “expert”. That is for others to decide. I am but a simple country doctor. So I am not an Endocrinologist, but I have personally trained literally hundreds of them, from all over the world. I consult for them on a regular basis. And I have a large number of physicians as patients. Hey, I must be doing something right! LOL
    Not to disparage Endocrinologists, but my colleagues who think they should be relied upon to expertly treat hypogonadism are in for an eye-opening experience. For it seems the Endocrinologists are the least likely to properly manage sex hormones. For instance, ask one how to properly manage estrogen in men. You response is likely “estrogen is not important in adult males”. The truth is estrogen is part and parcel of nearly everything that kills a man, outside of trauma. That I why simply optimizing the 40 or so estrogens in our bodies can turn a man’s life around. The evidence is out there, in droves. So why do they jealously maintain the position they do?
    That is why they don’t know how to use aromatase inhibitors, such as Arimidex (anastrozole), stating it is ”only for female breast cancer patients. So why are there between 100 and 1,000 times more men than women on it? Astra Zeneca is laughing all the way to the bank. They also will not use HCG to its best advantage, even though minimal thought is required to understand same. Or they will prescribe it at 10 times the effective dose, which is counterproductive in several important ways.
    For any of you wishing to see just a portion of the 20,000 scientific studies supporting what we do, I invite you to the American Academy of Anti-Aging website http://www.WorldHealth.net
    So what is an “expert”? Is it the head of some mucky-muck medical department? Those of us within the field notice those positions do not come from superior medical technique; but rather as reward for proficiency in paper-pushing and meeting-calling. Some of the finest clinicians I have seen are so because they exclusively value the health and happiness of their patients. It is their commitment to perfecting their art which brings their increased success rates. It’s what they do with their patients, not some shingle on the wall.
    Students of medical history know it was the top “experts” of their day who bled our first president to death, because blood was considered poisonous. And Dr. Joseph Lister was attacked by the top Surgeons of his time for daring suggest they wash their hands, and change their blood-soaked gowns between procedures. Remember when medical “experts” told everyone to stop eating margarine, because saturated fats clearly increase the risk of cardiovascular disease, and to eat margarine instead? They NEVER gave a thought to what trans fatty acids do to us. We now know they are literally toxic to our bodies.
    In my second year of practice I had the honor of delivering a lecture at The Royal College of Physicians, in London. The topic was my TRT protocols. In the museum portion of the building was a display case, for the purpose of poking fun at physician ignorance and arrogance. There was a lock of Dr. William Jenner’s hair, the physician credited with inventing the vaccination. Included were letters from some of the top “experts” of the day, demanding Dr. Jenner not only dismissed from the Academy, but drawn and quartered as well!
    Patients are much more interested in being healthy and happy than they are the shingles on a doctor’s wall. That is why a patient sitting in front of my desk may have already been to half a dozen other doctors, including Urologists and several Endocrinologists. They know I will solve their case, and so I do. It’s a matter of knowledge and experience, and I probably have as much experience in this area as any physician in the world. It’s all about being able to deliver effective medical treatment. Hey, if simple country doctor can figure this stuff out, why can’t everyone else?
    The host of this blog obviously has no idea how low the Standard of Care is with respect to, for instance, treatment of adult male hypogonadism. That is why, even with the increased risk of cardiovascular disease, cancer, diabetes, osteoporosis, depression, dementia, and sexual dysfunction low (even low-normal) testosterone levels bring, half of them put on TRT go off from it. The physician simply does not know how to manage it properly. So when he asks why anyone would travel to see me, when there are perfectly good doctors in their own area, it just show he knows nothing about the state of the art in treating this insidious and rampant (about half the men over the age of fifty) disease. Maybe this is why I have patients in 48 states and 20 foreign countries?
    There are perfectly good Heme/Onc and Cardiologists all over the country. So why do patients travel to the Mayo or Cleveland clinics, or M.D. Anderson? Ummm…is that “weird” too?
    This profound ignorance of how TRT works also leads many physicians to deny their patients the testosterone they need and deserve, because , for instance, “TRT will cause prostate cancer”. Find ONE shred of evidence to support that position! And where is it okay for doctors to tell patients things which are exactly the opposite of the truth—purposefully damaging the patient in the process? Rest assured, those opposed to TRT WILL be getting on board. The literature is so abundant it will become malpractice in the future to NOT screen testosterone levels. And its ability to turn around a patient’s life means the patients will demand it (or come to me). I suppose when physician income is damaged their ignorance will cease.
    As for myself, I sit on the Speaker’s Bureaus of both BigPharma companies that make T gel, the Medical Advisory Board of the Life Extension Foundation, Advisory Board of the Men’s Health Network, and serve on the faculty of my alma mater. My lectures are nearly always packed (you can watch one for free on my website), whether delivered in Las Vegas or the Michigan Osteopathic Association annual convention (where I have taught TRT three times). In fact, I was supported by both BigPharma companies AND an excellent compounding pharmacy—for the same lecture! I donated all proceeds to the MOA, and financed a statewide radio talk show from there, which I co-hosted, spreading the good word about Osteopathic medicine.
    As for our office protocols, patients may get their medications wherever they wish. That is pure Consumer Protection, as it should be. We provide the convenience of ordering their compounded medications for them, and have them delivered at exactly the same price as if they took the time and expense of ordering them themselves. And I do not know where the host of this blog practices, but it is extremely common these days for physicians to impose fees to encourage script writing that the time of the office visit.
    I cannot tell you how many gentlemen I have labored to save from the Internet Doper Doctors. Kindly do not lump me into that cesspool. In fact, it would be nice to receive some encouragement for this often thankless task.
    Finally, I shall place my trust in the Lord as to the state of my soul.

  31. #32 Dr. John Crisler
    January 12, 2010

    Well, ya got me on the legal issues with respect to our Consent Form.

    That stuff was included years ago, when we were fighting the Internet Doper Doctors toe-to-toe. you have no idea what it was like back then. I have not even looked at it in years. We will have Legal tune it up.

    Thank you for bringing it to my attention. It is an important issue.

  32. #33 PalMD
    January 12, 2010

    Dr J, thanks for coming by, and I’ll address the above. For clarification, I do not believe that at any time I accused you of prescribing/distributing anabolic steroids (other than testosterone).

    I also did not list prostate cancer as a complication of TRT since the data are weak.

  33. #34 PalMD
    January 12, 2010

    Ahh…I understand one of your points…the bit in the consent about anabolic steroids refers to patients using them on their own (presumably without your blessing). I’m curious, if you could tell me, does your program require people quitting or do you simply treat the side effects of steroid abuse?

  34. #35 Orac
    January 12, 2010

    I am but a simple country doctor. So I am not an Endocrinologist, but I have personally trained literally hundreds of them, from all over the world. I consult for them on a regular basis. And I have a large number of physicians as patients. Hey, I must be doing something right! LOL

    Lamest. Argument. Ever.y wander outside of their area of expertise, and i say this as a physician myself.

  35. #36 Orac
    January 12, 2010

    Let’s try that again:

    I am but a simple country doctor. So I am not an Endocrinologist, but I have personally trained literally hundreds of them, from all over the world. I consult for them on a regular basis. And I have a large number of physicians as patients. Hey, I must be doing something right! LOL

    Lamest. Argument. Ever. Doctors can be just as ignorant as anyone else when they wander outside of their area of expertise, and i say this as a physician myself.

  36. #37 Kristof
    January 12, 2010

    On the one hand, Dr. Crisler provides important help to people suffering from hypogonadism. Yet, his practice seems driven by high fees. I think it is fair for a fellow doctor to question his phone consultations, which can feel rushed or as if the Dr. is glancing at a patient’s labs for the first time and quickly prescribing his protocol. What was pointed out about the contract is also a valid criticism, especially the issue of not being responsible to deal with other complications beyond the estrogen/testosterone issues. It is good to see the Dr. accepted criticism in part on these points and will “tune up” the contract.
    He is innovative for opening a practice with a TRT specialty but his fees appear to take advantage of a population that sees his practice as the only alternative. A 400-500 fee to enter the door, then $60-$100 every time they talk to the doctor on the phone even for a few minutes.

    The Dr. has created a public profile and with that comes public critique. Some of it will be overdrawn and some of it will be fair. He deserves respect for tackling an important, misunderstood therapy, and he deserves critique for his marketing (contract, etc.) and high fees.

  37. #38 Dr. John Crisler
    January 12, 2010

    palMD:

    Oh, they get an earful, each and every time. But as you know, one must be careful to not damage Dr/Pt relationship, or you will lose them, as with all drug users.

    But showing LFT’s through the roof does seem to get through to them sometimes.

    So does the direct advice of someone who used to use the drug(s) in question. I have always been very open about my own previous AAS use, and so they seem to relate to me. I tell them I now worry every day about the damage I did to myself. AND FOR WHAT?!

    Many of them, as you would expect, have very low self esteem. They are then much more susceptable to ‘roids.

    But as I said, AAS users are a very tiny part of my practice these days. Thank goodness. Of that patient population, most of my work is in trying to recover their health through an HPTA-Restart. Otherwise they are condemned to a life of hypogonadism–and therefore greatly increased risk of return to steroid use.

  38. #39 David
    January 12, 2010

    Kristof,

    May I ask how much you think it costs to see a “board certified” endo?

  39. #40 Dr. John Crisler
    January 12, 2010

    kristof–

    Even a rudimentary study of my field would show you my fees are a fraction of those who practice at my level.

    And the detail of the medicine in each visit may include 5 or more issues. I understand most provide one major and one minor issue per office visit.

    You have no idea what it takes just for me to order, and recieve, the appropriate labs I need. I could tell you, but it would just sound like whining. LOL

  40. #41 PalMD
    January 12, 2010

    No, I’d like to know, John. A typical visit to an internist like myself includes addressing multiple chronic and acute issues, ordering complex lab and diagnostic tests, etc, and the average reimbursement from insurance is around 70 bucks.

  41. #42 Michael
    January 12, 2010

    Not only do DO’s learn everything MD’s do, but most of them also take the allopathic boards in addition to their own board exams. The reason that they do this is because a large portion of them take allopathic residencies.

  42. #43 Kristof
    January 12, 2010

    Dr. Crisler,
    There are many doctors “at your level” who do not charge a 400 or 500 entrace fee. That is a significant fee, and many doctors only charge for visits without this “retainer” fee. Granted, I have seen worse than your charges, but I have seem enough that are better to say that it is a bit excessive. The phone consultation is on par with what others charge for in-person visits for this type of treatment. Please don’t categorically discredit the level of other doctors who offer similar services. Your work on TRT is important and I do not mean to attack you at all.

  43. #44 Hypogonadic Henry
    January 12, 2010

    For what it’s worth, my last phone consultation with dr crisler went for at least 20 minutes and i was charged for 5 minutes. He really doesn’t strike me as a guy obsessed with money and it’s clear he works with a lot of blue collar guys because he’s actually pretty conscientious about the cost of extra appointments and medications if he feels they’re not necessary he discourages them. The initial office fee doesn’t seem high compared to any other specialist to me? Some doctors charge more than that for weight loss consultations.

  44. #45 Michael
    January 12, 2010

    I have seen Dr. Chrisler’s fees and they seem very reasonable. In NYC where I live most endocrinologists cost about 250$ to see(if my insurance doesn’t cover them). I have yet to be helped by any of them and have normal testosterone levels. Im 27 years old and have been dealing with these issues since I was in my teens, passed back and forth from medical speciality, until they usually tell me its in my head and or recommend another specialist.

  45. #46 David
    January 12, 2010

    I’ve operated for years on a HSA; and so I know how much various specialists actually cost (as well as the difference between the insurance “price” and the out-of-pocket price…lol!); and based on my experience here in Boston, Dr. Crisler seems EXTREMELY reasonable; even with the flight out to see him, etc.

  46. #47 David Craig
    January 12, 2010

    PalMD,
    I’d suggest you do a little more research on canidates for blog spueings.

    I really don’t know too mnay ways to say this, but you appear to be an idiot. Some simple googling, could have prevented this for you.

    Regards,
    David.

  47. #48 Ralph JR
    January 12, 2010

    Considering I had been to more than 6 incompetent doctors that prescribed me everything from antidepressants to anti-psychotics before ending up at Dr. Crisler’s and finally getting the proper treatment, I’d say any fees are well worth it. Compared to what I have spent at other doctors and a trip to a rather expensive endo, Crisler has saved me a LOT of money on my health care. He’s a very intelligent doctor and a great diagnostician, and I have and will continue to recommend him to anybody with hormone issues.

  48. #49 Matt
    January 12, 2010

    I’m hypopituitary. Dr. John saved my life where countless doctors across North America could not; including multiple endocrinologists. It’s sad that people are attacking him to be honest, he’s cutting edge and without him I don’t know where I would be. Try being programmed for death in your early 20s, and having everyone tell you your crazy. Think about that please, I urge you, before trying to bring down the only many that can save you of that, and in fact save your life as I mentioned. Sheer ignorance here.

  49. #50 legbuh
    January 13, 2010

    The problem with seeing an endo is:

    1. You have to be referred by your GP if they “see fit”. Hundreds of men a day are denied even that because they’re levels are in “range”. I am one of them. so far my GP and his referal docs have bascially told me for any ailment I have, “if it hurts when you do that, don’t do that”. so you’re talking min 2 visits and probably 3-4 months waiting just to hear “no”.

    2. If your GP RX’s HRT, or you see an endo then and he does, then you have to worry about your Dr.s competence with it. It’s a lot more than just RX’ing some test cream or injections. That’s why doctors like John will consult and teach. And why other facilities exist to specialize in HRT, especially for males.

    Bottom line, you say “testosterone” and everyone thinks of Arnold, Ronnie and other huge BBers that abuse themselves with steroids. What about we males that never touched the stuff, yet are going through “andropause” and want to live a normal life? Maybe get a boner once in a while, or have the energy to play with our children?

    But, when a woman goes through menopause, do you even think twice about RXing estrogen to her? Or insulin to a diabetic?

  50. #51 Itchynuts
    January 13, 2010

    I think the only one with class in this whole post is Dr J. He defended himself in a professional manner unlike others have demonstrated their lack of character. If you are good dr’s should you be focusing your time and energy helping patients instead of bashing a dr’s cause to help fellow men.
    In our practice we spend up to 30-45 minutes with patients on follow ups. Intial consultations are full hour covered by insurance. Endos are lucky to spend 10-12 minutes tops with a patients x 5 patients an hour at 70 a pop thats $350. Not to shabby. Majority of the people we get are from people tired of dealing with endos incompetence or scared push the numbers to get a clinical response. It people like Dr J that set the new standard in the field, but its a pity that these items are not taught in medical school. Endos are not trained to be hormone drs, but are better suited for treating diabetes.

  51. #52 Chris
    January 13, 2010

    David Craig:

    I really don’t know too mnay ways to say this, but you appear to be an idiot. Some simple googling, could have prevented this for you.

    Do you have specific comments on where PalMD was incorrect? What specific statements in his blog entry were in error?

    Why is Google a better reference than graduating from medical school, or even PubMed? If I Google a medical condition, how do I prevent having the first sites that come up from being alt-med sales sites trying to sell crap that is worthless?

    Failing to provide evidence that he is an “idiot” makes you look like an idiot. Really, do try to work on that constructive criticism technique. Quote the verbiage that is in error, and then when correcting it provide the appropriate reference.

  52. #53 Dr. John Crisler
    January 13, 2010

    palMD-

    It might be a good idea to retract your following statement:

    “The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.”

    It bears no resemblance whatsoever to reality, and is clearly libelous.

  53. #54 Dr. John Crisler
    January 13, 2010

    “No, I’d like to know, John. A typical visit to an internist like myself includes addressing multiple chronic and acute issues, ordering complex lab and diagnostic tests, etc, and the average reimbursement from insurance is around 70 bucks.”

    My office visit costs $60, and I do all that, including up to 5 issues.

    Do you address that many patient issues for $70? Or is it one major and perhaps one minor?

    I think I need to raise my fees!

  54. #55 Dr. John Crisler
    January 13, 2010

    “No, I’d like to know, John. A typical visit to an internist like myself includes addressing multiple chronic and acute issues, ordering complex lab and diagnostic tests, etc, and the average reimbursement from insurance is around 70 bucks.”

    My office visit costs $60, and I do all that, including up to 5 issues.

    Do you address that many patient issues for $70? Or is it one major and perhaps one minor?

    I think I need to raise my fees!

  55. #56 Dr. John Crisler
    January 13, 2010

    While my good name is being disparaged so here, it MAY interest some to know I have answered more questions for free than any doctor in the history of the Internet. I have literally well over 100,000 posts.

    My paper “TRT: A Recipe for Success” is freely given away (as are all my ideas), so patients may print it and take it to their own doctors, in hopes of receiving more eruditic medical care. From what I understand, countless numbers already have, until it is now recognized as the most highly read work in the history of my field.

    And if any of you can locate your old Playboy Magazine collection, look for the April 1997 issue. Page 100 has a story called “Dr. T to the Rescue”. The thread through the article is about a particular Anti-Aging Medicine doctor’s good character and extreme medical ethics.

    “Dr T” is my nickname.

    Now, what if a person is a former anabolic steroid drug user, who then suffers the unfortunate experience of watching his fiance die from leukemia; an experience leading him into medicine.

    This not-so-young doctor then decides he wants to help others (hopefully) escape the same potentail for future morbidity from anabolic steroid use (which is the same as “abuse”).

    Aided no doubt by the fact the doctor KNOWS what it feels like to have extreme serum androgen levels, all the way down to the weakness, fatigue, impotence and depression of hypogonadism, he finds he has a particular intuition for how hormones work in the body. And so many good books on the subject to read!

    Then, late one night, while staring at the ceiling, joyfully thinking about hormones–in particular issues with respect to the PK’s of the cypionate ester–a new way to combine old drugs comes to mind (and at lower doses than usually applied in medicine). This doc then posts his idea on the Internet. Next he is getting PM’s and phone calls from other doctors, asking about the “Crisler Method”. Soon he is being asked to lecture on this topic (around the world), and is approached by a major pharmaceutical company, because they are reading things about their own product they have never heard before. Why? Because this doctors ideas are logical, reasonable, and THEY WORK.

    Yup, and still but a simple country doctor.

  56. #57 PalMD
    January 13, 2010

    It might be a good idea to retract your following statement:

    “The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.”

    It bears no resemblance whatsoever to reality, and is clearly libelous.

    It is not “clearly libelous” but it is based on news reports of this letter being found as part of the investigation.

    What I wrote about that fact was:

    The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.

    The medications were putatively for “anti-aging” and “low testosterone” treatments. It would clearly be illegal for the leader to have diverted his own medications for use by others, but that isn’t the point.

  57. #58 PalMD
    January 13, 2010

    Based on the above comments, I will try to put together a “corrected” post, perhaps later today if time permits.

  58. #59 Katharine
    January 13, 2010

    “Aided no doubt by the fact the doctor KNOWS what it feels like to have extreme serum androgen levels, all the way down to the weakness, fatigue, impotence and depression of hypogonadism, he finds he has a particular intuition for how hormones work in the body. And so many good books on the subject to read!

    Then, late one night, while staring at the ceiling, joyfully thinking about hormones–in particular issues with respect to the PK’s of the cypionate ester–a new way to combine old drugs comes to mind (and at lower doses than usually applied in medicine). This doc then posts his idea on the Internet. Next he is getting PM’s and phone calls from other doctors, asking about the “Crisler Method”. Soon he is being asked to lecture on this topic (around the world), and is approached by a major pharmaceutical company, because they are reading things about their own product they have never heard before. Why? Because this doctors ideas are logical, reasonable, and THEY WORK.”

    Dr. Crisler:

    Put this to a scientific test. Run an experiment on it under the controls that we in biomedical science run it under.

    If it works, we’ve got a new tool to add to the arsenal. If it doesn’t, you have egg on your face.

  59. #60 Katharine
    January 13, 2010

    Just because it sounds logical and reasonable doesn’t mean it is. In addition, it is never wise to trust your intuition alone without backing it up with a good skeptical test.

    The kind of crap that you’re doing, Dr. Crisler, is what produced flat-earthers, creobots, etc.

  60. #61 Kristof
    January 13, 2010

    Michael says an endo cost him $250 so it is just as expensive as Dr. Crisler. My critique is Crisler charges an opening fee of $495, which is double the expensive endo.
    Virtual office visits are listed on his website as $60, $100 and $120 based on # of issues. The site also lists a fee for a copy of labs (no doctor has ever charged me such a fee, ever). Another fee is $15 to fill scripts elsewhere, which is also something I have never been charged for before. The medication list prices that he provides through a compounding pharmacy are not inexpensive.
    There are equally competent doctors available who can treat this condition for a fraction of this cost, but patients often are intimdated by docs concerning TRT issues and gravitate to someone who publicizes himself as a person they can “relate to” and feel comfortable with. These people don’t realize there are much more affordable options available and they seem to cling to the Dr.
    Look it is a free society and a “free market”, Dr., and we all have a right to quuestion fees and look for equal care at better prices. It is out there. Again, no disrespect intended, just an open discussion of prices.

  61. #62 Katharine
    January 13, 2010

    “So does the direct advice of someone who used to use the drug(s) in question. I have always been very open about my own previous AAS use, and so they seem to relate to me. I tell them I now worry every day about the damage I did to myself. AND FOR WHAT?!

    Many of them, as you would expect, have very low self esteem. They are then much more susceptable to ‘roids.”

    Very much not enough evidence.

    You may be deemed more trustworthy if you show your patients actual published studies.

    People have been known to experience various things and totally misinterpret what’s going on. I am not saying you are, because I have no idea whether you are or not, but you’re going to have to back up your own experiences with independent, peer-reviewed studies.

    What was your undergraduate degree in? Because that might give some indication of just how aware you are of the necessity of testing your hypothesis.

  62. #63 Katharine
    January 13, 2010

    I would suggest, in addition, that if you put them on TRT, you also refer them to a psychologist.

  63. #64 Dr. John Crisler
    January 13, 2010

    palMD:

    There was not a single medication in James Arthur Ray’s possession, in his room, or anywhere else prescribed by me. Now you have heard it, in no uncertain terms.

    It is obvious you are not concerned in the least bit with truth. Play semantics all you want, but your posts are morally, ethically and intellectually corrupt. You have jumped to totally unwarranted conclusions, without a shred of evidence, all in an effort to make yourself seem important (and done it while hiding behind a non deplume). They amount to nothing more than a sleazy, slimey smear of a colleague. A colleague who has done absolutely nothing wrong. Far from it, a colleague who has dedicated his life to exactly the opposite of the matters at hand.

    I have taken a lot of abuse over the years, from Internet dopers and Doper Doctors I have exposed, but I never thought I would get it from a colleague who is pretending to provide a service to society here. You are an extremely misinformed individual who thinks more of aggrandizing himself–at the cost of others–than his OWN soul.

    Every man gets to choose which line he is going to stand in.

    Here’s a little point ABC, their “expert” (ahem) and YOU have missed: Does James Arthur Ray LOOK like he’s on steroids?

  64. #65 Dr. John Crisler
    January 13, 2010

    “The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.”

    Please tell me, good sir, what individual produced this libel?

  65. #66 Katharine
    January 13, 2010

    Dr. Crisler:

    There is an example of the photographic evidence here.

    http://scienceblogs.com/terrasig/2010/01/james_ray_sedona_testosterone.php

  66. #67 PalMD
    January 13, 2010

    Here’s a little point ABC, their “expert” (ahem) and YOU have missed: Does James Arthur Ray LOOK like he’s on steroids?

    I have no idea what he may or may not have taken, only that they found that particular letter with him. Since you don’t prescribe anabolic steroids, that’s not really a concern. Perhaps he’s a little guy on TRT. Or perhaps he obtained medication from Crisler but then diverted it to his followers (which would be no fault of Crislers as long as he was careful about his prescribing practices). Or perhaps the letter had nothing to do with anything. But your hyperbolic defense of this supposed non-issue is…interesting.

  67. #68 Katharine
    January 13, 2010

    Seeing as Dr. Crisler doesn’t think my comments on his strategies are worth addressing, this greatly ups the odds that he is an insecure, financially-invested-in-his-crud quack.

    Now when he comments on not being afraid to do the studies to back himself up or shows us papers that back him up, I may reconsider my position about the legitimacy of his medical practice.

  68. #69 Katharine
    January 13, 2010

    In addition, a simple presentation of evidence is not libelous.

    Careful, Dr. Crisler, you’re straying into the anti-vaxxers’ territory.

  69. #70 David
    January 13, 2010

    “I would suggest, in addition, that if you put them on TRT, you also refer them to a psychologist.”

    Katherine: is your suggestion based upon peer-reviewed evidence that such a thing is needed?

    Based on what I observe here in this post/thread, I’d say that many of YOU actually do need professional counseling.

    Many of you have been attacking this good man without a shred of knowledge of who he is or what he does, and with even less respect and courtesy. Exactly why is a mystery to me. Lack of genuine scientific curiosity? Intellectual laziness? Professional jealousy? A desperate cry for attention? An attempt to drive internet traffic here? I don’t know. But there is something that seems willfully malicious about this. I think it’s just a rotten way to “debate.” And a less than rotten way to treat a colleague.

  70. #71 Katharine
    January 13, 2010

    David, low self-esteem, which he says many of the people he treats has, is quite treatable by going to a psychologist. In addition to testosterone replacement therapy, they might be aided by becoming more emotionally healthy. Yes, it is quite supported by peer-reviewed evidence, especially if the person’s low self-esteem produces depression.

    I don’t care about whether he’s ‘nice’ or not, David, no sane person should trust ANYONE who does not back their shit up. There’s no malice here. However, I feel, and frankly, every other person in science and medicine should feel, an obligation to poke as many holes in his flaw-ridden practices and arguments and argument methods as possible (and his supporters’ argument methods too; your emotional arguments will not do shit here) for the sake of not only those he treats but for the rest of humanity.

  71. #72 David
    January 13, 2010

    Katherine @ 67

    Dr. Crisler probably isn’t in the habit of responding to trolls.

  72. #73 Katharine
    January 13, 2010

    David:

    This isn’t Dr. Crisler’s blog.

  73. #74 David
    January 13, 2010

    Katherine @ 70

    Ditto.

  74. #75 Katharine
    January 13, 2010

    David:

    I think it’s up to PalMD as to whether I am a troll or not. He is perfectly free to delete my comments. But, in fact, even if I am being a troll, I think I am being far less of a troll than you are, as I am trying to construct a logical argument here from factual information and trolls have a rather large tendency toward emotional/nonsensical argument.

    Oh, it’s not your blog either.

  75. #76 David
    January 13, 2010

    Katerine,

    You might want to look up the word troll, trolling, etc. You don’t appear to understand the word, although I must say you embody the concept beautifully.

    And while your at it, since you don’t appear to understand much about TRT or Dr. John Crisler, etc, you might want to do some actual research next time before opening your mouth.

  76. #77 Katharine
    January 13, 2010

    “You might want to look up the word troll, trolling, etc. You don’t appear to understand the word, although I must say you embody the concept beautifully.”

    Great bit of projection there. Freud would be proud of you.

    If I remember correctly, trolls are usually on the side OPPOSED to the owner of the blog.

  77. #78 leigh
    January 13, 2010

    Here’s a little point ABC, their “expert” (ahem) and YOU have missed: Does James Arthur Ray LOOK like he’s on steroids?

    but Dr Crisler, you just contradicted yourself. all that energy you’ve put into differentiating your TRT from steroids, and you use THIS as your argument?

  78. #79 neurospasm
    January 13, 2010

    Wait. Is the good doctor saying he’s a pharma shill?

  79. #80 Nomen Nescio
    January 13, 2010

    i’ve no idea whether Crisler’s a “good guy” or not; i’d have to meet the man to pass any solid judgement on his personal character, and i’m not qualified to judge his professional competency.

    but i can tell, just from reading this thread, that for a self-proclaimed “simple country doctor” he appears to have an ego the size of the country he practices in.

    of course, that doesn’t necessarily mean he’s involved in anything unethical or illegal. (although people with massive ego problems do tend to be less concerned than most with keeping their actions within the bounds of ethical standards, so scrutinizing his a bit more strictly than average might perhaps be advisable.) but it does make me noticeably less likely to treat him with courtesy and respect — which fact i have no doubt will not perturb him in the slightest, large egoes usually not being easily deflated, after all.

    if he’s going to respond to simple statements of even potentially incriminating facts with accusations of libel, instead of with explanations of just how the facts do not incriminate him after all — if his first reaction to criticism is counterattack instead of defense — then he’s clearly got a thick enough skin to take rude and discourteous criticism without succumbing to depression. it’s the criticism that he (and his supporters) should be primarily concerned with, anyway, not the tone with which it’s delivered.

  80. #81 Gruesome Rob
    January 13, 2010

    @David:

    The only thing I see Katharine saying is “Put up or shut up”. That’s a reasonable request for *ANY* treatment.

  81. #82 Dr. John Crisler
    January 13, 2010

    leigh–

    What started all this nonsense about me is the idea I put Mr. Ray on steroids, and his emotional well-being thus deteriorated to the point he caused three people to die.

    There is no point in me trying to bring a little truth, or honor, to this blog. My grandfather taught me to “Never get into a pissing contest with a skunk”. LOL

    Now, I am off to Mexico City to train a bunch of doctors at the university medical school there. The best of luck to you all.

  82. #83 qetzal
    January 13, 2010

    Dr Crisler:

    In case you return to this thread, I have a very sincere question for you.

    If you are convinced that your treatment approach is dramatically better than the standard treatment one might expect from an average endocrinologist, why haven’t you published any of your findings in a professional medical journal?

    I understand you’re probably quite busy. Yet you’ve made time for pieces in Playboy, Healthy and Fit Magazine, Will Carroll’s Baseball Prospectus Talk Show, etc. Surely you know that none of those has any real chance of influencing medical practice.

    Why not at least publish a well-documented case series on your methods? If you truly are committed to educating your fellow MDs (as you suggest in comment #55), isn’t that what you should be doing?

  83. #84 Karl Withakay
    January 13, 2010

    “It’s amazing what people will post, hiding behind their computer monitors, under an assumed name.”

    “(and done it while hiding behind a non deplume).”

    Dr. Crisler, if it takes you more than five minutes of searching to figure out PalMD’s real name, then your internet search-fu skils are weak indeed.

    As to the rest of your comments,you do yourself no favors by supporting your positions with so many weakly constructed logical fallacies.

  84. #85 Karl Withakay
    January 13, 2010

    @ Dr. Crisler @81
    “There is no point in me trying to bring a little truth, or honor, to this blog. My grandfather taught me to “Never get into a pissing contest with a skunk”. LOL

    Now, I am off to Mexico City to train a bunch of doctors at the university medical school there. The best of luck to you all.”

    Any time anyone responds like that from now on, I will paste my all time favorite comment from any blog post ever:

    “And the moral we learn from that last comment, Boys and Girls, is that if you can’t win an argument on its merits, take a shit on the desk and leave.”

    -Someone named Jody in a thread on skeptico

  85. #86 Phil
    January 13, 2010

    Do a google search on my nick pmgamer18 you will get over 27,000 hits. I have been treated for Hypogonadism for over 28 yrs seeing one bad Dr. after the other I found Endo’s and Uro’s the worst. After 23 yrs of being told I am Primary meaning my Testis don’t work. And not feeling 100% on testostreone meds. Dr. John saved my life yes he saved my life I would not be here if he did not help me on the on the forums he goes to or runs. With his help I was able to figure out I am not Primary but I am Secondary Hypopituitary. I never seen him go gave him any money and I am not the only one.

    My story is long you can read it at this link.
    http://forums.realthyroidhelp.com/viewtopic.php?f=5&t=9239
    And the Heart Bypass update.

    I help men on the forums with low Testosterone, Adrenal and Thyroid problems. I have lost count as to how meny men and women post to me that are seeing Dr.’s that don’t know what they are doing. They have people a mess for yrs. When all they need to say is I don’t know.

    Of all the Dr.’s I have talked over the yrs I can tell you there are not many of them up on what is needed to treat low Testosterone problems in men like Dr. John does. Men suffering for yrs. will drive or fly out to see him because there is no good Dr.’s for this probelm in there area.

    And once they see him they post back to me how dam good it was seeing him and how much better they are feeling now.
    Phil

  86. #87 LL
    January 13, 2010

    @PalMD

    You don’t seem to get it. Dr. Crisler has stated that he did not prescribe a single medication that Mr. Ray had in his possession or anywhere else.

    As I pointed out in a different thread a few days ago – Mr. Ray’s letter pictured is old. It is undated and from a facility that Dr. Crisler has not occupied for multiple years.

    Yet people continue to criticize him even though it is apparent that he has no involvement with this case. I should not be surprised given the nature of this blog.

  87. #88 Matt
    January 13, 2010

    Here’s one for you Dr. John critics,

    Instead of going on a witch hunt, why don’t you acknowledge the “life-saving” heroics of this man? The evidence is here, and all over the world. Does that not account for anything?

    The same man that is presented here your enemy, would be your savior if your pituitary mal-functioned for whatever reason. The same man would be your savior if your manhood was taken from you whether it be due to genetic consequence or other. Think about it…

    But that’s the problem, you folks aren’t thinking about it. Yes the man may position himself as a doctor of anti-aging medicine, but it’s so much more than that. That’s what you fail to see, and acknowledge.

    I encourage any of you bash-happy “trolls” to even have a comeback to my evidence of his good work. Bring it on, because my livelihood knows you are wrong.

  88. #89 Prometheus
    January 13, 2010

    Crisler the Magnificent at #30 #37 #55 #63 etc.

    The erstwhile Crisler, who is but a simple country doctor, has had bestowed upon him innumerable accalades.

    From the moment of his professional naissance as a humble healer his advice has been sought by physicians of herculean repute from every corner of the earth. The Royal College of Physicians have bowed their wizened heads at the sweet strains of his ineffable wisdom.

    Have you people no sense of just how daunting a proposition is The Crisler? There has been nothing comparable since the Christ-child’s disputation with the doctors in the temple.

    He knows well he will feel the lash of small minds. What luminary has not borne a scourge?

    Like Jenner, Lister, Professor Otto Von Nozfinger (inventor of Nozfinger’s Magnetic Electro-suspensory belt)and the advocates of the now fully vindicated practice of Dynamic Tension his truth shall prevail.

    The Crisler will shrug your petty darts from his shoulders and proceed to take his place among the medical titans of posterity.

    I am enclosing 1250 golden quatloons. Please send a year’s supply of Crisler CardioFuel to compliment my Dr. Hammond’s Nerve and Brain Tablets for the treatment of men’s ‘special’ diseases.

    Seriously Doc, when the checks are rolling in from those five gallon buckets of supplement you flog, give serious thought to hiring a copy editor.

    You write like a parody of a side show barker.

    I kept waiting for you to use the expression “crowned heads of Europe”.

  89. #90 Karl Withakay
    January 13, 2010

    @ Phil @85 & others posting testimonials:

    Anecdotes and testimonials are not logical support for a position. You won’t impress many people here with them, however enthusiastic, detailed and sincere they are.

    There is a saying in the critical thinking community: The plural of anecdotes is not data.

    To this I will add the quote: “Anecdotes generate questions, not answers.” -Steven Novella

  90. #91 Matt
    January 13, 2010

    @86,

    Nail on the head… this blog is extremely bush league. The author pretty much sums up all things wrong in medicine today, and he has a host of lackies supporting him that unfortunately have no business speaking to the subjects at hand as it appears too complex for them to understand. Anyone who would criticize Dr. John in such ways obviously has a severe lack of experience and understanding in HRT.

    Ironically folks like this PalMD are the exact reason why suffering patients are unable to attain the help they so desparately require. Which is truly sad because patients need intelligent and open-minded physicians. Instead many patients are left to simply accept their bull-headed and uber-deficient MD because A) they don’t have a choice or B) they simply don’t know any better.

    PalMD – another wasted contribution to a medical field that sorely could use otherwise. And at the same time trying to bring down peers for being cutting edge, and well ahead of it all.

  91. #92 B
    January 13, 2010

    What exactly do you expect him to do a study on? The way he uses testosterone in his treatment? I think he’s pretty much covered here…

    http://www.hno.harvard.edu/gazette/2004/02.05/10-testosterone.html

    Or maybe you want to know why he uses low dose HCG? I think you will find a study on that here….

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

    Or is it that you don’t understand that some men, regardless what you do with their testosterone levels, WILL have high estrogen problems? I’m pretty sure it has been proven that Arimidex will lower estrogen, so it is just a mater of proper dosing to get the desired response. Do you really need more studies than what have already been done on Arimidex?

    So exactly what kind of study do you want? Everything he does regarding TRT has already been studied. Does it not make sense to keep the testicles functioning via HCG? Does it not make sense if estrogens do wander too high to control them via Arimidex or another aromatase inhibitor? Do you not see the benefit to this type of treatment over simply “raising testosterone into the upper mid range” as the Endo guide lines suggest?

    It’s no wonder most doctors cannot manage TRT effectively. They are not looking at the big picture.

    @Katharine, must you use obscenities in all your posts? Please, tell me what you do for living so I can be sure to steer clear of you if I ever require that type of service. You have proven yourself to be nothing but a (against my better judgment, I’m going to stoop to your level here) class A jackass.

    As to the Libel issue….

    “The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.”

    I believe that letter is very old since Dr. Crisler has not been at that address for quite some time. Just because Mr. Ray has a letter from long ago does not mean that the drugs that were actually found at this time were prescribed by Dr. Crisler. And the other site does not show the labels on the containers well enough in the pictures to read who the prescribing doctors were. The statement above also says that the drugs were “prescribed by AND purchased from this doctor”. Do you have proof that they were purchased from Dr. Crisler? No? I didn’t think so.

  92. #93 Matt
    January 13, 2010

    @89

    Count your blessings. Ignorance is bliss. Karma’s a bitch.

  93. #94 Mark
    January 13, 2010

    Obviously most of the detractors here have never dealt with a difficult medical condition and doctors who are unwilling to go the extra mile for a patient.

    Like Phil I’ve dealt with my hormone issues for coming up on 29 years. I heard for years that I was ‘adequately treated’, despite having a non-functioning thyroid due to thyrotoxicosis caused by iodine contrast tests, low testosterone, estrogens at twice the upper reference range, cortisol nearly double the top of the reference range and the list of abnormalities just goes on. I’ve lost track of the number of times I’ve been told everything was fine and requested a copy of my labs only to find that I’d been lied to. If I kept going back with complaints, rather than deal with the cause I was offered antidepressants. When I got frustrated with my last endo, (who incidentally charges about the same initial consult as Dr. Crisler for self pay customers, and more for office visits) she actually told me “I’m not a man, so you’re not going to get much sympathy from me.” (Yes, I did file a complaint)

    I’ve been told “You’re adequately treated”, “I don’t treat {name the condition}” and “you can live with this” more times than I can count. Seeing Dr. Crisler was a last hope for me, and the best thing I ever did for my health. As I sat in his office for over an hour, he repeatedly told me ‘we can fix this’.

    In the past 6 months since seeing him I’ve lost nearly 50 pounds, rediscovered an active lifestyle, recconnected with my wife and actually enjoy my children. For the previous years, frankly I’d simply been waiting to die.

    When I look back at half of my life spent in misery because the more than 30 different doctors I saw over that time were all unwilling or unable to tackle my problems, I frankly wish all of them could spend at least 6 months in my condition before treatment. Perhaps then they might begin to understand what it is like and why it’s not something anyone should have to live with. To a degree, Dr. Crisler has been there, so he does understand and that seems to make a world of difference.

  94. #95 James Sweet
    January 13, 2010

    but I feel very uncomfortable with what amounts to penalizing patients for preferring to choose their own pharmacy.

    Funny, that’s exactly what my prescription drug plan did, i.e. if they had a deal with CVS and if you got your prescription filled anywhere else they charged you an extra ten bucks.

    Private health insurance = consumer choice FTW!

  95. #96 James Sweet
    January 13, 2010

    Worthless anecdote: Our family physician is a DO, and he’s just fine. I’ve never known him to recommend any sort of quack treatment, and he’s very attentive to his patients.

    In fairness, he doesn’t really take a hardline against woo, either — though that can be a good thing (e.g. my wife’s friend expressed to her doctor a desire to delay her son’s vaccination schedule, and the doc went off on her and called her “stupid” — now she’s with our doc, the DO, who is trying to allay her fears, while at the same time working with her to make sure that if she does go with a delayed schedule, the kid at least gets all his shots eventually. I know some readers of this blog would be opposed to a doctor permitting a delayed schedule at all, but in this case I’d argue that’s a good thing overall, as the hostility of the first doctor would be more likely to drive this woman into the hands of an anti-vax quack, whereas the approach by the DO will at least minimize the harm…)

  96. #97 Katharine
    January 13, 2010

    B,

    Whether or not I’ve proven myself to be a class A jackass, it’s still better than being a class A idiot.

    Which is what you’ve proven yourself to be, from totally ignoring any requests for data or not using fallacious arguments.

  97. #98 Katharine
    January 13, 2010

    In addition, regardless of whether I am building a reputation as a slightly milder version of Physioprof or not, whining about my use of obscenity is a piss-poor tactic to try to divert the conversation from its fucking substance.

  98. #99 Prometheus
    January 13, 2010

    #97 Katharine

    I for one have had just about enough of your fucking potty mouth.

    #93 Mark

    “Obviously most of the detractors here have never dealt with a difficult medical condition…..”

    Awww shucks, I bet you just made a lot of friends.

    Crisler made me skinny and my winky works…huzzah! Light shines out of his ear holes! Yay men!

    This is absurd.

    If you people have to work this hard to sell a person, a treatment protocol or a used car it becomes patently obvious that the thing is busted.

    Why the hell would I buy anything from a collection of people who think the way to win me over is to accuse me of being stupid/ ignorant/lazy/naive for asking questions.

    If the interpersonal skills in real life of Crisler and his patients resemble what has been demonstrated here testosterone treatment may just be the futile act of getting all dressed up with no place to go.

  99. #100 B
    January 13, 2010

    @ Katharine, there you go again with the obscenity. And I’m not whining about it. I just think it is unprofessional and unnecessary to make your point. Apparently you think that makes you superior in some way. Or does it just make you feel better? It surely doesn’t make you look very professional as you are trying to portray yourself to be.

    As for the request for data. All you need to do is a little searching of the various medical study web sites to see that what Dr. Crisler is doing is backed by studies that have already been published.

    But it apparently doesn’t make sense to you that you need to address more than just testosterone when administering TRT for the best results.

    Obviously since you are a woman I should not expect you to do any research regarding male HRT because it will never personally affect you. But if you can’t read the studies that already exist and put two and two together then I guess I will just have to accept that fact.

    Oh, by the way, don’t forget to look both ways before you cross the road. Or do you need a study to tell you that traffic might be coming from both directions?

  100. #101 Hypogonadic Henry
    January 13, 2010

    This keeps getting stated in various forms but as far as I can tell it is not true:

    Dr Crisler charges patients a fee if they use their own pharmacy, and not a pharmacy of his preference.

    I have used both Dr Crislers default pharmacy, and my local pharmacy, I just looked up my receipt (which is always emailed to you, thankfully) and both times I was charged a $15 processing fee. I had my testosterone prescription filled through that pharmacy, and arimidex through my local pharmacy here in town.

    I believe this is what the policy is: if you ask for prescriptions to be filled outside of your scheduled appointment, there is a $15 processing fee, no matter where the prescriptions are filled at, to cover the cost of his & his reception’s time.

    Despite all of the lip service here about how important evidence is and how high the ethical standards are, let’s look at just a few the things that have been stated in public so far between these blogs about dr crisler on little to very thin evidence which are untrue:

    1) He owns a pharmacy ( What? )
    2) James Arthur Ray were sold to him by Dr Crisler ( Again, what? )
    3) He punishes you with a fee for not using “his pharmacy”
    4) He prescribed the drugs in James Arthur Ray’s possession

    Regarding number 4…

    I posted the following on another blog with the same topic here (edited for brevity):

    Obviously none of us have any idea whether it was dr crisler who prescribed him finasteride or why(he could have just written the letter) but dr crisler has an entire thread on his board that he started a few months ago just dedicated to finasteride and why he thinks men shouldn’t use it under any circumstances.

    Another thing is he states categorically he will not prescribe HGH

    Generally speaking he prescribes generic drugs (my testosterone is $20 a month) and this guy was on HGH that costs what $500 or $700 a month?

    Posted by: Hypogonadic Henry | January 10, 2010 8:46 PM

    So we have an undated letter with an ancient address on it, not dr crislers current office address, which simply states the person can lawfully possess the drugs and syringes on him. One of the drugs on the list (finasteride), dr crisler states in all his lectures should never be used for any reason, and he created a dedicated thread on his messageboard for men to post their finasteride horror stories and general discussion of it’s (presumed) dangers.

    Also, in july he spent some time on hairlosshelp.com advising men on finasteride of the problems he sees with it, again publicly agitating against it and warning men of what he perceives to be it’s danger.

    In one of his lectures he also categorically states “I have never prescribed finasteride, and I never will”

    Also, in each of his lectures that I have seen, he also says he will not prescribe HGH, and if you do you’re insane.

    So 2 of the drugs JAR had Dr Crisler has publicly railed against prescribing, one of them with considerable and easily accessibly public evidence of his total loathing
    for.

    In addition to this in these comments Dr Crisler has stated he did not prescribe JAR any of the medications that were found in his room.

    Now the evidence on behalf of him having prescribed, much less SOLD, these prescriptions to JAR?

    A very old letter (evidenced by the address) stating JAR is under his care and may possess these medications and syringes.

    5) Internet doctor (huh?), you don’t have to see him in person …. etc

    It’s really stretching the believability that any of this is about ethics.

  101. #102 Prometheus
    January 13, 2010

    #99

    “Obviously since you are a woman I should not expect you to do any research regarding male HRT”

    Hahahhahaha! Wow.

    Male gynecologist! How is that possible! It’s just so….alien…that thing ‘they’ have. What if it bites?

    Thank you PalMD for a thread that just keeps laying golden eggs.

  102. #103 Matt
    January 13, 2010

    @98

    “If you people have to work this hard to sell a person, a treatment protocol or a used car it becomes patently obvious that the thing is busted.”

    Or maybe we’re just that passionate about him, his work, and his good name? We’re not selling a used car here, we’re defending a gold mine.

    You fools are running a smear campaign of stupidity over here. Not asking you to buy-in, but at least grow a brain (or perhaps a few cells at least?) before trying to assasinate his work.

  103. #104 B
    January 13, 2010

    @Prometheus, you only quoted half of that sentence which makes your reply completely out of context. I said…

    “Obviously since you are a woman I should not expect you to do any research regarding male HRT because it will never personally affect you.

    I’m pretty sure I’m right about this, unless she has testicles that we’re not aware of.

  104. #105 Prometheus
    January 13, 2010

    “You fools are running a smear campaign of stupidity over here. Not asking you to buy-in, but at least grow a brain (or perhaps a few cells at least?) before trying to assasinate his work.”

    That won me over. I love compliments.

    You forgot to say something nasty about my mom.

  105. #106 Hypogonadic Henry
    January 13, 2010

    @ 98 Prometheus

    “If you people have to work this hard to sell a person, a treatment protocol or a used car it becomes patently obvious that the thing is busted.”

    no one is trying to sell anything.

    he’s being attacked and they’re defending him. if anything was being sold here, it’s the idea that you guys should leave him alone and take up a new cause.

    This all started with “This guy is an illegal internet steroid dealer” and when that didn’t hold water it’s become “This guy is an egomaniac” & “His practice is probably illegitimate because he hasn’t submitted any of his patients cases to a peer reviewed journal yet he claims his treatment is superior”.

    What’s with the crusade? His patients like him, there’s no evidence of harm, or of quackery. He uses real medications and hormones long proven to exist and to be manipulatable. He’s not doing reiki. He gives medications, and then looks at bloodwork and urine to help view how it has effected the patient. He’s not doing applied kineseology. He’s practicing the same evidenced based medicine that endos and urologists are. He believes he’s doing it better, so do his patients, many of which have seen both.

    What gives? Just let it go.

  106. #107 A. Noyd
    January 13, 2010

    B (#99)

    there you go again with the obscenity. And I’m not whining about it. I just think it is unprofessional and unnecessary to make your point.

    I just love people who whine about tone while condescension drips off their every word. Avoiding profanity does not make you any less of an asshole. But I guess it’s a useful thing to focus on when you can’t come up with the goods.

    Obviously since you are a woman I should not expect you to do any research regarding male HRT because it will never personally affect you.

    Yeah, forget that burden of proof thing. It’s all about Katharine’s ovaries.

    (#103)

    I’m pretty sure I’m right about this, unless she has testicles that we’re not aware of.

    Obviously since you are a man I should not expect you to understand why your comment is despicably misogynistic because sexism will never personally affect you.

  107. #108 Hypogonadic Henry
    January 13, 2010

    i hate not being able to edit for typos. effected/affected* and evidenced/evidence*

  108. #109 Nomen Nescio
    January 13, 2010

    @103:

    I’m pretty sure I’m right about this, unless she has testicles that we’re not aware of.

    or unless she has male friends and/or family members she cares about. people can actually be genuinely interested in, and knowledgeable about, things that will never directly impact them personally, y’know.

  109. #110 Kristy
    January 13, 2010

    I don’t know how to take you seriously, Dr. Crisler, after reading this:

    “While my good name is being disparaged so here, it MAY interest some to know I have answered more questions for free than any doctor in the history of the Internet.”

  110. #111 IaMoL
    January 13, 2010

    Let’s play a game… I know! Spot the logical fallacies in Matt’s posts.

    (Could he actually just be Dr.T’s sock puppet along with other Dr T supporters who just appeared here out of the blue?)

  111. #112 James Sweet
    January 13, 2010

    Obviously since you are a woman I should not expect you to do any research

    Oh, the quote-mining potential of that sentence…

    I don’t know how to take you seriously, Dr. Crisler, after reading this:

    “While my good name is being disparaged so here, it MAY interest some to know I have answered more questions for free than any doctor in the history of the Internet.”

    heh, nice. I guess we know what the market value of Dr. Crisler’s services are…

  112. #113 Katharine
    January 13, 2010

    … dude, B, as much as realistically, I have zero interest in HRT for dudes on any level (my thing is neurogenetics of cognition), if a woman is, for example, an endocrinologist or studies testosterone and its effects on the brain, she will want to know about HRT research.

    Do you live under a rock?

  113. #114 Katharine
    January 13, 2010

    “While my good name is being disparaged so here, it MAY interest some to know I have answered more questions for free than any doctor in the history of the Internet.”

    This is hilarious, partially because it’s pitiable.

  114. #115 B
    January 13, 2010

    @James Sweet, You obviously don’t know what a sentence is because you only “quoted” part it. But you sure are good at taking things out of context. I’ll be sure to read your blog for other great misquotes.

    @Nomen Nescio,

    or unless she has male friends and/or family members she cares about. people can actually be genuinely interested in, and knowledgeable about, things that will never directly impact them personally, y’know.

    Obviously I was referring to her “personal”, physical, body. Silly me, to suggest that a woman wouldn’t have testicles.

  115. #116 David
    January 13, 2010

    James Sweet @ 111

    That’s really great James – how snarky of you to mock someone who actually cares about people and helps them gratis. Oh, and if he charges anything, then you should accuse him of greed.

    That way, you get to attack him both ways. Because that’s the point of all this right? It’s becoming increasingly obvious that none of his critics here are interested in learning anything.

    This is just silly character assassination pure and simple, proffered by a bunch of smug narcissists, prickled with an intellectual vanity that is so prevalent in the medical-pharmaceutical industrial complex.

  116. #117 Katharine
    January 13, 2010

    “This is just silly character assassination pure and simple, proffered by a bunch of smug narcissists, prickled with an intellectual vanity that is so prevalent in the medical-pharmaceutical industrial complex.”

    Oh man, how did I know you were a conspiracy theorist? LOL.

    Also, your reading comprehension is terrible.

  117. #118 B
    January 13, 2010

    @Katharine,

    Really? You think I was saying that a “woman” shouldn’t do research on male TRT? Your reading comprehension is horrific. I said that you, being a woman, would most likely not do research on male HRT due to the fact that you don’t have testicles to fail you as you get older. I just said it in different words. Obviously if a woman is a doctor she may very well have good reason to research male HRT.

    Point being, that if you aren’t willing to do some research on your own to see if how Dr. Crisler treats his patients is valid then you have no place in this discussion. There are studies out there that backup his protocol practices. You just need to read them and put two and two together.

    To suggest that he should do studies for things that have already been proven to work is ridiculous because it would just be a waste of his time. I would prefer he spend his time moving forward in this field.

  118. #119 Katharine
    January 13, 2010

    Er, B, I never said that. You might want to castigate one of the other readers on the thread for it, since I saw that lack of reading comprehension from them.

    You’re the one with shit reading comprehension.

    Proven to work how? By studies? Or by your own flawed, subjective experience? Because, as I’ve said before, this is the kind of thinking that led people to think Earth was flat.

  119. #120 MonkeyPox
    January 13, 2010

    Castigate??? Castigate??!!!?? You horrible horrible person!!! You wants to take our ballzz!!

  120. #121 David
    January 13, 2010

    Katherine @ 116

    “Oh man, how did I know you were a conspiracy theorist? LOL.

    Also, your reading comprehension is terrible.”

    Funny you should mention reading comprehension – please do point out where I mentioned a “conspiracy.”

    “my thing is neurogenetics of cognition”

    Funny you should mention that too. I’ve been thinking lately about how Doctors/researchers seem to be drawn to areas of weakness and/or suffering. Many breast cancer specialists, for example, are former breast cancer survivors. I had you pegged as a person who has suffered lifelong from cognition problems; good for you for turning it to good!

  121. #122 David
    January 13, 2010

    Katherine @ 118

    A few facts for you:

    1. At no time in history has anyone in Europe or America broadly believed that the earth was flat.

    2. There are thousands of peer-reviewed studies supporting the efficacy of testosterone in hypogonadal males. What, exactly, is your problem?

    3. You are a foul-mouthed lout.

  122. #123 Katharine
    January 13, 2010

    “1. At no time in history has anyone in Europe or America broadly believed that the earth was flat.”

    *snigger* Okay, that took the cake; that settles it, you live under a rock.

    “2. There are thousands of peer-reviewed studies supporting the efficacy of testosterone in hypogonadal males. What, exactly, is your problem?”

    The fact that your doctor’s only real claim to fame, if you count out all the various silly testimonials which aren’t proof of anything, is giving internet advice for free. Yes, TRT is used in hypogonadal males. However, the way Dr. Crisler goes about giving it to men is highly ethically suspect.

    “3. You are a foul-mouthed lout.”

    Still better than being an anencephalic cretin.

  123. #124 David
    January 13, 2010

    Fact # 5. Everyone on this board apparently has a reading comprehension problem.

    Fact # 6. Except for Katherine.

  124. #125 B
    January 13, 2010

    @Katharine, You said…..

    as much as realistically, I have zero interest in HRT for dudes on any level (my thing is neurogenetics of cognition), if a woman is, for example, an endocrinologist or studies testosterone and its effects on the brain, she will want to know about HRT research.

    Do you live under a rock?

    By which, you are suggesting that I was saying a woman has no business researching HRT.

    And since you said “I have zero interest in HRT for dudes on any level” then you don’t belong in this discussion.

  125. #126 David
    January 13, 2010

    @ Katherine

    “However, the way Dr. Crisler goes about giving it to men is highly ethically suspect.”

    And your reasoning and proof for this is? … Oh, I forgot, Katherine allows herself to make silly accusations without evidence. And then keeps telling everyone (and herself) that everyone (but she) has poor reading skills. LOL!

    And, yes, please provide evidence that Europeans thought the earth was flat. Until you provide evidence to support that claim, you’re just discrediting yourself further. Thanks.

  126. #128 Kristy
    January 13, 2010

    Hey David…

    “1. At no time in history has anyone in Europe or America broadly believed that the earth was flat. ”

    There’s quite an number of historical maps that show otherwise.

  127. #129 Hypogonadic Henry
    January 13, 2010

    First of all, everyone stop stealing my line about reading comprehension.

    Second, why do you guys respond to Katharine? Focus on qetzal and palmd and the others who actually say things which are intelligent.

    Katharine just reeks of “I am a huge sycophant in a scene i desperately want to be part of but don’t fully understand or appreciate yet and i can try to make up for it by having a big personality but i dont realize it actually makes everyone feel awkward and embarassed and vaguely confused instead of impressing them”

  128. #130 Katharine
    January 13, 2010

    This Wikipedia article links to several non-Wikipedia citations. Essentially what it says is that the belief in a flat Earth lasted to roughly the Early Middle Ages. I will grant that post-Rome, very few people believed in a flat Earth.

    However, and I’m a little ashamed I didn’t remember this, geocentrism lasted well into the 16th century.

  129. #131 Katharine
    January 13, 2010
  130. #132 Katharine
    January 13, 2010

    B, stop verbally circumambulating.

    I did not say you said no woman had any business researching it. I was saying that you were under the false impression that no woman would have any INTEREST in researching it.

  131. #133 MonkeyPox
    January 13, 2010

    Talk about de-railing…

  132. #134 Katharine
    January 13, 2010

    “And since you said “I have zero interest in HRT for dudes on any level” then you don’t belong in this discussion.”

    Want to know why I’m in this discussion?

    It’s not because of the HRT. It’s because somebody made an ethical slip-up and also is totally incapable of arguing their point with logic, so they have to resort to several fallacies to try to get their flaw-ridden point across.

    No, I’m in this discussion because Dr. Crisler stinks of alt-med woo.

  133. #135 David
    January 13, 2010

    Kristy – nope; do you have a map at home? Take it out again and see if it’s accurate wrt a globe. You’re going to have to do better than that. The fact is, early Meso-Europeans were sailors (starting especially with the Phoenicians) and sailors always knew that the earth is round. At no time was there a broad belief otherwise in recorded European history.

  134. #136 Katharine
    January 13, 2010

    “Katharine just reeks of “I am a huge sycophant in a scene i desperately want to be part of but don’t fully understand or appreciate yet and i can try to make up for it by having a big personality but i dont realize it actually makes everyone feel awkward and embarassed and vaguely confused instead of impressing them”"

    Really? That’s actually what I’d call typical of what you Crisler sycophants are doing. Because you desperately want to be a part of this discussion, but you don’t seem to have an understanding of the various separate ethical and medical nuances of the situation.

  135. #137 B
    January 13, 2010

    Katharine, you must be very highly educated. However, you apparently are not smart enough to realize that all the studies have been done and are published. Heck, I posted a link to the study on why low dose HCG should be used in a TRT protocol (here and on one of the other blog posts), yet you still say you want published proof. Since you obviously missed that link I will provide it to you again. Don’t be afraid to open the document and actually read it.

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

    Do you not know what Arimidex is used for? It’s use to keep estrogen in check. Look it up. Most endo’s don’t even check estrogen. Why not? Is it not another very important sex hormone that might be most useful (and harmless) if it is kept in normal physiological ranges? I suppose you need a study to tell you that? They are out there, in droves.

    And obviously there are studies regarding testosterone replacement itself.

    How could the way Endo’s suggest TRT should be done be superior to a method that addresses these other issues?

    I’ll tell you what, assuming you are married, when your husband needs TRT (and eventually he will if he doesn’t already) you go and find him an endo that will use their method of treatment for him. Then you come back here in a year or so and tell me how happy he is that he has grown man boobs and his balls have shriveled up like a couple of raisins.

  136. #138 Katharine
    January 13, 2010

    I’m also particularly amused as to how David only asks for European examples of it. What, brown people don’t count?

  137. #140 A. Noyd
    January 13, 2010

    B (#114)

    Obviously I was referring to her “personal”, physical, body. Silly me, to suggest that a woman wouldn’t have testicles.

    That wasn’t the substance of your original claim, you disingenuous fuckwit. However you try to slice it now, you were assuming the gender of her “‘personal’ physical body” poses some sort of “obvious” limit to her willingness to do research.

    (#117)

    Point being, that if you aren’t willing to do some research on your own to see if how Dr. Crisler treats his patients is valid then you have no place in this discussion.

    It doesn’t work like that. It’s not Katharine’s job to provide evidence supporting your or Dr. Egomaniac’s claims.

    I would prefer he spend his time moving forward in this field.

    If there’s a “forward” to move towards, the darling doctor should help others get there by submitting his methods or findings to peer reviewed journals. Otherwise his only observable progess is adding more clowns to his sycophant circus in an ethically dubious fashion, which any quack can do.

  138. #141 Katharine
    January 13, 2010

    The PDF doesn’t mention Arimidex, if that’s what you’re trying to say, but.

    Arimidex, as I understand, regulates estrogen by way of aromatase inhibition, which suppresses the production of estrogen. This only tilts the testosterone-estrogen balance one way or another; it does not actually increase the amount of the total amount of both hormones. Inevitably, treatment is going to depend on the TYPE of hypogonadism.

    In addition, I think part of what you may be pissed off about is that testosterone reduction is often a symptom of other conditions, to wit: genetic abnormalities, hemochromatosis, pituitary deficiencies, inflammatory diseases, chronic kidney failure, cirrhosis, and a whole host of other diseases that are a great deal more serious in the short run than hypogonadism. This may be part of your endocrinologist’s less-than-enthusiastic desire to jump straight to the TRT.

  139. #142 IaMoL
    January 13, 2010

    At no time in history has anyone in Europe or America broadly believed that the earth was flat.

    This fails as fact. Please cite references. It fails as a sentence as well. You fail.

  140. #143 B
    January 13, 2010

    That wasn’t the substance of your original claim, you disingenuous fuckwit. However you try to slice it now, you were assuming the gender of her “‘personal’ physical body” poses some sort of “obvious” limit to her willingness to do research.

    Are you retarded? I never said such a thing. I was saying that since she doesn’t have testicles to fail her as she gets older that she probably doesn’t give a rip about male HRT, therefore probably wont do any research. Just like I don’t research female HRT because I don’t have ovaries to fail producing estrogen.

  141. #144 Katharine
    January 13, 2010

    B, are you talking ‘looked it up on the interwebs’ research or ‘am actually doing stuff in a lab’ research?

  142. #145 Vicki
    January 13, 2010

    B @142: I’ve never had a stroke, and I don’t suffer from migraine, partial seizures, or chronic pain. But I care about, and keep an eye on, those subjects because they affect people I care about.

    You’re either saying that you care only about your own well-being and assume the same is true of other people (we all tend to assume others are like us), or asserting that Katherine is a gender separatist and that none of the people she cares about are male. I’ve seen no evidence for the latter claim.

  143. #146 Katharine
    January 13, 2010

    “I’ll tell you what, assuming you are married, when your husband needs TRT (and eventually he will if he doesn’t already) you go and find him an endo that will use their method of treatment for him. Then you come back here in a year or so and tell me how happy he is that he has grown man boobs and his balls have shriveled up like a couple of raisins.”

    Bit young for that. I’m 21.

    Which endocrinologists are you referring to? What method of treatment? You never specified.

    Also, why do you keep piling on with the ‘You’re gonna be sorry’? That’s just window dressing on a slum.

  144. #147 D-Pan
    January 13, 2010

    There is clearly a lot of hormone imbalances on both sides of this debate that need addressed.

  145. #148 James Sweet
    January 13, 2010

    heh, I think I understand david’s confusion about the whole flat earth thing… It is indeed a common misconception in the US that everybody thought the Earth was flat in Columbus’ time. That’s patently false, but it makes for a good narrative (“Everybody thought Columbus would sail off the edge of the Earth, but brave and clever Sir Christopher knew better!”)

    david probably heard that, and assumed it meant that everybody everywhere knew the Earth was round.

    Which is astoundingly stupid. Do you think early cavemen developed language and then immediately said, “Ugh. Me think planet more like ball that we not invented yet, instead of like flat ground”? heh…

  146. #149 PalMD
    January 13, 2010
  147. #150 Prometheus
    January 13, 2010

    I love this thread.

    Love love love it.

    I don’t care one bit about Crisler, HRT efficacy, raisin balls, par boiled Sedona wootites, weird sideways misogyny or Katherine’s dirty dirty mouth.

    What I do care about is that “Dr. T” manages to exhibit all of the cluster b personality disorders AND a raging messiah complex in every paragraph.

    That’s scary.

    He tries so hard to be erudite he isn’t even aware that he is using Dickensian code words reserved in Victorian literature for the identification of characters that masturbate too much.

    That’s a laugh riot.

    His supporters, patients, defenders and what-have-you are an army of the anecdotal that use a level of hyperbole you usually only see at Lourdes or when Sun Myung Moon does a mass wedding.

    That is really really scary, makes thinking people suspicious and when I point out that this may not be the best way to convince people they spaz like june bugs in a microwave.

    Then there is this:

    “CardioFuel is an {redacted} exclusive supplement made by the world renowned Dr. John Crisler”

    “CardioFuel can dramatically reduce the symptoms, and improve the lifestyle, of those with:

    * Heart Failure
    * High Blood Pressure
    * Lung Disease
    * Diabetes
    * Fibromyalgia
    * Chronic Fatigue Syndrome
    * MS
    * PVD
    * Neurological Disorders
    * Depression
    * Fatigue
    * Cancer
    * ED
    * even “normal” aging.

    CardioFuel thirty day supply Regular Price: $105.99″

    Oh shit! I have normal aging!!!

    “Not selling anything” my ass.

    He’s peddling over the counter Panexa.

  148. #151 Katharine
    January 13, 2010

    http://www.endo-society.org/guidelines/final/upload/AndrogensMenGuideline053006.pdf

    From Pal’s latest post. Just to bring it into the comments.

    Is this the standard you’re referring to, B?

    From my undergraduate-biology-major understanding of it, it appears to read like this:

    1) Figure out whether it’s primary or secondary hypogonadism.

    2) Instead of estrogen levels, they measure LH (luteinizing hormone) and FSH (follicle stimulating hormone), which are present in men in the testes.

    The initial few paragraphs of the recommendations, if you are too lazy to read it, read like so:

    We recommend testosterone therapy for symptomatic men
    with classical androgen deficiency syndromes aimed at
    inducing and maintaining secondary sex characteristics
    and at improving their sexual function, sense of wellbeing,
    and bone mineral density. (1| )

    We recommend against testosterone therapy in patients with
    breast (1| ) or prostate cancer. (1| )

    We recommend against testosterone therapy in patients
    with a palpable prostate nodule or induration, or PSA
    above 3 ng/mL without further urological evaluation.
    (1| )

    We recommend against testosterone therapy in patients
    with erythrocytosis, hyperviscosity, untreated obstructive
    sleep apnea, severe benign prostatic hyperplasia symptoms
    (AUA prostate symptom score > 19), or uncontrolled
    severe heart failure. (1| )

    We suggest that when clinicians prescribe testosterone
    therapy, the therapeutic target should be to raise serum
    testosterone levels into a range that is mid-normal for
    healthy, young men. (2| )

    The table of treatment methods is on page 12. I do not know what problems Dr. Crisler sees with this.

    In addition, you should know that testosterone is gradually going to decrease as a man gets older. Older men will not have the same testosterone level as younger men.

    The quick summary of the article is on page 19.

    One caution: The ‘quality of evidence’ is, most likely, only an indicator of the fact that one should take precautions, but not be terribly drastic about making a decision based on the evidence presented. Please feel to correct me on this, Pal, since you’re the physician here; I’m just trying to interpret it for the sake of making a point.

  149. #152 A. Noyd
    January 13, 2010

    B (#142)

    I was saying that since she doesn’t have testicles to fail her as she gets older that she probably doesn’t give a rip about male HRT, therefore probably wont do any research.

    Here’s your statement: “Obviously since you are a woman I should not expect you to do any research regarding male HRT because it will never personally affect you.” The original phrasing is a lot more assertive (“obviously” has magically become “probably”), emphasizes her gender, and assumes her own body is the limit of what personally affects her and thus the limit of what she’ll research. Which is not only bad reasoning, it’s an especially stupid assumption on a medical blog.

    Of course, now you’re trying to cover up the wrongness of your statement when it was itself an attempt to cover up your inability to point towards citations supporting your claims. Why don’t we agree that whatever you meant, your actual choice of words was boorish and regrettable and get back to the problem you’re having with burden of proof?

  150. #153 Orac
    January 13, 2010

    While I have been the subject of Internet attacks over the years—from nitwit steroid users to Doper Doctors I have gone after—I have yet to see one as vicious as this. It’s amazing what people will post, hiding behind their computer monitors, under an assumed name. What troubles me is that it is from someone who is supposed to be a colleague. If you just would have called me, I would have been happy to clear up your misconceptions—before you libeled probably the most anti-steroid doctor in the country.

    Libel. You keep using that word. It do not think it means what you think it means. In fact I’d go as far to say that you, sir, are full of shit.

    In any case, where’s the libel? I see none. For one thing, there has to be intentional deception for there to be libel. Stating an opinion is not libel. Even being wrong in one’s opinion (and I am not saying that PalMD is wrong–only using the example of if he were) is not libel.

    Finally, regarding the whole “anonymous” thing, it is quite easy to figure out who PalMD and I are, and even if it weren’t, you do know, don’t you, that whining about anonymity on the internet is right up there among the lamest of the lame when it comes to retorts. Grow a backbone, fer cryin’ out loud. Do you realize how pathetic you sound crying “libel!” and whining about those poor mean anonymous bloggers and commenters?

    I’m with Prometheus on this one. This thread is incredibly entertaining because you are so full of yourself and un-self-aware that

  151. #154 Jack
    January 13, 2010

    When did this world become so cynical and so cruel?

    Seriously… When did we all determine it is our right to judge others and rant about it online without fully investigating the facts?

    I actually had a really friendly and well respected local endocrinologist tell me that my total testosterone level, which was just slightly above the low end of range for all men, was essentially fine for someone in their early 30′s.

    After seeing a urologist, two endocrinologist, and another hormone specialist, I decided I had to make the trip to see someone with more progressive ideas that might actually help me.

    In the 5+ years I have been trying to solve my problems, I have made the most progress in the 1 year I have been with him. I do not know if my – what appears to be a rare & challenging medical condition… will ever be solved – but I believe I have the best chances working with him.

    And for the record – he has NEVER pushed anything he sells on me, like “CardioFuel”. And his office staff – hands down – are the most friendly medical office staff I have ever experienced. By a huge margin. I could write paragraphs on this subject…

    I truly pity those that are posting such negative things about someone they do not know and have never met. Some day someone perhaps will judge you unfairly, and you will see what it is like to have your name drawn through the mud.

    From my experience with him, he’s a darn good person, and a damn good physician.

  152. #155 Katharine
    January 13, 2010

    Facts. I do not think it means what you think it means, Jack.

    As to the hormone levels, I can’t comment on that.

    “When did this world become so cynical and so cruel?

    Seriously… When did we all determine it is our right to judge others and rant about it online without fully investigating the facts?”

    In this case, for patient safety, it is not only our right, it is our responsibility, and I don’t see precisely what stone isn’t being unturned here. Please let us know if there is one that is not.

    And shit, folks, will you grow a skin? Are you afraid of even moderately vigorous debate?

    “I actually had a really friendly and well respected local endocrinologist tell me that my total testosterone level, which was just slightly above the low end of range for all men, was essentially fine for someone in their early 30′s.

    After seeing a urologist, two endocrinologist, and another hormone specialist, I decided I had to make the trip to see someone with more progressive ideas that might actually help me.

    In the 5+ years I have been trying to solve my problems, I have made the most progress in the 1 year I have been with him. I do not know if my – what appears to be a rare & challenging medical condition… will ever be solved – but I believe I have the best chances working with him.”

    Rare/challenging medical condition? All other alternatives have been ruled out, right? Does Dr. Crisler rule these out? Did your other endocrinologist rule these out? What was your testosterone level? Slightly above the low end of the range – as I said, I can’t comment on the hormone levels much, but ‘slightly above the low end of the range’ appears to me to mean ‘low end of normal’, which is still within ‘normal’. What is the range?

    There are a whole lot of questions here that aren’t being answered.

  153. #156 Orac
    January 13, 2010

    Oops. Hit “Post” too soon.

    My comment should have finished:

    I’m with Prometheus on this one. This thread is incredibly entertaining because you are so full of yourself and un-self-aware that you are your own worst enemy.

  154. #157 neurospasm
    January 13, 2010

    I suspect that musclechat suddenly went all-registration because of embarrassment about the threads there.

    I was wondering if anyone could lend some insight on the pathology/psychology of commenters here and on the previous post who feel so compelled to blindly defend someone who clearly has delusions of grandeur. There’s kind of an icky, Jim Jones feeling that I’m getting.

    btw, if anyone’s “world-famous,” it’s PalMD. PalMD is one of the most beloved and admired physician bloggers in the international medical blogosphere. Dr. Crisler should feel honored to have drawn his attention.

  155. #158 Joshua
    January 13, 2010

    For those who are concerned at the fees that Dr Crisler charges, I saw a Nephrologist last year who charged me $600 for 20 minutes. His conclusion to my myriad of health problems was to take three salt tablets several times a day and that there was no fix my health problems. I since found Dr Crisler’s website and forum which encouraged me to find a doctor who specialises in TRT/HRT. I am now on my way to recovery. Had I have chosen to stick with the advice of the overcharging arrogant nephrologist I’d still be where I was before. Thank you Dr Crisler for making your protocol available.

  156. #159 Joshua
    January 13, 2010

    Katherine @ 154
    “Slightly above the low end of the range – as I said, I can’t comment on the hormone levels much, but ‘slightly above the low end of the range’ appears to me to mean ‘low end of normal’, which is still within ‘normal’. What is the range?”

    Typically the ranges are not age adjusted, so if I’m 23 and my TT is at the very bottom of the range or less, I’ve got the same serum androgen levels as an 80 year old. Tell me how that is fair.

    As a whole, the comments on this post are vulgar and would serve more good the article and it’s associated work being removed.

  157. #160 PalMD
    January 13, 2010

    As a whole, the comments on this post are vulgar and would serve more good the article and it’s associated work being removed

    Joshua, you may want to visit this blog.

  158. #161 Katharine
    January 13, 2010

    “Typically the ranges are not age adjusted, so if I’m 23 and my TT is at the very bottom of the range or less, I’ve got the same serum androgen levels as an 80 year old. Tell me how that is fair.”

    The ranges are, in fact, age-adjusted, because testosterone declines as one ages normally (Dr. Crisler is in the business of ‘anti-aging’, which indicates that he may give men of any age enough testosterone to make their hormone levels similar to that of a 20-year-old). However, if a 23-year-old has the testosterone of an 80-year-old, that man has a small issue.

    I asked Dave the question about the testosterone, not you.

    Also, Joshua, your comments about the vulgarity on this post deflect from the substance of the article.

  159. #162 Joshua
    January 13, 2010

    @Katharine #160

    “The ranges are, in fact, age-adjusted, because testosterone declines as one ages normally”

    Are you positive about that? They are not in Australia at the labs that I use.

    “I asked Dave the question about the testosterone, not you.”
    So now you are not open to free speech? If that is the case, the author of the original artical has no right to have written it. Double edged sword.

    “Also, Joshua, your comments about the vulgarity on this post deflect from the substance of the article.”
    No further comment required. Go back to your uni class.

  160. #163 Karl
    January 13, 2010

    The first visit fee is not out of line.Dr Crisler’s first visit in his office is 90 minutes long. How many Dr’s spend that much time with you. After your hormones are optimized you only need to have a consultation once every six months for a $60.00 fee. I am a patient of his and was told up front that I could use any pharmacy I wanted to. Before seeing Dr Crisler my internist prescribed me Androgel for low T. He did not test for estrogens,shbg or bioavailable testosterone which is typical with many Drs out there. I feel very lucky to find a Dr who not only knows how to manage and balance all hormone levels but more importantly cares about me as a patient and adjusts things based on how I feel not purely based on lab results within or outside there normal ranges. I didn’t find it necessary for him to defend himself against this nonsense.

  161. #164 Paul
    January 13, 2010

    Sheeezzz…..

    First of all PalMD you really should be careful what you say about other people in your profession. It’s unprofessional. If you have a beef with a colleague there are proper channels. The fact that you post this for the public to read say’s you are in this for you and any peeps you might get to read your post’s. If I were Dr. C I would seriously think about taking you to court.

    To the rest of the cult a la PalMD. I hope none of you never need treatment for something such as hypogonadism because if you do it’s going to suck when your Dr. throws a tube of Andro Gel at you after a 15 minute consultation and tell’s you to hit the road. Once your nut’s shrivel up like raisin’s and you feel like a truck ran you over then you will start to realize that maybe your good ol family Dr. or Endo doesn’t know what the heck they are doing.

    And to Kathrine, your just an angry person. Take it easy honey. Life get’s better after Menopause so they tell me.

  162. #165 Mpda
    January 14, 2010

    Katherine sounds hot I say let’s just naked! Other than that all your big words I could give a shit about. I like my Dr. and I’m feeling good. My proof is in the pudding and I don’t care what you have but I am not shareing my pudding..

  163. #166 Chris
    January 14, 2010

    Anecdotes is not the plural of data. Try using actual scientific evidence from real medical literature and you would not have to resort to stupid comments like “let’s just naked.”

  164. #167 Joshua
    January 14, 2010

    Getting naked sounds good though! (must be the optimal T making me horny again)

  165. #168 Mpda
    January 14, 2010

    Still not giving up my pudding

  166. #169 Micawber
    January 14, 2010

    Whatever you do gentlemen, don’t give up thy pudding! Ever.

  167. #170 Isis the Scientist
    January 14, 2010

    There are some real classy d00ds in here. You guys could get naked, but mostly so we can all see just how shriveled your sacks are.

  168. #171 Paul
    January 14, 2010

    What this all boils down to is a Dr. who has to much time on his hands. I have been to many many Dr’s over the years and they are WAY to busy to take the time to do research on other Dr’s much less post a blog about them. If they aren’t working they are taking seminars or spending time with their families. They also NEVER criticize other Dr’s even though I’m sure they would like to because of the legal ramifications. A questions for Dr. Pay Pal.

    Dr. Pay Pal. Why do you spend so much time researching what you consider “bad” or “questionable” Dr’s instead of improving your own practice and staying up with current medicine? Don’t you have other hobbies that are more productive? How about a family to spend time with?

    Medical discoveries are happening on a daily basis. Surely you would do your patients a much better service if you were to do research on medicine instead of bad mouthing your colleagues.

    If you don’t have a family now might be a good time to start one. If you don’t have an urge for one, possibly looking into low testosterone might be a suggestion. I know a wonderful Dr. I can point you to. He’s one of the top in the country and takes good care of his patients. Although I am not one I have talked to many men who are very happy with his treatment and bed side manner. He is at the top of his game mostly because he does research and doesn’t spend his time criticizing other Dr’s he knows nothing about.

    Posting what you do not only looks bad on you but it looks like you are insecure and trying to bolster your own internet cult following “which it seems you have”.

  169. #172 Micawber
    January 14, 2010

    Dr “Pay Pal” – LOL!!!!! Thanks for the very hearty laughter this morning? And cheers to you Paul for yer merry wit! LOL!! ~Cawbs

  170. #173 B
    January 14, 2010

    @A. Noyd

    Of course, now you’re trying to cover up the wrongness of your statement when it was itself an attempt to cover up your inability to point towards citations supporting your claims. Why don’t we agree that whatever you meant, your actual choice of words was boorish and regrettable and get back to the problem you’re having with burden of proof?

    I’m not trying to cover anything up. You are just reading WAY too much into it.

    The only thing regrettable is the complete closed mindedness of the people who frequent this website.

    Again, all the studies regarding the medications and what Dr. Crisler uses them for have already been published. You just choose not to take the time to read them and put the pieces of the puzzle together to understand why he does what he does.

    There are no studies to do because each and every patient is treated according to their individual hormonal issues and how their body responds to treatment. You won’t get that from most PCP’s or endos. They get your lab results for testosterone into the mid normal range and they are done with you as far as TRT goes, regardless if you are still having problems or not. If you are still having other problems they will most likely just put you on an anti-depressant or Viagra or any number of other meds that most likely would not be necessary if they would just look at the big picture of what was really going on.

    The fact of the matter is that Dr. Crisler does what the endo guidelines someone posted here suggest should be done. But for some reason you guys just don’t seem to get that. The difference is that he doesn’t stop there where most endo’s and PCP’s do. There are many other things that will need to be addressed once testosterone is elevated appropriately. Most doctors don’t seem to give a rip while Dr. Crisler does.

    You obviously have a severe case of CRI. Perhaps you should stop by PalMD’s office so that he can help you “rectify” the situation. Then you might be able to get enough oxygen into your obviously over educated brain (which apparently lacks the least bit of common sense) to realize simple things that are plainly visible to most individuals.

    Also, if anything is boorish it is the obvious Napoleon syndrome of most of the bloggers on this site.

  171. #174 A. Noyd
    January 14, 2010

    B (#173)

    I’m not trying to cover anything up.

    You were telling Katharine to go find studies herself, read them, and “put two and two together.” Which ain’t how it works. The one making the claim provides the evidence. Yet rather than make a serious effort at that, you’ve dodged around, focusing on whining about how we all mistook what you said.

    Again, all the studies regarding the medications and what Dr. Crisler uses them for have already been published.

    So provide links to them or cite where they’d be found.

    There are no studies to do because each and every patient is treated according to their individual hormonal issues and how their body responds to treatment.

    Okay, you’re contradicting yourself here. If there’s a “two and two” or a “puzzle” to put together, there’s a something Dr. I’m More Awesome Than Jesus does which can be subjected to study. If his treatment is both effective and innovative, he should publish on it in medical journals. He should encourage other docs to follow what he does rather than dancing around the internet crying about persecution and pretending sun shines out his asshole. “But for some reason you guys just don’t seem to get that,” indeed!

    Then you might be able to get enough oxygen into your obviously over educated brain (which apparently lacks the least bit of common sense) to realize simple things that are plainly visible to most individuals.

    Ah, I see, you’re one of those asshats who thinks that education is “the bad” and everything really truly real can be seen by an average schmoe with an “open mind.” Problem is, we tried that shit for how many thousands of years before the scientific method? And it got us what? Ahh, if only you and Dr. There’s a Waiting List to Suck My Dick could quit wasting my oxygen and go back to those halcyon days of plague, rampant ignorance, and dying too early to have hormone issues.

    In science, you play by the rules or you don’t get to screech how no one acknowledges your greatness. Dr. I Need a Second Car to Fit My Ego might very well have a totally legit and effective treatment. Too bad he’s apparently more interested in making sure his sycophants-to-be won’t sue him and waving his dick around other people’s blogs rather than sharing his knowledge the way that would do the most good.

  172. #175 parser
    January 14, 2010

    Entertaining, but I do feel that things have wandered away from the central point. One doesn’t need to go beyond Dr.J’s FAQ for some serious ethical questions to rear their head. http://www.allthingsmale.com/faq.html (quotes to follow are from this page, copied at the time of posting)

    The FAQ has a number of things that could be considered questionable based on the method of presentation. For example, the first section, symptoms, will catch virtually everyone of any age on a regular basis, often with several hits. The followup paragraph does state that these symptoms arn’t usable for diagnosis, but implies that the presence of some constellation of these symptoms indicates hypogonadism.

    =============QUOTE===========
    Q: What are the symptoms of hypogonadism (“low testosterone”)?

    Fatigue
    Loss of muscle mass
    Fat gain
    Poor recovery
    Irritability
    Depression
    Decreased memory
    Lack of libido
    Erectile Dysfunction

    A problem with using these symptoms to diagnose hypogonadism is that you cannot directly relate either the number of symptoms present, or the severity of any of them, to the actual severity of the hypogonadism. That is why proper evaluation by a physician specifically trained in this type of medicine, as well as appropriate laboratory testing (much more on that in future articles), is absolutely necessary.

    ===============================

    No statement that the symptoms may indicate many other things than hypogonadism. Only the implication that if you have these symptoms, you have hypogonadism, and only the severity of your problem is in question.

    The most egregious, in my opinion, is about half way down, where a politician-quality misuse (or misunderstanding) of statistics is used in a claim that half of all men “are sick” with hypogonadism.

    ==========QUOTE==========
    The “normal” reference range for Total Testosterone is found through statistical means, meant to include 95% of all adult males. Yet, when tested properly-with what is called a Bioavailable Testosterone assay-about half of all men over the age of fifty have low testosterone . That means a significant percentage of those included in “normal” range are actually sick with hypogonadism (reread the list of serious diseases associated with hypogonadism). Therefore “normal range” has absolutely nothing to do with health and happiness!
    ================================

    This is analogous to the claim that a school is failing because half of the students are below average.

    There are many other questionable, misleading, and unsupported statements that seem to be designed to instill fear (“This guy is a doctor and HE says I’m sick”) to sell a product. Medicine seems to have followed law into this cesspit.

  173. #176 Bill
    January 15, 2010

    Wow. After reading all of this, all I got out of it, is that Katharine is a twit.

  174. #177 Carl in Louisiana
    January 15, 2010

    I can’t believe I read this entire thread.

    I’m a patient of Dr. Crissler’s and while I can’t credit him with saving my life I can honestly tell you that he has made my life far better than it was before. I was fortunate enough to only have to go through 3 different local doctors before finding out about his practice. I knew what was wrong with me and I wasn’t going to accept that my Total T of 247-320 (different days) was normal. I also wanted nothing to do with the lack of libido, weight gain and loss of muscle even while laboring strenously on a daily basis at work. I’m blessed that I had the means to fly from the gulf coast to East Lansing to see him. The man knows his stuff when it come to treating hypogonadism. There are not many doctors in the same league on the subject. I could care less that he has a profitable practice (good for him). I could care less that there’s a $15 fee to take the time to phone my local pharmacy so I can more easily claim my meds on my insurance. I have a PCP here for any other issues (the same one that suggested that all I needed for that low testosterone was 100mg of DHEA daily)and I’ll just continue to have Dr. Crissler treat the issue that he knows best and I’ll continue to be happy. I’m still a little fat but my muscle is coming back. I don’t want to be a muscle head, I just want to be attractive to my wife. With the renewed libido she needs to desire what I’m selling. Sure, my “winky” works great now, like it did when I was half this age. (Whomever minimized that earlier in this thread must not use his. Maybe he was a fan of Marshall Applewhite?) That in itself is priceless. I’m 47 years old and I feel better than I have in a very long time. If anybody has a problem with that, F&$% you. Don’t like Dr. Crissler’s business model? Mind your own F%$&ing business. If a doctor isn’t willing to think outside the box then they’re just getting in the way.
    I noticed that big pharma has started bombarding the TV with commercials about “low T”. The funny this is that Dr. Crissler has been talking about the same thing for many years. He was just ahead of the game. I hope he’s making a killing. He was sharp enough to see a need and thank God he filled that void.
    P.S. Katherine….when was the last time you wore heels? ;)

  175. #178 V
    January 15, 2010

    Dr Crisler is much more than a country Dr, he has done a lot of real good and helpful things.
    The are of medicine he knows and that is very effective.
    It is too bad so many people have to degrade him that do not know but very little in this area of medicine.

  176. #179 B
    January 15, 2010

    A. Noyd,

    Gee….I’m a fuckwit, asshat, and I’m sure there were a few others that I have missed. And you really expect people to take you guys seriously? You sure show no professionalism, that’s for sure. I bet your employers would be proud of you for carrying yourselves at such a classy level.

    For the record, no I don’t thin education is “the bad”. But I do think that a lot of highly educated people lack basic common sense.

    The put “two and two” together I was referring to is the studies on the various drugs that Dr. Crisler uses in tandem to manage TRT for his patients. If you weren’t so lazy you would take a look for yourself for the studies that are easily found on PubMed and other sites. Sorry, but I’m not going to do the work for you, I have better things to do. The studies are there, go read them. All this “you must provide the proof” is bullshit when the studies already exist and are easily found on the Internet.

    The “puzzle” is each individuals hormonal system and how it functions. Which is one very important thing that most doctors, including Endo’s, don’t take into consideration. They just use a cookie cutter approach and once your hormones are at a certain level they consider it a success regardless if the patient is actually feeling better.

    Dr. Crisler has himself stated many times over the years that he does nothing special, and any doctor can do what he is doing. They just choose not to and continue to stick with the “cookie cutter” for everyone.

    By the way, go ahead and continue with the insults and profanity, I personally couldn’t care less. At the end of the day I’m probably feeling a hell of a lot better than you do.

  177. #180 Vicki
    January 15, 2010

    B–

    I just did a PubMed search for “Crisler J” and got ten papers, all of them so irrelevant that either it’s different J. Crislers, or this Dr. Crisler went into his current field after research on such topics as lead poisoning in sandhill cranes, the history of surgical treatment of epilepsy, and Pneumocystis carinii pneumonia.

    If you’re referring to papers by other people, you really need to give us title and authors if you want the citations to be taken seriously, or expect anyone to read them.

  178. #181 Deen
    January 15, 2010

    Joshua wrote:

    So now you are not open to free speech?

    Nice accusation coming from someone who suggested the removal of an entire blog post and comment thread. I nominate it for
    “Irony Meter Explosion of the Day”.

  179. #182 A. Noyd
    January 15, 2010

    B (#179)

    And you really expect people to take you guys seriously?

    You really expect people here to take Dr. My Dick Is So Big I Ride It To Work and his pack of goons seriously when you and they constantly avoid substance and focus on style? When they whip up a rumor about PalMD being a pedophile rather than coming back with sound scientific evidence? Please.

    For the record, no I don’t thin education is “the bad”. But I do think that a lot of highly educated people lack basic common sense.

    Meaning you value common sense over education, critical thinking and the scientific method, correct? Which was my point. Common sense is a completely useless way of knowing whether something is true or false. While it’s fine for largely inconsequential day-to-day decisions, only an idiot would try to give it the final say in medicine. And if we’re to rely on common sense, an obvious conclusion about the treatment offered by Dr. I Taught Chuck Norris Everything and Regrew His Balls, as leigh jokingly pointed out over here, is “this particular therapy regimen imposes some kind of cognitive impairment.” I had just the same thought. Is it correct to really think that’s true?

    If you weren’t so lazy you would take a look for yourself for the studies that are easily found on PubMed and other sites. Sorry, but I’m not going to do the work for you, I have better things to do.

    No, no, no, and no. For the last time, the burden of proof is on those making the claim. It might be informal in science as opposed to law, but it holds true and for good reason. If you’re saying X works because of Y, it’s your duty to present Y as well as further evidence supporting the “because of” bit. You don’t get to call us lazy for not doing your job. We have better things to do, too. But if you present claims and refuse to back them up, you lose the right to say that we’re wrong to dismiss those claims.

    By the way, go ahead and continue with the insults and profanity, I personally couldn’t care less.

    I can totally tell you don’t mind by the way you keep bringing it up.

  180. #183 Micawber
    January 15, 2010

    What in heaven’s name has any of this to do with canoeing? Stay on topic please.

  181. #184 B
    January 15, 2010

    Vicki,

    The studies were not done by Dr. Crisler. Here is a like to a study regarding the use of HCG.

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

    After reading this study please explain why the Endo Society doesn’t think this is a worthy addition to their treatment guidelines. I would like to know why everyone seems to think that Dr. Crisler is using this medication inappropriately when this study clearly supports what he uses it for.

    There are other studies published regarding the usage of Testosterone (obviously) and Arimidex. They are there, I have read them. However, I do not have links to them. You should find the info by searching for testosterone, hcg, arimidex & hypogonadism.

  182. #185 B
    January 15, 2010

    A. Noyd,

    This blog site has accused a medical doctor of being unethical (with no real proof), of selling steroids (with no real proof), of treating patients he has never personally seen (with no real proof), of inappropriately using medications to treat his patients (with no real proof).

    I would say that places the burden of proof on the author of these blog postings. If the blog poster can’t prove that these statements are true then these ridiculous blog posts should be corrected. Until the author has proven he is correct then Dr. Crisler (nor anyone else for that matter) needs to prove anything to you.

  183. #186 A. Noyd
    January 15, 2010

    B (#184)

    This blog site has accused a medical doctor of being unethical (with no real proof), of selling steroids (with no real proof), of treating patients he has never personally seen (with no real proof), of inappropriately using medications to treat his patients (with no real proof).

    Interesting that you overlook both the reasons given for such claims and how claims where the evidence didn’t hold up have been taken back. Ironically, rather than encouraging that trend by acting like the stand-up guy you think he is, your extra-special buddy Dr. Bigger Than Infinity Times Eternity has instead added to the remaining red flags by spazzing out just like a quack and hoisting a few new flags up the pole.

    But speaking of accusations without any proof, do you support your dearest friend’s rumor-mongering about PalMD being a child molestor?

    Until the author has proven he is correct then Dr. Crisler (nor anyone else for that matter) needs to prove anything to you.

    Do you have a degree in sucking at logic or does it just come naturally? Nothing PalMD or anyone else says about him changes the fact that Dr. I Pee Holy Water has an obligation to demonstrate, based on evidence, that his own claims have merit. You’re running one major distraction campaign to try to get him out of that. It truly leads one to wonder why.

    Or maybe the latest is just to get yourself out of admitting that, in medicine, putting common sense before science is idiotic.

  184. #187 B
    January 16, 2010

    Vicki,

    I posted a link to a study regarding HCG use in hypogonadal males while on exogenous testosterone yesterday but it apparently has not been approved yet. Go figure. If you look back through some of the other blog posts by PalMD you will find that same link. After reading that study please explain why that is not a worthy addition to the guidelines published by the Endo Society.

    A. Noyd,

    The reasons for PalMD’s original accusations are unimportant if he can’t back them up with facts that prove they are true. As a matter of fact, anyone with any morals wouldn’t have posted such things without investigating to see if his assumptions were actually true first.

    It seems you guys can’t play by your own rules.

    As to the Pedo comment, that was the Doc showing just how ridiculous unfounded accusations can be. If you don’t understand these points then you truely are a retard.

    And you still apparently don’t get the education thing. Education is very important but so is common sense. Without an education common sense won’t take you very far in life. But without common sense an education is basically worthless because you won’t use rational though to apply your knowledge base. I work with a lot of highly educated engineers and I can’t even count the number of projects that had to be redesigned because they were just looking at their calculations and not how they were actually working in the individual given situation they were being applied to. Very smart people yet it took the pretty average people around them to find and correct their mistakes. So I don’t take a highly educated person very seriously if they don’t show a similar level of common sense.

  185. #188 A. Noyd
    January 16, 2010

    B (#186)

    As a matter of fact, anyone with any morals wouldn’t have posted such things without investigating to see if his assumptions were actually true first.

    I’m sorry you’re so unfamiliar with the concept of evidence that you can’t even see it when it’s presented, much less manage to come up with any of your own. No, you merely throw tantrums and grasp at fallacy after fallacy to try to distract from the fact that there are still legitimate reasons to be concerned about the supposed efficacy and ethics of Dr. I Make Bull Elephants Jealous’ methods.

    As to the Pedo comment, that was the Doc showing just how ridiculous unfounded accusations can be.

    Bullshit. Perhaps you interpret it that way because your beloved doctor can do no wrong in your eyes, but it really amounts to nothing more than special pleading.

    But without common sense an education is basically worthless because you won’t use rational though to apply your knowledge base.

    Common sense is not rational thought. Common sense is the naive judgment people use to decide the sensibility of something based on its high degree of common acceptance and/or endorsement. At best, it’s the sort of intuitive quasi-rational thinking one does when one doesn’t know enough to make an informed judgment. (Look it up.) Rational thinking, on the other hand, is learned and far less error-prone. Actual rational thinking would make it “plainly visible to most individuals” that there isn’t enough information in your anecdotes to conclude that this treatment works.

    So I don’t take a highly educated person very seriously if they don’t show a similar level of common sense.

    You seem to be deciding people lack common sense by their refusal to agree with what you believe. I guess that seems pretty sensible to a common-sense guy like you, eh?

  186. #189 Jaydee
    January 17, 2010

    This blog is absurd. There is so much EVIDENCE plasterd all over the internet that Dr Crisler is anything BUT what he is being accused of here that it makes me wonder if the writer of this blog is just trying to draw attention to himself.

    Dr Crisler has made many, many posts on a CLOSED Finasteride sufferes forum, meaning, you must be a member to be able to see the content of the posts. There must have been around 1000 members on this website. How then is Dr Crisler doing such good, free work and at the same time “over-charging” his patients?? The shoe just doesnt fit.

    And this is not including the tens of thousands of free knowledge Dr Crisler has shared with people he doesnt even know on the internet over the years.

    He also literally gives away his TRT protocle on his website.

    On top of all of that, Dr Crisler is CONSTANTLY figuring out better ways to treat his patients and patients all over the world. To do this takes time and time and is money. If you want the best medicine has to offer in the world of TRT for men, then the fees the Dr Crisler charges are very reasonable, considering the level of extra care and years of knowledge that Dr Crisler posesses.

    As a patient of Dr Crisler’s, I can assure you that the first medical assesment is one that is not only very personal, but extremely comprehensive and worth every dollar of the fee. The follow up phone consultations I have had with Dr Crisler have been worth far more the than $70 fee I am charged and often go on for twenty minutes plus. Some of them, I was not even charged for as my case was a very complicated one, and I can only put this down to Dr Crisler’s good nature and high level of compassion.

    With the high level of knowledge that Dr Crisler has obtained in this business, comes guys who would like to pull him down. This happens from time to time and every time, those who know Dr Crisler and his patients feircly defend him. There is a good reason for that.

    Jaydee

  187. #190 DJ
    January 17, 2010

    The trolls coming in are poor quality, similar to antivaxers and creationists. I don’t care to directly interact with irrational trolls (don’t feed the trolls). At least Pal is getting more page views though. Too bad science based medicine is wasted on them.

    I do find it mildly entertaining to observe the irrational arguments, ad hominems, strawmen, and avoidance of the actual questions raised about the practices of Dr. Crisler by his super classy posse. Perhaps the traffic will result in Pal getting a few more pennies for blogging this month.

  188. #191 PalMD
    January 17, 2010

    This site very specifically did not accuse anyone of selling or distributing illegal steroids. My opinions of the practice as represented on its website are consistent and based on core principles of medical ethics.

    It is certainly possible that the website does not properly represent the way Dr. Crisler practices medicine. But based on the data publicly available, the practices appear to be well outside the mainstream. To point that out is not a cruel and unusual thing to do. I write publicly and I am called out on what I write daily. When one makes public claims and statements, there will be critics. If Crisler wishes to argue that the way he practices is well within the usual standards of care or usual practices, or that his website does not represent the way he practices, that’s great and I would stand corrected.

    But a valid argument is not, “Well, Pal is a silly fat canoehead.” It may be amusing, but it’s not an argument.

  189. #192 Who
    January 17, 2010

    PalMD,

    You did not accuse Dr. Crisler of selling steroids, but others posting here have. If it wasn’t’ on this particular blog post then it was on one of the other ones regarding Dr. Crisler.

    Just because he doesn’t do things in the “usual” way doesn’t automatically make them unethical.

    For instance, his visits over the phone are not unethical. This type of treatment is not the type that requires seeing the patient in person each and every time they talk about their treatment. So between Dr. Crisler seeing the patient once per year and the patient seeing their PCP regularly this shouldn’t be a problem. Why should he make the patient drive to his office and wait there each and every time when they can simply answer their phone to discuss their treatment? Just because it isn’t the “usual” way of dong things?

    If everyone stuck to the “usual” ways of doing things then nothing would ever progress in this world.

  190. #193 MonkeyPox
    January 17, 2010

    Out of curiosity, Who, what is your background in medicine, medical ethics, and standards of care?

    I ask because you seem pretty certain about your assertions.

  191. #194 Jaydee
    January 18, 2010

    “Silly Fat Canoe Head”

    Now THAT is funny…

    “Super Classy Posse”…..Dr Crisler wouldnt have it any other way….

    Have a nice day.

  192. #195 JLee
    January 20, 2010

    Could someone please address the following:

    1) Given that at least one serious study published in a top endo journal has shown that HCG does in fact mitigate testicular atrophy in men treated for low testosterone, why shouldn’t it be included and why does the doctor including it need to be the one who did the research. Same question for controlling estrogen levels?

    2) Why doesn’t extensive clinical experience matter?
    (If you guys think that most doctors stick strictly to what has been proven by multiple double blind studies are sorely mistaken. Much good medicine is based on clinical experience and educated common sense.)

    3) To conclude that Crisler’s methods are unsound by appealing to his personality (ego, Messiah complex, oder of woo woo) are employing a basic informal logical fallacy. Supposed evidence based types should really avoid this.
    (His ego is absolutely irrelevant. BTW, it appears to that PaulMD is about the same–but again–so what?)

  193. #196 neurospasm
    January 20, 2010

    Now that the flame has died out here, Dr. Crisler and his minions may now take up at ERV’s blog. Enjoy your stay. LOL!

  194. #197 GirlyMan
    January 22, 2010

    “Now that the flame has died out here, Dr. Crisler and his minions may now take up at ERV’s blog. Enjoy your stay. LOL!”

    I am nobody’s minion. And I think I’m gonna be here for a while enjoying my stay. Thanks for the invite.

  195. #198 neurospasm
    January 22, 2010

    You sure, GirlyMan? Looks like one of the cavemen has already engaged with ERV:

    http://scienceblogs.com/erv/2010/01/steroids.php#comment-2218843

  196. #199 Lippo - Sucked
    January 28, 2010

    [comment redacted]

  197. #200 PalMD
    January 28, 2010

    I’m sorry for having to resort to censoring a comment but the above comment contained some fairly incendiary and unsupported accusations about a “Dr Crisler” who isn’t further identified.

    Criticism of a person’s specific actions is one thing, but lobbing unsubstantiated, inflammatory accusations is not acceptable around here (unless, apparently, they’re aimed at YHN).

  198. #201 David
    January 28, 2010

    PalMD, you may want to talk to the poster of the last post you last edited. I don’t think thier posting were false acusations, or unsubstantiated. I am fairly sure they have plently of accusations that are supported. They may have an intresting story to tell.

    It’s interesting to me that Dr. Crisler is doing Lipo surgery when he is a supposed to be a specialist in male hormones. They really don’t go hand in hand or support each other.

  199. #202 PalMD
    January 28, 2010

    Please…there is nothing in any of his literature that I have found that offers these services. I’m not saying either of you is lying, but since there is nothing to substantiate your claims it is patently unfair to air them publicly, and I will not be the conduit for it.

  200. #203 PalMD
    January 28, 2010

    I’m really starting to hate you guys for making me defend Crisler.

  201. #204 David
    January 28, 2010

    I hear ya. I just encourage you to hear the poster out. Maybe contact them at the email they posted with…?

    that’s all.

  202. #205 Girlyman
    January 31, 2010

    @198 “You sure, GirlyMan?”
    Yes neurospasm, I am sure.

  203. #206 Scott
    February 2, 2010

    John is very well known and liked for the record.
    With as many of you that hate him, 10 times that like him and have had good results from his protocol.

    What if one day one of you haters needed to be put on TRT?
    Would you go with someone that by word of mouth has allot of happy customers, and a full plate?
    Or, to an endo that really has little experience in the hormones at hand?
    I’d take a stab at that and suggest you would look into his methods.

    As for some of the women that are quite vocal, young, and highly opinionated, not to mention foul mouthed, your suggestions and advice would be like me giving you advice on how to fix your PMS (which no doubt you suffer from)…….lol

  204. #207 MonkeyPox
    February 2, 2010

    So basically what you’re saying is you believe in this dude independent of any externally valid evidence, and you hate women.

    Nice.

  205. #208 Dick
    February 2, 2010

    Scott, that is some awesome mansplaining. You are the D00D!!!

  206. #209 Dick-er
    February 2, 2010

    d00d’s got it just right. get on the big T, stamp out all that girliness inside, and while you’re busy being not-teh-ghey, get on your knees and worship at the feet of the Dr J. Oh, and as long as ur down there…

  207. #210 bikemonkey
    February 2, 2010

    of course ‘roids and lipo go together. Don’t you think his patients eventually want a little reduction for the gynecomastia side effect?

  208. #211 Scott
    February 2, 2010

    Externally valid evidence?
    There is ton’s literally, he has helped many and many praise him.
    If I had to rate him, I would put him right up there with Shippen, which was the pioneer in this field.

    And for the record, I don’t hate women; I just hate in your face, trash talking, fat, ugly women, which have bigger nuts than me…..lol
    No lady would talk like that.
    Sad that one chooses to communicate with words that are not expressive of ones ability to be concise.

    I love it when people have a large opinion of something they have no knowledge of.

    I would like for anyone of you haters to show me one person that went to John and was not satisfied.
    Or post up any information that shows what he is doing within his protocol to be flawed or wrong.
    I am waiting with baited breath.
    Good luck with that one….lol

  209. #212 MonkeyPox
    February 2, 2010

    And for the record, I don’t hate women; I just hate in your face, trash talking, fat, ugly women, which have bigger nuts than me…..lol

    Yes. Yes, I get it. My bad. Women with strong opinions whom you find unattractive are definitely hateful. I almost forgot.

  210. #213 Ed Yong
    February 2, 2010

    I love it when people have a large opinion of something they have no knowledge of.

    It’s sort of a personal mantra for you, isn’t it?

  211. #214 Dick-er
    February 2, 2010

    That really upset me.
    I posted but little good that will do……….lol
    That chick is a whack job, her mouth is foul, I bet she isnt pretty either.
    Id hate to hook up with that one….lol

    Keepin’ it classy at the boards, eh, Scott?/hackskii?

  212. #215 Scott
    February 2, 2010

    Classy?
    Yah, potty mouth chick is anything but that, glad you cleared that one up for me.

    You take something good someone does and give the appearance of something bad.
    Fact is, John has helped many people with fantastic success, and you guys give him static.
    And then ask for proof…….lol

    Your name: Dick-er is proof of the above……..heee heee
    If this was a classy board, I just might keep it clean, but considering it isnt, You know what they say “When in Rome?”….

  213. #216 akb
    February 2, 2010

    Sad that one chooses to communicate with words that are not expressive of ones ability to be concise.

    perhaps you meant to say “sad that one fails to be concise” instead. that, or “concise” does not mean what you think it means.

    /irony

    And for the record, I don’t hate women; I just hate in your face, trash talking, fat, ugly women, which have bigger nuts than me…..lol

    because words typed on a keyboard are SO reflective of one’s appearance. the mere fact that you need to resort to disparaging someone’s physical appearance using false assumptions based on some text on teh interwebs to show your disagreement, just shows how fucking empty-headed and lacking in originality you truly are. go fuck a goat, goatfucker, because you sure as hell aren’t getting any from any real women with that peanut brain of yours in charge of your behavior.

  214. #217 Scott
    February 2, 2010

    Oh, that is a good one…..
    And calling me a goat fucker is something you thought of all by yourself?
    Good boy/girl, or what ever you are.

    I am just offering you the same hospitality that you folks (liars) are offering others.
    I figure if I potty mouth this site it will undermine the laughable topic at hand.
    See credibility goes far in my book, something of which this site lacks.

    I bet my assumption is correct about potty mouth girl, and I did say I would bet money on it.
    Id think that if you don’t care about facts, then you don’t care about truth, but I am willing to bet my truth is correct.

    Strange, my wife does not talk like trash mouth, oh but then again she is a Lady and quite pretty I might add.

  215. #218 neurospasm
    February 2, 2010

    @211 Scott

    Or post up any information that shows what he is doing within his protocol to be flawed or wrong.

    That’s not how evidence-based medicine works. It’s the other way around: you formulate an idea based on sound biology and physiology (and Crisler makes several good points in that regard), but then you follow with a blinded, placebo-controlled (or standard of care-controlled) trial with defined eligibility/exclusion criteria followed by measures of outcomes and statistical analyses.

    We (physicians and scientists) do this to protect ourselves from our own biases, positive or negative. In fact, when scientists get a positive result that confirms their hypothesis, they try everything to prove themselves wrong to be sure that they are indeed right. The docs here can comment more but you can fool yourself by only looking at patients who respond and write positive things on your discussion forums. That’s called “confirmation bias.” Not saying you didn’t benefit but there’s a reason that The Endocrine Society practice guidelines do not fully support Dr. Crisler’s protocol.

  216. #219 Scott
    February 2, 2010

    Trust me I do understand what you are talking about.
    But there is more than one diagnosed hypogonadism, primary and secondary.
    For some men even sleep apnea causes one to be lower in “T” values.
    Even the timing of ones blood test can show either low or high depending on the day.
    When they tested me I was low, but I took the test in the afternoon.
    John knows that timing of test makes a difference.

    How about the man that has low testosterone levels and does a study?
    Did you know that lipid profiles are seriously compromised with low testosterone levels?
    Or many men suffer from depression with low test levels?
    Or men that can’t even get an erection on Viagra when their levels are low?
    Or bone loss, anxiety, to the point of suicide?
    Giving this man a placebo would almost be criminal when all he wants to do is feel normal.
    I can comment on this because I was there.
    This is serious, and it is like you guys make fun and turn it into a joke or even worse, something bad.

    My point was many endo doctors don’t know how to treat certain things; the men get frustrated and then go to John for help. He does just that, he helps them.
    It’s not fair that some guys go years with problems and you guys make fun of this and actually suggest he is a profiteer.
    I don’t think that is fair, funny, nor even nice to the men that have suffered.

    I think if you dug deeper, asked questions on some of the boards as to why things work, it will open up your eyes.
    Testicular atrophy is a big deal for some men, as their testicles can shrivel up to the size of raisins; this can be an esthetic issue, women get boob jobs and nobody bats an eye, in fact it is encouraged, but for a guy to have HCG in his TRT protocol to allow him to look or appear normal, that is a crime?
    Not to mention the other effects that HCG mimicking LH and their effects on mood, but then again he is not ethical?

    You wont find one guy that he has helped to call foul, ethics, or anything but praise for John.
    Wonder if the original poster can say the same thing?
    Bet if I dug enough Id find something but then again you would blindly flame anyone that ever did any such thing.

    I have seem men that were in such bad shape, it is so sad to see, and totally not warranted.

  217. #220 El Picador
    February 2, 2010

    nobody bats an eye at boob jobs? they are *encouraged*?

    Maybe in your world, GrapeNutsTM dude. Not in mine.

  218. #221 Scott
    February 2, 2010

    My point is simple.
    Some guys understand what is going on with other guys, and can treat them with good success.

    Others might wait till the peer reviewed journals come into play.

    Sad, the guys in between do not get the attention they deserve.

    It is not the guys fault that need help, it is the slow wheels of progress that can help them.
    So, with that said, anyone that hinders progress to those that need help, are part of the problem.
    To that shame on you.

    Sad is the day that a man can’t act as one, any man that suggest otherwise needs to be socked in the face,
    I have seen said men, it is so sad.

    But for a woman or anyone to suggest otherwise is part of the problem and not the solution.
    Those that are part of the solution are part of the problem, and Dr. John is part of the solution.
    Shame on anyone else that suggest otherwise.

  219. #222 Scott
    February 2, 2010

    My point is simple.
    Some guys understand what is going on with other guys, and can treat them with good success.

    Others might wait till the peer reviewed journals come into play.

    Sad, the guys in between do not get the attention they deserve.

    It is not the guys fault that need help, it is the slow wheels of progress that can help them.
    So, with that said, anyone that hinders progress to those that need help, are part of the problem.
    To that shame on you.

    Sad is the day that a man can’t act as one, any man that suggest otherwise needs to be socked in the face,
    I have seen said men, it is so sad.

    But for a woman or anyone to suggest otherwise is part of the problem and not the solution.
    Those that are part of the solution are part of the problem, and Dr. John is part of the solution.
    Shame on anyone else that suggest otherwise.

  220. #223 B
    February 2, 2010

    @neurospasm

    you formulate an idea based on sound biology and physiology (and Crisler makes several good points in that regard), but then you follow with a blinded, placebo-controlled (or standard of care-controlled) trial with defined eligibility/exclusion criteria followed by measures of outcomes and statistical analyses.

    I have seen you and a few others suggest that you do see some logic in what Dr. Crisler is doing with his treatment practices. Rather than bash him for not doing the studies you think should be done, why don’t some of you knowledgeable scientist types contact him and help him get the ball rolling? I mean really, if you think there is potential for his protocol practices to be an improvement why not find a way to help get the studies done so that more people can be helped with better treatment? I’m not suggesting you help pay for the studies but it sure sounds like there should be people here who could help find ways to raise the funds and other necessities for such studies. Dr. Crisler is a pioneer in the field of male HRT. We need people to help doctors such as him, not attack them.

  221. #224 Micawber
    February 3, 2010

    Hey Scott,

    Don’t worry too much about Neurojism et al. They’ve had so many “rides” in Dr. Paypal’s curiously little “Blowjob Barge,” their poor little brains are too full of semen to think for themselves anymore. Imagine what that must be like? We should pity them. This also explains Katherine’s potty pie-hole. Take a look at that photo of Dr. PayPal and his “canoe” at top. If you look carefully, you’ll see her hand sticking up just inside the starboard hull.

  222. #225 Scott
    February 3, 2010

    Sad is the fact he throws other doctors under the bus for sensationalism.
    With that said, I find it difficult for one Dr. Peter Lipson to have any credibility to any of his bashings of other doctors when he himself has more than enough negative information on him on the net by other doctors.

    Common denominator here is he lacks credibility and his blog is nothing more than childish bullies in a school yard.

    What will be irony is the fact he is closed minded and won’t ever get out of his shell to understand the big picture of helping others.

    If one was to consider others as a resource, then one may draw upon others for a resource.
    Burning bridges and poking at others will only limit said resources.
    Sooner Peter realizes this the sooner he will accept growth in life.
    The posters on this site reflect this same attitude and will never be accepted as credible as well.

  223. #226 Lippo-sucked
    February 5, 2010

    PalMD,

    Thank you for your sincere response. Everyone will not always agree with you. When John Crisler claims to be ‘someone special’ you are 100% right that there will be critics. But to draw in patients confindence claiming ‘your expertise’ and you are not an expert; is 100% wrong. I appreciate your comments and the disection of John Crisler’s medical expertise. Kudo’s to those who have gotten help, those believers should also relize that these practices do not work for everyone. As far as intimidation, I am not intimidated and will always fight for what I know is right.

  224. #227 Michael R
    February 20, 2010

    I don’t think doctor Crisler even deals with patients who currently uses steroids anymore. He usually deal with HRT only as far as I understand it. He prescribes replacement dosages of hormones not supra physiological dosages.

    I really think it is tacky and unprofessional to be putting a doctors practice up for public scrutiny with out knowing the facts. He does not prescribe over the internet, a patient must first visit his office and do so once a year and have regular blood work drawn. A patient must also have a hormone deficit to be prescribed any hormone, which is also obvious since a replacement dosage wouldn’t help with any non medical purpose anyway. He is obviously under constant scrutiny by people such as your self so I am so sure all of the prescriptions he writes are thoroughly looked over by the powers that be.

    This is all about as tacky as those doctors on the E channel who try an guess using their personal expertise about what plastic surgery celebrities have had. This whole site is a true tabloid meant to excite people.