Our post on drugs and documents found in the Sedona resort room occupied by self-help guru James Ray requires a correction and a clarification related to the Michigan doctor of osteopathy who, according to publicly-available records, prescribed some of the drugs as detailed in these publicly-available documents.
1. Correction: Dr. John Crisler was referred to as an "Internet physician from Michigan." To be clear, he is a physician with an office in Lansing, Michigan, with an internet presence at allthingsmale.com. On his website, he lists an "Office Visit Fee - Office or Virtual" for $60.00 and "Anti-Aging Consultation" for $495.00. The patient information link on this page leads to a "Coming Soon" placeholder.
2. Clarification: According to his website, Dr. Crisler's medical practice specializes in "testosterone replacement therapy," or TRT, to treat hypogonadism. His frontpage prominently displays his talks and memberships in the "anti-aging" community. Some of the drugs employed in TRT are also used by bodybuilders but the apparent intention of TRT is to restore normal testosterone levels. In the case of Mr. Ray, the publicly-available document from the search warrant affidavit simply refers to the drugs as "treatment therapy."
For reference, this was the paragraph from the original post:
Dr. Crisler operates the website, allthingsmale.com, and offers in-clinic and online consultations. The frontpage of his site argues strongly that he is in the business of anti-aging therapies as shown lecturing to the American Academy of Anti-Aging Medicine and offering subscriptions to Life Extension Magazine. Further exploration of his website reveals that he specializes further in assessment of low testosterone levels, or hypogonadism.
I welcome any and all feedback to clarify this post. I would, however, encourage first that one read the original post in its entirety.
Questions came to light after two posts went up on discussion forums at the All Things Male MuscleChatRoom.com and the anabolic steroids section of Meso-Rx Men's Health Chat at mesomorphosis.com. We received 98 and 90 hits, respectively, from each of those sites (barely 5% of our last 4000 visits) and several commenters protested that TRT was being unfairly conflated with bodybuilding anabolic steroids.
It really pisses me off the way that he keeps referring to it as anti aging/bodybuilding, as thou it were some undercover way of getting steroids for bodybuilding enhancement.
d00d, do you not see the irony that you wrote this on a forum called "MuscleChatRoom?"
But I do stand corrected and will refer to this drug combination as testosterone replacement therapy. I suspect that as I age and face the inevitable decline of testosterone levels, I may become a candidate for such therapy.
My original post did make a lengthy point that, in medical terminology, testosterone is a steroid with anabolic activity but that the general public thinks of anabolic steroids as the semi-synthetic compounds sold on the black market. Testosterone, instead, is a naturally-occurring anabolic steroid that is available by prescription as a transdermal patch, gel, or injection.
The primary purpose of the post was to document the backstory on my ABC World News Sunday appearance last week where I was asked to comment on whether these agents had the potential for inducing in Mr. Ray behaviors that could have contributed to his actions observed at the sweat lodge tragedy in October. Last Sunday's article celebrating the life of Kirby Brown, a victim from Los Cabos, describes these events. I noted that I am not a board-certified endocrinologist, or a physician for that matter, and that I could only comment on the effects that the drugs could have in a hypothetical person. Moreover, I was not privy to Mr. Ray's behavior prior to being prescribed these drugs.
However, I'll leave it to the reader to peruse the forum threads at MuscleChatRoom and Mesomorphosis to observe the personalities of other TRT users. Props to anyman for rising above the fray.
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"d00d, do you not see the irony that you wrote this on a forum called "MuscleChatRoom?""
I suspect irony may be a skill lost with TRT...
Did I mention my spouse is an endocrinologist?
He starts his inappropriate use of hormones lecture with baseball card shots of Sammy Sosa and Barry Bonds as rookies and then after their careers took off. Their heads inflated like the image on the screen of the Wizard of Oz.
But I'm sure they were just repleting natural hormone stores.
Unfortunately, this is what happens when scientists objectively present an hypothesis based on scientific facts vs an impassioned but uninformed public who don't fully comprehend what the discussion is actually about. Not one person in the MuscleChatRoom presented anything other than personal opinions to refute the scientific evidence you described in your previous post and offered little but the hope that your balls fall off(!).
" I suspect that as I age and face the inevitable decline of testosterone levels, I may become a candidate for such therapy."
My fear is that sensationalism will embolden the witch-hunters who will then make obtaining treatment and medication difficult to obtain for those of use who have a legitimate medical need.
Why do you think that, fellow?
And what "witch hunters" would those be?
@ Professor in Training
Are you really expecting people to present scientific evidence here? Of course you are going to get personal opinions. The online forums mentioned are open to the general public. They draw a wide range of participants. Some are well spoken, some not so well spoken. Some are on TRT and others are not.
With some research you will find that the TRT protocol discussed is more common than you think. If you are expecting Sunday morning blog posters to prove anything to you, you might want to reconsider your training.
It is clear that this article was written by an author with no familiarity of Dr. Crisler or the fact that this specific protocol is being used by many in the TRT field.
LL, medicine is not about being well spoken or being supported by unnamed persons in an unrecognized field.
First I'd like to address pascale's proudly cynical and ignorant comment.
There are many people who stop by the all things male forum whose endocrinologists have prescribed them testosterone, hcg, and arimidex in combination, as well as other drugs such as clomid.
Dr Crisler is in no way an internet physician. You MUST see him in person for the 1st consultation. After that, you can do followups over the phone for up to one year, when you must see him in person again, before you can continue the phone appointments.
Do you realize how much better our lives would be if more doctors worked this way? Sitting there in a waiting room for 45 minutes vs just answering your phone?
If you actually paid attention to what you were watching in dr crisler's lectures, he never glorifies bodybuilders or supraphysiological hormone levels, and shows slides of bodybuilders who have died from renal failure from steroids. He also takes digs at them by saying whenever a new hormonal compound is discovered, bodybuilders are the first ones to figure out how much of you can take before it kills you.
Dr Crisler doesn't own the name musclechatroom.com or have any connection to the website. It's run by someone else who offered him his own forum area called "all things male" named after his medical practice. The forum solely exists for his patients and patients of other doctors to discus their progress, support, and hopefully learn from each other.
The vast majority of the discussion on this forum is about impotence & general erectile function and pervasive lethargy and fatigue.
There are many people on the board, me included, who are consideraly overweight in the range of 30 to 100 pounds or more with debilitating fatigue. There is very little talk of workouts, weights, etc, we occasionally discuss nutrition.
All of the guys there are suffering, or were recently suffering, from low hormone levels, many of them are older, are depressed, have troubled sex lives, and have never done steroids or knew anything about them before they were diagnosed with hypogonadism.
In my case, I went to my GP for fatigue, he, thankfully, knew to test for testosterone as well as all the usual suspects. My testosterone came back so low it was outside of the reference range. He said "well perhaps your testosterone has always been low and this is just normal for you, i don't know what to make of it i'm outside of my depth. I can refer you to an endocrinologist" Now, on the one hand its great he said he was out of his depth and said I should see an expert, on the other, it shows how broad the level of misunderstanding is about hormone replacement that lower than the reference range and every hypogonadism symptom in the book could "just be normal for you". Perhaps pascale's spouse comes from this school of thought.
After I did some googling for hypogonadism and treatment and searching for local doctors who treat it, it quickly became apparent it was very difficult to find a physician who would treat it and there were many horror stories of general physicians, endocrinologists, and urologists improperly treating people with 6 week waiting lists while they remained mired in agony being put on and taken off their medications to test baseline vs medicated readings all wasting months and months of their time while they continued to suffer often worse than before they had started due to the see-sawing of these physicians inexperienced with treating male specific hormone deficiencies. Androgel is still a pretty new drug and until one of the giant pharmaceutical companies puts out something that costs $350 it's not a legitimate therapy, right? For the record, urologsts seemed to work out for more men than endrocrinologists did in this area, GP's were batting around 0.0.
So eventually through the searching process I found dr crisler and his patients, watched a lecture or two and read his white papers on TRT, and HCG, and considering he was only 2 hours away it was pretty clear he was my guy.
Before I made an appointment, I did my own research on testosterone therapy to look at its success rate and side effects and make sure I felt like pursuing it made sense for me. I read the abstracts of many studies on pubmed and medline (and there are many testosterone studies at this point), read the meta-analysis summaries regarding the old (now debunked) fears of prostate cancer & heart disease, etc. The outcomes were almost unanimously positively, with quality of life factors improving in most men, with the big drawback of it exacerbating or perhaps even causing sleep apnea. I already have sleep apnea (which i treat with a cpap) so I had to give this serious consideration. I have an auto-adjusting cpap that senses when I need greater pressure and applies it, so most likely I'm compensating for any change has happened in this area, however that doesn't necessarily mean I may not be afflicted by a change it apnea severity if I am indeed experiencing one. All things considered this seemed like a reasonable risk to take on with my therapy.
I read study abstracts of deficient young men, old men, obese men, and normal healthy men to test the effect on things like cholesterol profiles in healthy non-deficient men.
My point is, for myself, just like many other people, I approached this seriously and critically as an attempt to cure an illness or otherwise increase my health. I didn't take it on frivolously as some sort of incredibly expensive extra-curricular activity to amuse myself or grow my head larger.
I'm 300lbs, have metabolic syndrome, am basically type II diabetic, never had _any_ muscle mass, whenever I've tried doing a bench press in the gym everyone would crack up because i could barely lift the bar by itself.
Each person on that message board and that dr crisler treats has their own story like my own and isn't spending $500 at the doctors office for fun and games.
As to why people came to your blog from the other muscle forum the problem is that people with actual medical problems have basically nowhere else to go online to discuss their issues or learn more than the websites run by steroid abusers because it's just not a very popular mainstream topic yet, although suzanne somers seems to be changing this for better or worse.
The other reason is that guess what happens to a sizable % of steroid abusers? They destroy their ability to make their own hormones and become weak depressed and impotent.
I can hear pascale saying "Great! that's their Just Desserts!" in his head right now, but do we deny someone metformin or insulin because "they're obese and gave themselves diabetes"? So these guys then turn to urologists and endocrinologists who don't trust them with prescription medications because they've already been black market steroid abusers, and have no else to even turn to but someone like dr crisler and other "anti aging" doctors because like how it happened or not, their life and health is still destroyed at the end of the day and they have a right to treat it too. Just like a heart patient who ate mcdonalds every day his whole life, and someone who got aids from unprotected sex.
The reason why some of the guys may have been less than articulate in their comments on your original post, is because they all feel beaten down and frustrated and are used to doctors "not listening to reason". So they just vent angrily because they feel like that's the only thing they can do, since their pleas are inevitably always ignored anyway.
Frankly, I can identify. I don't even know pascale and I already hate him because he wants to get between me and a normal life to preserve this abstract idea he worships that has no real meaning in his own life whatsoever. He watched 2 minutes of a lecture saw a baseball player and now he's an expert. We all understand how easy it is to be a cynical blowhard. Believe me the cynical thoughts I've had about pascale from reading 3 sentences he wrote are extraordinary. I picture him returning and reading my comment and deciding my hormonal problems don't count because I'm overweight, they must be self-inflected, why don't I just diet and exercise, and on & on. Basically, a sh*thead. But I'm also aware none of that is true, and this is a fictitious caricature of pascale I made up in 10 seconds in my mind because I'm not 8 years old.
What's his excuse?
what i parsed out of that is that a real doctor diagnosed you with low testosterone and referred you to an expert. Because of your own preconceptions or personality disorder or whatever, you declined that wise advice and sought out some internet doc with no special expertise.
Smart.
You have poor reading comprehension.
IOW you had a preconceived notion that your doctor's advice was not going to work out, so rather than taking the advice you took a crash course at Google U.
huh? If i had preconceived notions my doctor's advice was not going to work out, I would have ignored him instead of seeking out an expert as he suggested. Guess what? I found one.
I have no idea what an internet doctor is. It's illegal to practice medicine online as far as I know. I called a receptionist and made an appointment. I drove two hours. I sat in an office with a doctor and 2 receptionists. He wrote me some prescriptions. He called me in 6 weeks.
Crazy huh?
If only more patients had this personality disorder of reading study abstracts for their conditions and being a little bit more educated, maybe they wouldn't do ridiculous things like demand antibiotics for viral infections...
And your experts board certification? Expertise as judged by???
Are you guys high? How can someone without board certification write prescriptions? He's a graduate of MSU medical school, board certified, etc. He's a doctor? Hello?
Well, HH says he followed the advice of his PCP. So this guy's gotta be board certified in endocrinology, duh, PalMD...
No, as I stated, he is a licensed physician and therefore can do just about whatever he wants. He is not however boarded by the main family med board or by the main endocrine board. This doesn't mean he can't practice, but most docs who claim expertise in a field are board certified.
http://www.abms.org/About_Board_Certification/means.aspx
He is not however boarded by the main family med board or by the main endocrine board.
...oooooopsies, HH!!
So if I had gone to a urologist (which as I stated I almost did) would I still not be following the advice of my GP? What planet do you guys live on? Talk about having preconceptions.
Again, poor reading comprehension. Why do I care if he's board certified in endocrinology or "the main family med board" if he is effectively treating 100's of patients and this has been his sole area of practice for almost 10 years?
What do you tell all of the guys who come to him after their first, second, or third endocrinologist made them worse? Resulting in them getting in an airplane and flying to another state rather than driving to the 4th board certified endocrinologist guy?
Grow up. Again, it's easy to be a blowhard when it doesn't effect YOU. Get over it.
You should care that he demonstrates to his colleagues a superior level of competence, and should rely less on the testimony of "100s of patients" or your own internet research.
I can tell you from many years of experience that board certification is difficult, far from impossible, and really a minimum bar.
Urologists are also competent to treat hypogonadism depending on their particular focus.
I should also point out that "Big Pharma" has for years been pushing for more diagnosis of male hypogonadism and "male menopause" despite the paucity of data.
"Again, poor reading comprehension. Why do I care if he's board certified in endocrinology or "the main family med board" if he is effectively treating 100's of patients and this has been his sole area of practice for almost 10 years?
What do you tell all of the guys who come to him after their first, second, or third endocrinologist made them worse? Resulting in them getting in an airplane and flying to another state rather than driving to the 4th board certified endocrinologist guy?"
proof please
Also, Hypogonadic Henry, 'WAAAAAH I'M FRUSTRATED AND HYPOGONADIC AND TIRED' does not excuse you or anyone else from acting like an adult or give you free reign to be an unreasonable arsebag.
"After I did some googling for hypogonadism and treatment and searching for local doctors who treat it, it quickly became apparent it was very difficult to find a physician who would treat it and there were many horror stories of general physicians, endocrinologists, and urologists improperly treating people with 6 week waiting lists while they remained mired in agony being put on and taken off their medications to test baseline vs medicated readings all wasting months and months of their time while they continued to suffer often worse than before they had started due to the see-sawing of these physicians inexperienced with treating male specific hormone deficiencies. Androgel is still a pretty new drug and until one of the giant pharmaceutical companies puts out something that costs $350 it's not a legitimate therapy, right? For the record, urologsts seemed to work out for more men than endrocrinologists did in this area, GP's were batting around 0.0."
Oh fuck, one of those 'IT'S ALL BIG PHARMA'S FAULT!' conspiracy theorists. It costs $350 partially because of testing and ensuring quality.
Unlike your vaunted DOs and other crap like that who jump to conclusions that often kill people, I would guess the reason that MDs are considerably more circumspect in their prescription and probably considerably more reluctant to prescribe various drugs is the fact that there is a good deal of regulation that they must deal with, they must depend - and rightly so - on studies and several of them, and have good reason to mistrust people, for example, who use steroids to misuse another medication they're given (PalMD, can you verify that anabolic steroids destroy your ability to produce more hormones?).
Guys. I read skeptical blogs daily. I'm a regular reader of http://www.sciencebasedmedicine.org/ I understand quackery, anecdotal evidence, and plain old bullsh*t. Stop filling in this caricature of who you think I must be to help support your tired biases. Of course I realize "Big Pharma", (again, not the sort of person you're trying to imply with that) is pushing for male menopause, I more or less stated that. And yup, that's the only reason there is growing awareness of hypogonadism, otherwise it would continue to be summarily dismissed and/or mistreated.
There is not a paucity of data, how would you even know? How much research have you done? Which article did you read someone else you think is smarter than you say "despite the paucity of data" that makes you confident repeating it authoritatively like you've ever spent a second of your life dispassionately examining it. Yes, I know about the women's health initiative. Yes, we'll continue to learn more about hypogonadism and other hormone supplementation. The wyeth combo pill that was happily dispensed by all the board certified doctors as sole estrogen replacement for decades was actually creating worse outcomes in mortality in every way measurable where estrogen alone was only, but still, increased stroke risk. In the larger danish studies, it fared the same, but other methods of estrogen supplementation actually decreased mortalities from stroke/heart attack/etc as was the previous conventional thinking that the wyth pill was accomplishing.
The moral of the story is, all physicians are beholden to the same set of problems facing them in medicine. Being a board certified endocrinologist doesn't make you magical or give you super powers. My doctor reads the available research, treats patients, and examines the results. The big difference is, he specializes in one thing 8 or more hours per day, instead of having 1% of their patients seeking hypogonadism treatment which is not really pushing an impetus to develop an expertise in it.
Katherine: Since you're none of the above, what's your excuse for acting like an ass? The proof is his patients stories on his messageboard, and others. Come post on it and solicit some life stories. Since you appear to be a sociopath, it will make for some good laughs for you. But at least you'll get some of the proof you're looking for.
On what planet are DO's regulated less than MD's? They've been virtually identical for like 80 years. They go to the same medical schools, have the same residency requirements, they're basically identical to MD's, and have to comply with every law and regulation and competence test MD's do.
My GP is an MD. I really didn't seek out an DO. I could care less, I've been to both throughout my life and have seen no difference personally. No one's ever tied any cranial-whatever-1915-spanishflu-nonsense on me so far.
In most areas, there's very little difference between DOs and MDs (at least not for those who trained in the last 20 years or so)
First of all if a person is book smart is one thing, but practicing what they learn in medical school is another. It is not the fought of endocronologists but rather the stuff that they learn in medical school. I also work in tandem with a MD that thinks outside the box same as Dr J has. We have learned alot of valuable information from Dr Crislers contribution to his work in the HRT field. IF you want to grow old and feel like an old fart then that is your choice, but we practice what we preach and are living example of how Dr J work has made a dramatic impact on our own personal lifes as well as hundreds of people that fly in to see us on a weekly basis as well. People are just sick and tired of being lost in the system because Endos are lazy at running a complete battery of tests. Dr J and people like our selves are the ones that have do damage control from endos that are afraid to treat the person instead of treating numbers. OH you 301 ng/dl range is 300-1100 your normal nothing wrong goto see a shrink. I cring when I hear stories like this because I was also a victim of the system as well for 3 freaken years because they told me I was normal. HAHA now I am sitting on the other side able to give proper care these people need for once in the life. The best gratification I get is when they return to there GP who told them to seek counseling take an SSI. After 8 weeks of coming to see dr's like DR J and other expert in the field they walk in to the office a new person then dr comments counseling and SSRI must be working. The person just kindly smiles gets a copy of their medical records walk s out never to be seen again. Now that is gratification in and among itself..
Wow. So many unfounded assertions, so little time...
Hypogonadic Henry, #24:
Hypogonadic Henry, #25:
Anyone see anything inconsistent about these two quotes?
@PalMD, you are a doctor, correct? If I remember correctly you said that you are a MD Internist? You also said that you treat patients for hypogonadism, and that if you have problems you refer them to an Endo, correct?
You also say above that there is very little difference between a MD and a DO. If that is the case why do you act like Dr. Crisler is not qualified to treat patients for hypogonadism?
I don't understand why you are basically attacking a fellow doctor who is obviously a specialist in male HRT who you have stated is just as qualified as you are to treat hypogonadism.
Being a board certified Endo does not make them an "expert" in male HRT. It makes them a jack of all trades in endocrinology.
However, I would argue that someone who specializes in male HRT and that has been their focus 100% for the last decade or so is most likely an expert in that filed of treatment, Endo or otherwise. How many doctors, Endos or otherwise do you personally know who have dedicated as much time as Dr. Crisler to specialize in the treatment of male HRT? I'm guessing the answer is a big fat zero.
You should read Dr. Crisler's work that is freely available, and then do some real research on the subject for yourself because you obviously haven't. You might just find that there are hundreds, possibly even thousands of published studies to support Dr. Crisler's treatment practices.
You need to read a little more closely. I didn't say he isn't qualified to treat it but that it does not appear that he is an expert as claimed. I also cannot find evidence that he is board certified, which is kinda disappointing.
He is a good Dr and knows what he is doing and cares very much about his patients.
How can you be attacking this Dr like this?
He has helped so many out.
Something like this always happens to a Dr at some point the patient may do something that trys to make the Dr look bad when it is actully the patient.
Dr Crisler doesn't seem to have published any scientific research articles that were peer reviewed so I'm assuming that you are referring to the links on this page of Dr Crisler's website. These are blurbs for mass media consumption, not research.
The majority of commenters here are scientists and/or physicians who are trained to objectively analyze data collected under controlled experimental conditions and to formulate conclusions based on the evidence presented. Heated and impassioned, but ultimately anecdotal, testimonies from patients do not constitute scientific fact.
Go back and read Abel's original post and note that it was a scientific discussion based on scientific evidence and was not a personal attack on Dr Crisler.
My Dr is not board certified and specializes in family medicine and also HRT.
Professor in trining,
Why do board certified Urologists and board cetified endocrinologists among other Physicians ask Dr Crisler for advise even after knowing what background he has?
He knows what he is doing board certified endocrinologists sometimes do not understand things as well as Dr Crisler as he understands and treats such patients.
To talk adversley like this about the Dr is attacking him, are you attacking all Dr's that prescribe medications such as Dr Crisler as endocrinologists Rx these medications as well on some occasions for the same reasons as well as other Physicians.
How many Dr's actually treat HRT.
qetzal, katherine was specifically asking for proof that he has patients who go to him after seeing endocrinologists.
She asked for proof of this.
Considering I've read at least 10 of these experiences over the last 6 months, and the depths of honesty people plunge on this topic going into extensive details on their erections and whatnot, and general lack of obvious motive, I'm not inclined to think they're lying about their previous medical history before finding a better or in some cases still trying to find a better doctor.
Again, many people on dr crislers board don't even see him. Some of them rotated endos and urologists 4 or 5 times before they found one that could help them. Some of them give up and make the trip to see dr crisler.
I have to say I'm kind of blown away by how qetzal had to have _intentionally_ used my quote out of context. You're making a snarky implication about being science minded while selectively misquoting to me to convince someone who isn't paying close attention I said something I did not, rather than contributing anything substantial to the conversation.
This has reached a new level of bizarre.
Anyway, you guys have totally derailed the point of all this.
The point isn't whether someone should see dr crisler or an endocrinologist or a urologist or whether I'm the biggest idiot on the internet and the rest of his patients must be as well.
The entire point of my post was simply to state the fact that he actually believes he's treating a medical condition, and people who believe they have a medical condition, who couldn't be farther from bodybuilders, like myself, go to see him, and he's not a random jerkoff steroid dealer dirtbag or a mythological "internet doctor".
You can say whatever you want about the validity of the treatment or the validity of his credentials or whatever suits your fancy to distract from that point because it's clear you decided via instant-analysis he & everyone involved are clearly incompetent and you want to be sure blanket negativity prevails under any circumstances.
I am rather confused on the whole matter. In the original posting there is a picture of a letter from Dr. Crisler stating that James Arthur Ray is currently on the following medications:
Testosterone Cypionate
HCG
HGH
Arimidex
Finasteride
However, doing a internet search on his name I came across this youtube video that had been posted on June 18, 2009:
http://www.youtube.com/watch?v=B8e7HERXA3s
Listen to this video carefully. At approximately 1 minute Dr. Crisler says:
The question I have is between the time of that conference and the letter was written why did he have such a change of heart concerning finasteride?
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.
Maybe he didn't prescribe it? Maybe the patient was already on it, doing ok and demanded it and he complied? Who knows.
Another thing is he states categorically he will not prescribe HGH, the only thing in that territory he says he would prescribe is GHRP-6.
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? ghrp-6 is $30. I suspect, based on what I've seen, and his public pronouncements and advice, he only prescribed the guy the testosterone/hcg/arimidex and just wrote the letter covering the legitimacy of all his medications. But maybe he did write them all for him for whatever reason I have no way to know.
hey, that musclechatroom thread you link to with all the geniuses coming over here has been pulled. you maybe think that the good dr is a bit embarrassed by his followers ranting and raving?
I was not aware anecdotes constituted proof.
Some articles would help.
Also, don't do what PC did and pull studies that don't even have anything to do with the argument to support your idiocy.
@Hypogandic Henry
Fair enough. I was assuming everything that was included in the letter he signed was prescribed by him.
As you say, I have no way to know.
Sociopath? No. Just dispassionate enough to not be swayed by personal accounts.
Katherine, you are really failing at trying to sound smart here.
If someone says they rode the bus this morning, or ate a peanut butter and jelly sandwich for breakfast, do you demand proof?
If someone says they saw an endocrinologist, and you've decided in advance they're lying to you for some bizarre unfathomable reason, what's the proof you're expecting to find exactly?
Do they need to photocopy their records to you, or do you need to come out and visit them personally, and accompany them to the doctors office where the two of you can be introduced and you ask them personally if they've ever met the patient before? What if the doctor is a clone, a patsy, or has just been paid off to tell you anything you want to hear?!?! Oh lord, where will it end! The burden of proof must be met !
Hypogonadic Henry, here's my problem with what you've said so far:
Dr. Crisler has demonstrated that not only is he not board-certified (why? Did he try to become board-certified and not pass the required exams? One has to inquire), but he is most definitely not an expert (he has nothing published on the subject).
Your standard of 'proof' is a bit like the shit on commercials for those pads that they say detoxify your body but really don't. Testimonials aren't proof. I want studies.
Yes, hypogonadism is a medical condition. I can acknowledge that. Yes, people are actually prescribed testosterone by actual board-certified endocrinologists. But why the fuck did you go to Dr. Crisler, who is not a board-certified endocrinologist, instead of someone who actually is?
Katharine, Some Drs know little about prescribing HRT and ignore the fact that the patient may have a condition.
Do you know a good Dr who knows anything about male HRT?
http://www.aace.com/resources/memsearch.php
and this
http://www.aace.com/resources/memsearch.php
Katherine, I think you're so stupid you forgot the question you asked me. You quoted me saying people go to dr crisler after they've seen endocrinologists, and asked for proof. That was it. You're brain damaged. You've also said at least 3 other really bizarre & erratic things. I can't help you any further. Carry on.
@Hypogonadic Henry #36 & #37:
Katharine asked for proof in response to your statement about Dr. Crisler:
I assumed Katharine was asking for proof that Crisler has treated 100's of patients effectively, after they'd already seen endocrinologists. I guess your point was only to show that Crisler treated 100's of patients that had previously been to endos, without regard to the effectiveness of his treatments.
In light of that, I agree that my juxtaposition of your two statements was inappropriate, and I apologize.
However, it was not an intentional quote out of context. It never occured to me that you were arguing only about the number and history of the patients he treats, rather than the effectiveness of his treatments.
qetzal, regarding people seeing endocrinologists and then seeing Dr. Crisler.....The fact that they saw the endo's first and felt they were treated poorly by them, but are still working with Dr. Crisler should tell you something about quality of treatment. Most endo's won't treat high estradiol and won't use hCG to keep the testicles functioning.
If you go and read several of the message boards with sections dedicated to hypogonadism/men's health, you will read many testimonies from people who were initial treated very poorly by endo's prior to finding a doctor who could treat them properly. The doctors they end up working with are usually not endo's. As HH pointed out, there is nothing for these people to gain by lying about their experiences with endo's.
I guess until you have hpogonadism you just won't do the necessary research or have the life experience of truly crappy care from a highly educated, board certified, endocrinoligist.
For all the men posting here who are bashing one of the few doctors out there who truly cares about men's health.....Good luck with your endo when you find yourself with hypogonadism.....you're going to need it.
B,
Testimonials tell us next to nothing about the quality of Dr. Crisler's treatments. Only that there are a bunch of people who believe his treatments have helped them.
There are also people who believe that homeopathy really works, that caffeine enemas "detoxify" you, and that you have to clear yourself of body thetans and engrams to reach your true potential. All of these people can point you to hundreads or thousands of testimonials as 'evidence' of the truth of their beliefs. I hope you'll agree that the existence of those testimonials is not a reason for us to believe in all those things.
Please note. I am NOT attempting to imply that Dr. Crisler's treatments do not work, or that he is a quack. I don't know a thing about the quality of his treatments. I just know enough not to judge him based on testimonials.
Qetzal, DO you suffer hormone problems?
G, I find your method of argument very convincing.
qetzal, actually testimonials are quite useful in this case because the only way to truly compare doctor performance is by patient satisfaction. You aren't going to find scientific data comparing one doctors quality of treatment to another. I know which doctors I have been too who were good at what they do and I know which one's were not.
If many patients have been to endo's and weren't happy with their treatment (i.e.: still felt like crap with no improvement in symptoms, lab results not optimal or maybe even got worse) and then went to another doctor and their symptoms were resolved and lab results were optimal, then you can't discredit those facts. If you want scientific data you aren't going to get it because it doesn't exist.
Professor in Training, I never said that Dr. Crisler had any published scientific research articles. But if you read his "blurbs" (as you call them) and then do some research (I posted a link under the original blog post regarding HCG) you would see that Dr. Crisler's treatment practices are backed up by ton's of scientific data that most endo's ignore.
His "blurbs" are there to help educate all the doctors who don't understand how to properly treat hypogonadism.
I see that none of Crisler's supporters have read this:
http://scienceblogs.com/whitecoatunderground/2010/01/dr_crisler_i_fear_…
His ethical practices are HIGHLY suspect.
Crisler's supporters are far too trusting, I think.
An essential part of good logic is not being afraid to call bullshit even on your friends.
B,
Even if testimonials really are the only available evidence, that doesn't suddenly make them "quite useful." They still remain really lousy evidence of treatment effectiveness. A dollar isn't suddenly worth more just because it's the only money you've got.
Seems a shame that Crisler has a way to treat patients that's way better than the std. endocrinology approach, and is based on "ton's of scientific evidence," but he's unable or unwilling to publish it in a reputable form. If Crisler really wanted to "help educate all the doctors who don't understand how to properly treat hypogonadism" as you say, he wouldn't waste his time publishing stuff in the lay press or writing reports to put on his website. He'd at least start publishing some case reports or case series in reputable medical journals.
He's an MD; he knows how it works. MD's don't make treatment decisions based on articles in Healthy and Fit Magazine. They make treatment decisions based on articles in JAMA or NEJM or maybe Clinical Endocrinology.
But, do you know who does make decisions based on articles in Healthy and Fit Magazine and interviews on Will Carroll's Baseball Prospectus Talk Show? I'm guessing bodybuilders who want someone to treat their steroid-induced hypogonadism do. Not to mention men who are concerned about aging and are willing to throw money at anyone who suggests he can keep them young.
Funny how all of Crisler "publications" are in venues that are just perfect for appealing directly to credulous men who want someone to sell them the fountain of youth.
Of course, just because Crisler publishes in places like that doesn't prove he's doing anything wrong or unethical. But remember, the more it walks like a duck and quacks like a duck, the more you should suspect it just might be a duck.
really, where is all this evidence? i have made earnest attempts at finding legit studies, and have found little more than small pilot studies. there seems to be little standing evidence for benefit, and some notable risks.
Those of you who are suggesting that an endocrinologist would be a better choice compared to any of thousands of doctors across the country specializing in TRT, you are living in a fanatasy world. Mainstream endocrinologists are practicing 1950's level medicine constrained by the limitations imposed upon them by health insurance corporations and Medicare reimbursement rules.
Ask an endocrinologist about testosterone. When they reply. "what's that?" don't be surprised. You would have a better chance of getting Androgel from your urologist than from an endocrinologist. How much endocrinology do you think your urologist knows? Probably less than you, the patient. Sad but true.
Before you defame and smear a reputable physician, you better have some real evidence. So far, none has been presented, and what we have here on this web site is cause for civil litigation for defamation of character and libel. You ought to be ashamed of yourselves stooping to the level of the lowest of the low.
Pardon me, but if an endocrinologist says "what's that?" when asked about testosterone, I think you should report them to the state medical board, because they are obviously unqualified.
My uncle is a urologist. I should ask him if he knows what testosterone is, given your assertion that urologists probably know less than their patients. (Mind you, his primary specialty is kidney transplants, so hormone replacement therapy could well be outside of his normal sphere of practice.)
"Ask an endocrinologist about testosterone. When they reply. "what's that?" don't be surprised. You would have a better chance of getting Androgel from your urologist than from an endocrinologist. How much endocrinology do you think your urologist knows? Probably less than you, the patient. Sad but true."
If you have actually asked an endocrinologist what testosterone was and gotten that answer, you are either talking to an incompetent endocrinologist or you are not talking to a physician at all.
This is something EVERY physician learns about, if I remember correctly.
Shit, if you take a college biology class, you know what testosterone is.
I would argue that you probably have not asked an endocrinologist this question.
Furthermore, I argue you are full of shit.
"But, do you know who does make decisions based on articles in Healthy and Fit Magazine and interviews on Will Carroll's Baseball Prospectus Talk Show? I'm guessing bodybuilders who want someone to treat their steroid-induced hypogonadism do. Not to mention men who are concerned about aging and are willing to throw money at anyone who suggests he can keep them young."
It is common knowledge that many of these bodybuilders and hypogonadic men are far too stupid to read a scientific article. Because the vast majority of our species is, unfortunately, far too stupid to read a scientific article.
This is only a small part of why I cannot stand 99% of humans.
Katharine,
I think you go too far in calling so many people stupid. IMO, the biggest barrier to understanding a scientific article isn't intelligence; it's training, experience, and motivation. I believe most people are easily intelligent enough.
Be that as it may, my point was that we can identify Crisler's target audience by looking at where he publishes. If he wanted to educate other doctors, as B claimed in #57, he'd publish in venues that doctors are likely to read - e.g. medical journals.
But he doesn't. He publishes in venues that are likely to be read by potential new patients. A charitable interpretation is that he's trying to let possible patients know about a treatment that he truly believes can help them. The more cynical intrepretation is that it's basically just a marketing exercise. Given everything I've seen to date (including his consent form that PalMD discusses here), I lean toward the latter.
@66
qetzal,
First off if you sat and personally talked to Dr. Crisler as a patient you would most likely have a very different view of him. He is without a doubt in my mind a doctor who is very caring and concerned for his patients health and well being.
Yes, he puts information out in forums where the people most likely to require his help will find it. In my mind that is a great thing that more doctors should do. If you know you can help people why wouldn't you put the information out there so that they know there is someone who can help them? As for his documents, many men have taken those documents to their doctors who have used Dr. Crisler's treatment principles to better treat their patients. That is also a very good thing in my mind and it is helping educate other doctors.
The ridiculous accusations that there is no data to backup what he does is just plain mind numbing to me. He basically does what is in the endo guide that someone posted but doesn't stop there. If someone needs to be a little higher in the normal range of testosterone, he is not afraid to raise it a bit. If they need to be lower then he will lower it. If he sees that their estrogen is going too high he will first try to adjust the testosterone levels to bring the estrogen back down. If that doesn't work then he will try using an aromatase inhibitor but only if absolutely necessary. And yes, he rules out other potential problems that may be causing the low testosterone before starting treatment.
What he does can't be studied because the treatment is different for every individual. He does not lock himself into a cookie cutter treatment of "oh, your testosterone is mid range now, so you are fine". He will fine tune things until the patient is feeling good again.
All the studies regarding the medications he uses and what he uses them for have been done. There is nothing new that needs to be presented to support his treatment practices.
As far as Katharine goes, she is obviously young (I believe she said she was 21?) and still a bit immature and it shows in her comments. Although there is no doubt in my mind that she is a very intelligent person.
After reading a lot of posts here it is obvious that most people here are so rapped up in their technical, clinical thinking that sometimes they just aren't using good old common sense.
B
How did he decide that it was appropriate for him to go beyond the "standard" endo approach? How does he know that someone needs to be a little higher or lower in testosterone or estrogen or whatever, especially if their levels are in the normal range? He has to be using something to make such judgments!
Of course it can be studied! How else could Crisler have come up with his superior treatment approach? In order to decide what things to do (beyond the standard guidelines), he had to actually try them and see if they worked better or not. If Crisler did it, other MDs can as well.
Now, perhaps Crisler's treatment can't be studied using placebo-controlled double-blind protocols. If that's what you mean, then fine. But it CAN be studied. If Crisler is convinced that his approach is objectively better, he should be able to describe the evidence that convinced him, as well as exactly how he makes his patient-specific decisions. Then other MDs and endos could try his approach and see if it works for them too.
Are you saying that there ARE medical publications that describe Crisler's treatment approach? If so, great, but why doesn't Crisler cite them? Why not tell us all that he follows the approached described by Schmo et al. in J. Endocrinol. Vol. X, pp. Y-Z?
Or, are you saying that each individual thing he does is backed by some study somewhere? If so, it's really naive to claim that nothing more is needed. It may be well established that Drug X alters the levels of hormone Y, while Drug W alters the levels of hormone Z. That doesn't prove that it's good to use Drugs W and X to adjust hormones Y and Z a little bit higher or a little bit lower within the normal range in hypogonadic men.
Once again, let me acknowledge that Crisler's approach may well be better. If you're happy with it, then I'm sincerely glad to hear it. But if you or Crisler want to convince the larger medical community that his approach is objectively better, you need more than testimonials and poorly-supported assertions. Crisler needs to put together a clear description of how he treats his patients, including how he decides to do each customized thing he does, and then describe a series of actual patients that he's treated, how he treated them, and what evidence shows that the outcomes were better than expected from the standard approach. Then he needs to publish that in a medical journal, so others can evaluate it and (hopefully) reproduce it in their own practices.
"I suspect that as I age and face the inevitable decline of testosterone levels, I may become a candidate for such therapy."
I suspect you may be right. If you are fortunate, you will, like me, be among the vast majority of hypogonadal men who respond adequately to traditional TRT (Androgel, in my case). If you are among the small minority of hypogonadal men who continue to suffer despite traditional TRT, I also suspect that you are likely to become more interested in the off-label use of less traditional ancillary medications.
For background, I want to mention that I am a 53 year old professional mathematician but I have spent quit a bit of time studying the philosophy of science and skeptical literature. It is a pastime of mine to oppose pseudo-science on the internet.
The fight against pseudo-science is commendable but after having read the comments at a few blogs about Crisler, I must say I think there is a great deal of over reaching on the part of the skeptics.
In fact, this is the first instance I know of where I would say that the skeptical side of the argument is being poorly argued. Much of the mainstream medical literature is far less scientific than most realize (poor statistical models etc.). Medicine is not yet physics. On the other hand, practical matters of clinical experience, even unpublished clinical experience, are being given short shrift here in service of a simplistic and overwrought notion of scientific rigor (medicine isn't really as up to this as you think).
Despite this, there actually IS published evidence that Crisler's use of HCG, for example, is effective. It is certainly possible to be an expert in something, at least in an important sense of the word, without having published fundamental research. Indeed, this is not and should not be the main concern of a clinician.
I have yet to see real evidence (remember that??) for anything other than that Crisler's practice is extremely focused and visible and that he has possibly made some technical errors of the type I expect is made unknowingly by doctors everywhere including PaulMD (ironically a sort of internet guru himself).
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" (LOL) by multiple double blind studies are sorely mistaken. Much good medicine is based on clinical experience and educated common sense.)
3) Those who conclude that Crisler's methods are unsound by appealing to his personality (ego, Messiah complex, odor 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?)
The self proclaimed guardians of mainstream evidence based medicine have been very hasty and sloppy here.
Now my personal experience. I am being treated by an MD for low testosterone. She knew nothing about the use of HGC until I brought her an article about it from a top endo journal. I am still not taking HCG and have no connection with Crisler or an anti-aging group.
As for endocrinologists; well, I called the offices 4 of them in my city and none treat older men for low testosterone.
It begins to appear that this topic is not even on the radar of many endocrinologist.
In short, while Crisler's practice is certainly out of the ordinary, it is far from clear that he is guilty of any "woo woo" medicine.
Damn JLee, I think I just found a reasonable man.
JLee:
Disclaimer: I'm not an MD either, and I don't know the medical literature on this topic. That said...
1) One study is rarely if ever enough to confirm that a given treatment works for a given condition with an adequate risk/benefit profile. That's especially true when the definition of "works" hinges mainly on subjective measures such as how a patient feels. If you're familiar with pseudoscience, you no doubt understand this already.
Nothing says the doctor including it has to be the one who did the research. That's not the point. Crisler claims his treatment methods provide dramatically better results than the "official" treatment guidelines. The question is whether he can back that up with adequate evidence - his own or someone else's. Maybe he can, but I haven't seen him do so yet.
2) Extensive clinical experience certainly matters, but's that doesn't mean it's enough by itself. If you've studied pseudoscience, you understand how easily patients and doctors can fool themselves when it comes to subjective endpoints. That's why new drugs don't get approved on the basis of uncontrolled clinical experience, and why new treatment guidelines should be based on more than anecdote.
3) I haven't concluded that Crisler's methods are unsound, only that they appear to be inadequately supported by evidence. I draw no conclusions from Crisler's personality traits. However, I do think it's valid to consider his statements and actions.
He states that his treatment is better than the standard, and that one of his goals is to help all MDs use his improved treatment approach. Yet his publications are in venues like Playboy and Healthy and Fit Magazine. Those aren't even medical trade magazines, much less clinical research journals. Crisler knows very well that publications in such magazines are not going to change accepted medical practices. That makes his claim appear rather disingenuous.
He makes many claims on his website (and in the documents linked there), but provides no supporting evidence, no references to the medical literature. He touts testimonials from people like Dr. Nick Delgado, purveyor of "super foods" and various extremely dubious "wellness products."
In short, he shows many of the signs that are commonly associated with woo-meisters. Obviously that's not proof he is a woo-meister, but it's reason to be suspicious.
As for your personal anecdote, what's your point? Whether the average endocrinologist knows enough about this topic is completely irrelevant to evaluating Dr. Crisler.
"Crisler claims his treatment methods provide dramatically better results than the "official" treatment guidelines."
If he makes that claim, he is subject to the fallacies JLee insinuates. And, as JLee, points out, he would not be alone.
If, on the other hand, he is addressing a community of men who either have not had success with traditional TRT, or who for one reason or another are incapable of restarting their own endogenous systems, then it is no more than advertising a reasonable medical alternative.
If a physician in the U.S. knows of an off-label medication with a known mechanism of action which might reasonably help his patient who has not responded to first-line treatments, they would be remiss if they refused to prescribe it, or at least refer the patient to another physician without similar trepidations.
ummm, for clarification, it was not I (JLee) that made the insinuation. The last post was by qetzal and mine previous to that.
By the way, the guidelines actually do mention that HCG is a reasonable tool for Hypogonadotropic Hypogonadism:
http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf
It still seems like Crisler is behaving reasonalbly and ethically as far as any actual evidence has shown.