SURVIVING HEALTHCARE

Lance Armstrong beat the French at their national sports: drugging, lying, and cycling.* US federal prosecutors tried to fine him $100 million. Their goal was to boost their careers by destroying people, and a superstar turned villain was a perfect candidate. They spent tens of millions of taxpayer dollars and settled for $5 million—an abject loss. Whatever you think of Armstrong, the French, prosecutors, or athletic doping, the following is clear. Over the past four decades, sports became drenched in drugs. They are integral; they are not going away, and they enhance performance. If you do not believe this, particularly if you think Armstrong is a cheater, spend 20 minutes watching mainstream strength sports such as CrossFit championships. These performers parrot Lance: “We never tested positive.” Yet the press labels Armstrong “disgraced.” They never acknowledge their hypocrisy: nearly everyone in America—including them—takes powerful prescription drugs every single day. *Give thought to what we do here in the US before being too critical of the French.My mission is to improve health and longevity for people who have declining hormone levels. I recommend higher doses than most physicians, but I am not knowledgeable about sports use. If I openly advocated it, my peers would cast me out as a renegade. An athlete’s aim is to maximize performance. If you decide to supplement, begin by learning the basic information here. Then get coaching, take responsibility for your actions, and become an expert. You may be taking health risks, although the concerns are exaggerated. As you explore what works and what is safe, be cautious and skeptical. Big Pharma, the journals, the medical mainstream, the supplement makers, and the bodybuilding industry all have conflicts of interest—they are selling something. Most have little concern about damaging you while they get rich. I would caution you, in particular, to avoid believing random articles from internet searches. Most are written by corporate sources. And most doctors who prescribe hormones have a lot of the story wrong as well. Remember that half of the standard medical practice is questionable, and the medical journals are unreliable (see my other book and The Journals’ Sins are the Editor’s Sins chapter here). Rick Collins (cgmbesq.com), an attorney who defends athletes, wrote to me about bodybuilding sources:[They] (including the magazines) have been historically far, FAR closer to the truth than mainstream physicians on issues of nutrition, exercise, and ergogenic drugs. Bodybuilders saw the value of fat in the diet when doctors were still advising patients to eat “low fat” diets–poisoning them with sugar and excessive carbs. Bodybuilders knew the importance of resistance training for decades while clueless doctors were advocating that all you need is aerobic exercise. Bodybuilders knew steroids build muscle when medical orthodoxy insisted that steroids didn’t work—and rigged studies to “prove” it. Bodybuilders knew the risks of testosterone and HGH were wildly exaggerated and distorted decades ago–while doctors STILL have no clue. Of course, the downfall of bodybuilders is the mindset of excess–“more is better.” There must be limits on the doses, but they are unclear. Testosterone produces acne, hair growth or loss, sterility, and testicular atrophy (small balls). Women may get deeper voices and enlarged clitorises. The FDA says that testosterone increases heart disease, but the studies purporting to show this are wrong. If you use estrogen and have a uterus, you must use progesterone or risk a higher chance of uterine cancer. High doses of vitamin D3 and thyroid can cause toxicity. Testosterone relatives, such as methylated or alkylated anabolic steroids, can Support the show

The human growth hormone (HGH) story is a variation of the others. The punch line is that if it was economical and unrestricted, it might be the most valuable hormone of all. It is likely the safest.Steven is a gay 72-year-old cosmetic surgeon who practices in West Los Angeles. He hangs out with a string of young, good-looking partners. Steven used testosterone, DHEA, and vitamin D for six months and improved. But he was still sore and fatigued, so he started HGH. After five weeks he said: My sex, energy, and sleep are off the charts. I can work out again without getting sore. And I just got back from a boot camp!Growth hormone was used to treat a growth hormone deficient boy in the late 1950s. It made him taller, so the idea caught on. A commercial product derived from human pituitary glands became available in the late 1970s, and by 1985, 27,000 children had been treated worldwide. When a few people who received HGH were found to be infected with fatal Creutzfeldt-Jacob disease (CJD), the use of pituitary-derived HGH was halted.In 1985, Genentech developed an FDA-approved “recombinant” bio-identical HGH. It has never caused CJD. Since then, the industry has introduced thirteen other nearly identical products. Their prices are all exorbitant. In 1990, Daniel Rudman published a six-month study of 21 older men taking HGH (NEJM). Compared to controls, they had an 8.8 percent increase in lean body mass and a 14.4 percent decrease in fat. This was an “anabolic” effect—a proven reversal, in a short time, of the usual aging trend toward muscle loss and fat gain.This trial was a benchmark that spawned other research. Soon, evidence developed that the medication increased bone density, strengthened immunity, decreased cardiac risk factors, improved cardiac function, decreased cholesterol, improved mental functioning, and improved quality of life. See Appendix C for references about how growth hormone prevents Alzheimer’s disease and improves cognitive function. HGH has also been used successfully to treat burns, heart failure, Crohn’s disease, obesity, fibromyalgia, multiple sclerosis, ulcerative colitis, and other conditions. Hormone physicians say these findings support using growth hormone to combat aging and improve vitality. And since most adults over 60 have about the same HGH production as people with damaged pituitary glands, they believe prescribing it is reasonable.Unfortunately, the FDA did not agree. Human growth hormone received approved for AIDS wasting, but strangely, it is off label for most other adult applications including all the above. A 2005 JAMA commentary declared that off-label human growth hormone prescribing was illegal. And a 2019 Drug Enforcement Administration monograph claimed “anti-aging” use was illicit. The FDA tries to dictate medical practice, which is not their job. Every physician knows that prescribing conventions allow them to treat conditions with any approved medication if they document the reason. Estimates of the total drugs used off-label range up to half of all prescriptions written. We have substantial evidence that HGH improves health, and prescribing it for aging is legitimate.Athletes have employed growth hormone for forty years. Although it is not a controlled substance like testosterone, HGH has bSupport the show

Which replacements do men and women sense the most? Many women feel distinct improvements when they use thyroid, estrogen, testosterone, or progesterone. Some have dramatic responses to vitamin D. For men, testosterone is the most noticeable and some feel better with HGH. A few older men improve when they only take DHEA.See Appendix A and B for dosing and blood testing information about each hormone. Sally’s story: I started menopausal symptoms at 29. I was not a healthy individual. It took coming to you, and you asked how I felt. You actually let me adjust the dosage and fine-tune myself, and now I feel attractive and I’m sleeping again. It’s just a better overall quality of life that I didn’t have for eleven years. I would go to doctors and they would say my hormones were in the normal range, but I didn’t feel good… They didn’t give me enough… I felt amazing within two to four weeks after I started…Another story.MELATONIN is a harmless but potent antioxidant or clean-up hormone with many benefits. It is taken at bedtime and improves sleep. It also helps mood, migraines, energy, and the immune system. Dentists say that patients taking melatonin have improved gum and mouth health. It has favorable effects on both breast and prostate cancer. Some use it to reset the sleep-wake cycle. When travelers enter a new time zone, they take up to 100 mg on the first night. Melatonin has also been used to help addicts stop Valium and related sedatives. And it decreases nighttime urination for men with large prostates.An anecdote: Those taking melatonin may see their grey or white hair gradually change back to the original color. As this happens, they get dark roots and white tips, which is the reverse of what happens to dyed hair as it grows out. This may mean their health is getting better. The best melatonin preparations last six hours or longer. Compounders make these slow-release products as prescriptions. These are also available over-the-counter for purchase at either Nutrascriptives.com or LifeExtension.com. The melatonin capsules made by compounders are 1, 2, 3, and 5 milligrams and higher. Women start at 1 mg and men at 3 mg. Dosage is increased until good sleep or side effects occur. For men, the average dose needed is 9 to 30 mg and for women, 1 to 30 mg. Up to 100 mg every night is safe and some people need that much.The only problems with melatonin are sleepiness and vivid dreams. Since it is taken at bedtime, most people do not mind these, although a few become agitated and cannot tolerate it. Several weeks may go by before the full response occurs. Some people must take melatonin several hours before going to bed because it has a slow onset for them. These effects are individual.I wanted to have dark hair, but melatonin gave me restless sleep. So I am still using dye.VITAMIN D (D3) is a steroid hormone, just like estrogen or testosterone. True vitamins cannot be made by the body, but this is produced in the skin during sun exposure. Those with a deficiency who take it often get an energy boost and have less joint pain. Susan is 63 years old and has a vitamin D level of only 11 ng/ml. She is black, vegan, has high blood pressure, and gets little sun exposure. She wears sunscreen every day and takes Norvasc, a high blood pressure medicine. These all make D deficiency more likely. Susan would probably feel more energetic if she took supplements and had higher levels. A 2015 DanSupport the show

Menopause information is everywhere—some good, some bad, and all of it confusing. Many authorities call this unpleasant syndrome “natural” and recommend ignoring it. But hormones greatly improve women’s health and menopause symptoms. June is 49: She started estradiol, progesterone, and testosterone eight weeks ago: Hey, doing well on my hormones. About two months in now. My energy is up, as is my sex drive and my enjoyment of it. My muscle tone and skin look great, and some old friends I gathered with on the East coast last week accused me of having an aging painting of myself in a closet somewhere. I’m still having hot flashes at night and wonder if I should adjust my estrogen up some? My reply was: Increase your estradiol to two mg each morning. We may decide to increase your progesterone and will check your levels on your next office visit.How the female reproductive system works: Young women start with hundreds of ova or eggs. Each cycle, the uterus is prepared for a potential baby and one ovum is used. As women mature, usually in their mid-40s, the eggs run low and periods become irregular. After the eggs are gone, the cycles stop but some hormone production persists as long as the ovaries are not cut out.This is the “change of life.” Progesterone levels typically fall and estrogen production continues. Some women get depression, anxiety, irritability, and sleep disturbance. Other symptoms include bloating, acne, breast tenderness, and heavy, irregular menstrual periods. At about age 50, women “fall off a hormonal cliff.” As all their hormones decline, full menopause develops. Many are miserable and have intense hot flashes. After a few last irregular periods, they are in complete menopause, defined as a year without a menstrual cycle. Their symptoms are usually more dramatic and unpleasant than men’s at the same age and often more severe than any pre-menstrual syndrome (PMS) they had earlier in their lives.For the first several years, most women need only progesterone. As menstrual periods slow and stop, estrogen and the other hormones should be added. Estradiol has the strongest effect on hot flashes. Testosterone improves strength, alertness, sexuality, and helps with bladder and vaginal symptoms. Since it transforms into estrogen, it protects the heart in both sexes. Patients who want simplicity or are on a tight budget sometimes use it as the sole therapy.Janice, 64, watched her husband die of lung cancer two years ago after a three-year illness and has been “out of gas” ever since. She said she was “done with men,” so she flew to Los Angeles to have her breast implants taken out. Because Janice had fatigue, depression, anxiety, and no interest in sex, I discussed menopause therapy with her. She agreed to try. So I wrote a prescription for estradiol and progesterone and placed a testosterone pellet. Janice called four months later—she had a new boyfriend and felt great. She is returning to have her implants replaced. Hormone supplementation slows and may prevent: ✪ Alzheimer’s disease (AD).✪ Heart disease✪ Fatigue, depression, sleep disturbance, anxiety, and irritability.   ✪ Bone loss, osteoporosis, and increased chance of fractures. ✪ Skin problems including thinning, wrinkling, itching, sagging, easy injury, and loss of elasticity. ✪ Thinning of joint cartilage. Tooth loss and gum disease. ✪ Vaginal area difficulties: dry, thin, and inelastic. ✪ Spontaneous urination during coughing or lifting. ✪ Sexual decline including painful sex. Linda is a 63-year-old registered nurse: Testosterone makes me feel sexy and gives me an overall feeling of well-being. My strength and muscle tone improve, esSupport the show

Estradiol has the most dramatic effects of any hormone. Its benefits include:✪ Helps the heart more than other hormones. ✪ Decreases the risks of cataracts, vaginal atrophy, and macular degeneration of the retina. ✪ Reduces the chances of stroke, diabetes, colon cancer, Alzheimer’s, memory problems, and osteoporosis.  ✪ Cures hot flashes and improves sexuality. From the Los Angeles Times, 1999: I could live without my husband, children, or cats. But I could never live without my beloved estrogen. Who should use estrogen and how much? Menopausal women and sometimes men transitioning to women are prescribed estrogen. Men with prostate cancer are also occasionally treated with it. Women in menopause should start at 1.5 milligrams in the morning, then increase to 2 to 2.5 milligrams. This brings blood levels up to about 70 pg/ml, which protects the heart and other organs. We believe this is safe because young, healthy women have estrogen levels in the hundreds during parts of their cycle. Premarin, the horse estrogen, was the first treatment for menopause. It has many beneficial effects, but it causes a slight increase in blood clotting. This makes it obsolete for long-term use. Estradiol, the primary bio-identical type, is safer. Every study on it—KEEPS, EPAT, WEST, CORA, DANISH, and ELITE (those academics love acronyms)—found no increase in blood clotting. Although the estradiol transdermal patch may provide the best relief of hot flashes and does not cause blood clots, it does not protect against heart disease. In contrast, both types of oral estrogen protect the heart. This was proven in many studies, including the CORA, ELITE, WEST, and DANISH. Since many medical authorities think that oral estradiol and oral Premarin are the same thing with the same risks, they often recommend using the patch if there are concerns about blood clotting. Doctors should instead prescribe brand name, generic, or compounded oral estradiol. These are safe and protect against heart disease and stroke. Doctors are usually hesitant to prescribe oral estrogens for sick patients or those with heart risk factors such as smoking, obesity, or a family history. They use the patch for them if they recommend hormones at all. However, as I describe in the Be Careful Whom You Trust chapter, these are precisely the patients who need cardiac protection the most. In nearly every situation, their risk to reward ratio favors the oral type. We should accept the minor hazard of blood clotting to protect their hearts. Dr. Rouzier describes these issues in a well-referenced article.Surgeons and anesthesiologists have many responsibilities, and they rarely read the confusing estrogen studies closely. Since blood clots after surgery are such a hazard, most of them tell their patients to stop all replacement before surgery. Some gynecologists are adamant about this. Estradiol is available as generic, compounded, or patented varieties. Hormone doctors mostly recommend a compounding pharmacy's product because generics are less predictable and the patent type is too expensive if not paid for by insurance. Brand names from foreign sources made by major manufacturers are often affordable and of excellent quality. Estradiol patches such as Vivelle Dot (twice a week) or Climara (once a week) may relieve menopause symptoms better than the oral forms. The higher dose of .1 mg a day works best. To help the transdermal patch stick, patients scrub the area with alcohol before they apply it. The device sometimes causes skin irritatSupport the show

I am now retired, but I spent the last thirty years in private practice performing cosmetic surgery and sometimes assisting with my patients’ medical care. Most of the women I worked with who were over 50 years old suffered from poor sleep, fatigue, hot flashes, muscle wasting, and irritability. They were all looking for a way to feel better and a lot were taking antidepressants. Many thought that I could improve their spirits with surgery, and sometimes they were right. But since they had hormone deficiency symptoms, surgery alone was not the best solution. Most plastic surgeons operate on a string of depressed people without considering why they are so miserable. My patients were trusting me, and I wanted to help, so I took training. For nearly two decades, I offered appropriate candidates hormone treatment along with their procedures. Those who listened to my advice were usually grateful. Some were not interested, and I respected that as well.I knew women had doubts about hormone replacement. I also knew that patients never take at least a third of their prescriptions, even vital ones like kidney transplant anti-rejection drugs. Since hormone benefits can take weeks to be felt, I used long-lasting, inexpensive testosterone pellets implanted under the skin. If my patients didn’t like this idea, I offered it as a cream. Testosterone transforms into estrogen, so they received this as well.  When I saw them a month later, most were thrilled. I then suggested they consider adding progesterone, estrogen, vitamin D, and sometimes thyroid, DHEA, and melatonin. If their finances were tight, I showed them how to inject themselves once a week with testosterone. (Each shot costs only $2 for women and $10 for men.) I followed blood tests, symptoms, and physical exams, and customized therapy based on patient responses.I saw a few women who felt terrible in their mid-30s. Blood tests showed they were in premature menopause and had estrogen and progesterone levels close to zero. After they began treatment, they felt great again. Many of my patients brought in their friends and husbands, and they responded as well. Hormone replacement should be a “feel-good” story. We have overwhelming proof that it is safe and effective. Most hormones are affordable, and tens of millions of people have used them. Thyroid has been available since the late 1800s, and insulin, estrogen, and testosterone for nearly that long. These treat or prevent heart disease, depression, impotence, diabetes, some cancers, and Alzheimer’s disease (AD).  But misinformation is everywhere: ✪ Doctors and patients “know” that estrogen causes breast cancer and blood clots, testosterone causes heart disease and prostate cancer, and that human growth hormone (HGH) is practically poison. These ideas are false. ✪ We have been led to believe that insulin’s high price is justifiable. Wrong. ✪ Mainstream medicine says that thyroid disease is relatively uncommon and hazardous to treat. This is also incorrect—it may afflict a third of mature women and is under-treated because of doctors’ economic turf wars rather than unusual risks. Hormone therapy is a strange opera with many twists and bizarre characters. To navigate it, patients need physician-level knowledge—a tragic situation. I studied this subject for a decade, but you can learn the basics in a few hours with no prior background. Journalists think every issue has two sides. Law and news stories, for example, are rarely black or white. But medical care is right or wrong, and I challenge you to find the truth here. I present: ✪ What the science says. ✪ Opinions of independent experts. ✪ The collective physician experiencSupport the show

PREFACEIf you do not know by now that corporations have disfigured healthcare, you have been living under a rock. For example, hormone therapy is claimed to be hazardous, but a century’s science and experience prove its value. When these natural substances are low or absent, replacing them may be the safest and most effective treatment we have. In contrast, drugs are foreign substances that cause side effects and worse. Hormone supplementation potentially treats or improves:Longevity: Low levels of thyroid, growth hormone, estrogen, testosterone, and DHEA (dehydroepiandrosterone) are linked to premature death.  Cancer: Estrogen, DHEA, testosterone, progesterone, melatonin, and human growth hormone (HGH) all have protective effects against cancer. General health: In women under age 60, long-term estrogen replacement therapy decreases strokes, blood clots, colon cancer, diabetes, and macular degeneration. It reduces the likelihood of tooth loss, depression, osteoporosis, and death because of bone fracture. Breast cancer is unaffected, contrary to common opinion. Avoidance of estrogen was estimated to cause 50,000 excess deaths over ten years in a Yale study. Alzheimer’s disease (AD): When long-term care costs are included, this is the most expensive ailment of all. Estrogen decreases the chances of getting AD significantly when it is started within 10 years of menopause. Heart disease: Over 40 observational studies have shown that giving estrogen to women reduces coronary artery disease, heart attacks, and deaths. When men have higher levels, they have less heart disease. Giving natural estrogen to deficient men improves cholesterol but does not increase blood clotting. Depression: Estrogen, DHEA, progesterone, testosterone, and melatonin all have antidepressant effects. Thyroid has been studied and used for depression for over fifty years. Obesity: Thyroid, estrogen, testosterone, DHEA, and human growth hormone reduce unhealthy belly fat and promote weight loss.“Bio-identical” hormones are the same as those found in humans. These are safe, affordable, and have few side effects. But since these natural body substances cannot be easily patented, they are barely profitable for big Pharma. So the drugmakers concoct proprietary imitations from chemicals or animals. Their prices are extortionate. Stories have been spread that hormones such as estrogen and testosterone cause cancer, heart disease, blood clots, and other diseases. With few exceptions, these are false. And for insulin, growth hormone, and others, we have allowed the drugmakers to exorbitantly increase their fees using proprietary manufacturing. The result is that hormones are overpriced and difficult to prescribe. Doctors are pressured to use toxic, expensive patent drugs instead. These trends are squandering our resources and costing us years of healthy life. Support the show

Medicine has become a pseudo-religion; our patients must be gently encouraged into apostasy and renunciation...   [We have all] been enslaved by the medical–industrial complex, and it is time we rebelled. Society needs to reach a new accommodation with old age and death.Seamus O’Mahony, Can Medicine Be Cured (2019)Here is the silver lining: when you better understand your fragile life and the limitations of medicine, you will avoid getting sucked into a lot of useless nonsense. By 60, most people have some coronary artery disease; by 70, most have cancers growing somewhere. Nortin Hadler states the cold facts: “Any claim to a science that offers a path to longevity beyond eighty-five years is fatuous… over 85, you are off-warranty.” My pathologist friend Chris Gonzales adds, “something will get you, eventually.” He cuts up dead people for a living, so he knows.Worrying about your lifespan or expecting medicine to save you will not bring you peace. Instead, focus on your mission and the tasks. Be philosophical about your health as it declines. At the end of life, some people can become more grateful rather than more afraid because they have learned to treasure each moment. Max Ehrmann wrote, “Gracefully surrender the things of youth. Nurture strength of spirit to shield you in sudden misfortune.”My friend Dana understood this. He taught me what he could over his final year, and I loved him dearly. He had coronary artery disease with congestive heart failure, and for months, we knew he might die. He had always been optimistic, but during this period, he ignored all negativity and told me he felt better and better. He knew he had no time for regrets, complaints, whining, or worry. I realized later that we are in the same position as Dana every day of our lives.Support the show

How modern psychiatry developed: A few decades ago, psychiatrists were losing their status. Then, the fabrication of new diagnoses along with the invention of medications to treat them saved them economically. First the antidepressants, and then the newer antipsychotics came to the rescue. This moved the specialty into the medical mainstream because the psychiatrists were the only ones who purportedly understood it all. The novel diagnoses—some say concoctions—were enshrined in the psychiatric manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Pharmaceutical companies played a huge role in its creation. The American Psychiatric Association (APA) started aggressive disease-mongering of the new ailments. They hired ad agencies to produce “public service” drug advertising. The corporations marketed the new supposed cures alongside. By 2008, twenty-eight percent of the APA’s income came from drug companies. According to influence theory, this made the APA virtually a subsidiary of the companies. Senator Chuck Grassley (R, Iowa) publicized the story in a congressional investigation. Ben Furman, MD, a psychiatrist in Finland, explained how it happened in a 2018 blog: The psychoanalytic belief system was thrown out and replaced with the DSM and the biomedical doctrine: everyone should have a diagnosis, and everyone should have medication. The psychiatrists now treated all the conditions that had been treated with therapy with medication. This became the treatment of choice for almost all mental health conditions regardless of whether the patient was an adult, teenager or child. A patient without medication became a rarity. The data system of mental health services required clinicians to diagnose anyone who sought help.The psychiatrists and corporations ignored studies showing damage from long-term drug use. They left disparaging critics out of the debate and out of the textbooks. Finally, long after the science matured, a few of the doctors are telling the truth. In 2012, an editorial in the British Journal of Psychiatry said the psychiatric medication revolution was at an end. Others now echo this sentiment. Support the show

The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. Arnold Relman, MD, former editor NEJM (2002)I wrote about a thousand Prozac-type SSRI prescriptions over my career, which might have been a half-million dollars in drug sales. I screened my patients, as I was trained, by merely asking them a few questions. Peter Kramer's bestselling Listening to Prozac (1997) duped me. He said Prozac could save patients from common symptoms of guilt, fatigue, sadness, sleep disturbance, and even aches or digestive problems. He also claimed it could be a lifestyle drug similar to today's Viagra, boosting ordinary peoples’ performance. I learned later that the SSRIs are toxic, have limited utility, and the hype has produced vast overuse.Industry marketed SSRIs as an improvement on the older tricyclic antidepressants. These cause sedation, and only a month’s supply is needed for suicide. Part of the promotion of the Prozac-class drugs was that sleepiness is mild and even enormous doses rarely cause fatality. Before the drug era, doctors thought depression was rare and most often self-limited to about three months. Now (2020), Wikipedia claims that 17 percent of the US population becomes depressed during their lifetime, making them all candidates for expensive, indefinite medication usage. Legions of paid Wiki contributors, many of whom work for pharmaceutical companies, make this source only a little better than a drug industry link-farm. Support the show