Men with Borderline Low Testosterone are Suffering From Depression

LowTestosterone2In a study presented March 7, 2015, at the annual meeting of the Endocrine Society, over half the men with borderline testosterone levels were suffering from depression. They studied 200 adult men between 20 and 77 years of age whose testosterone levels were borderline (200-350 ngm/dL) and found 56% of the study participants had significant depressive symptoms. (You can read more here… )
These rates of depressive symptoms were higher than the 15 to 22% in an ethnically diverse sample of primary care patients and the 5.6% among overweight and obese US adults. Other findings in these borderline and low testosterone men were:
• Overweight (39%)
• Obesity (40%)
• Physical inactivity (51%)
• Erectile dysfunction (78%)
• Low libido (69%)
• Low energy (52%). (Read more here… )

I am glad to see the endocrine society sharing this awareness that low testosterone is both prevalent and causing a lot of distress in our male population. Current guidelines being used by many insurance companies won’t pay for testosterone replacement therapy unless a man has two levels below 300 ngms/dL. Hopefully this will change as awareness increases that more and more men (young and old) are suffering from low testosterone.
If you live in the Portland Oregon area and need your testosterone checked, you can contact my clinic: Natura Integrative Medicine at:
• 971.317.0222
• 11790 SW Barnes Rd. #120, Portland, OR 97225

Dr. Paul

Opioid Dependence Treatment Guidelines: 2015 Released

opiate addictionThe guidelines released “Federal Guidelines for Opiate Treatment Programs” March 2015 (which can be read here… ) are intended for government opioid maintenance programs using methadone or Buprenorphine containing medications. Some key components worth mentioning are the importance that those put on maintenance have had at least a year of continuous opioid dependence, have tried and failed at least twice to wean off of opioids (no more than two attempts allowed at the same program), and if pregnant, that the pregnancy is verified. For pregnancy, withdrawal should not be initiated before 14 weeks or after 32 weeks gestational age. If pregnancy is a possibility, a pregnancy test should be done before initiating withdrawal from opioids.

It is advised that all patients and their families get training on signs of opiate overdose, and have a prescription for Naloxone that could be administered if an overdose took place.

Substance abuse counseling is recommended and all opioid dependent patients should be encouraged to attend 12-step programs. Screening for HIV and Hepatitis C, along with other STD’s is advised and monthly random urine drug screens are recommended for drugs of abuse.

At our office-based opiate detox clinic, Fair Start, we focus on those who are opiate dependent and age 30 or under. In most cases we are able to safely and successfully wean patients, slowly over 6-24 months, off opiates using a Buprenorphine containing medicine. If you have a loved on who lives in Oregon or Southwest Washington in the under 30 age group and dependent on opiates (heroin or pain pills), contact Fair Start at 503-924-1000 to see if our program might be the right fit for them.


Dr. Paul



Testosterone Replacement Therapy Reduced Heart Disease for Those With Low Testosterone

testosteroneThe Intermountain Medical Center Heart Institute in Utah studied 5,695 men ages 53-71 who had initial low levels of testosterone (read the study here… ).  Only 14% of these men received testosterone replacement to achieve normal to high levels of testosterone.  Those who did not take supplemental testosterone remained at low levels for the three years of the study. The 14% who replaced their testosterone to normal or high levels had reduced rates of death and reduced heart attacks or strokes at both one and three years.

According to the FDA there were 1.3 million patients with prescriptions for testosterone in 2010 and 2.3 million in 2013. Men ages 40-64 make up 70% of these patients. My own experience is that we are seeing much greater numbers of men, young and old, who are in desperate need of Testosterone Replacement Therapy (TRT).  I suspect it is a result of the huge increase in use of endocrine disrupting chemicals that are now in each of us at increasing levels.

There have been a few recent studies that were casting doubt on the safety of TRT.  The bulk of studies support the use of TRT for those who are low and thankfully we have several bio-identical products available to us.

For my previous blog on Hormone Replacement Therapy, see here…

You can also learn more about testosterone studies here…


Dr. Paul




Picky Eaters- Prevalence and When to do Something

PickyEaterPicky eating in childhood ranges from 8-50% of children.  Typically, a toddler or child limits the amount of food, or limits vegetables, or is unwilling to try new foods.  In the study, “Picky eating during childhood: A longitudinal study to age 11-years,” researchers looked at “prevalence, persistence, and characteristics of picky eating in a prospective study of 120 children and their parents followed from 2 to 11 years”. You can read the study here…

In this study, the issue was there 13-22% of the time and those who were picky eaters were that way for over 2 years 40% of the time.  The good news was that there was no issue with growth or development.  I often reflect back to my own parenting with this issue.  I found that for my children, if there were breakfast cereals in the house, that was mostly what they wanted for breakfast and for snacks or evening treats (provided we didn’t have any other options for junk food or deserts).  I found that if we had deserts then they had a poor appetite for dinner and the appetite mysteriously returned for desert!  If we had cookies, crackers, or similar processed foods, those were the foods desired and those were the food over which tantrums or whining was the norm.

I have a brother who raised his girls to finish everything on their plates or it returned on the next meal, and then the next meal, and so on, until that plate was clean.  They served only the healthiest of choices and small portions so it was simply training that his girls would not get to exclude certain healthful foods in preference for junk food or carbs or desert or some other more desirable food. I have a sister whose daughter, at age 3, would make requests for something different than what had been prepared for dinner and she would  make a new meal for her daughter.  Today she eats most foods well also. Most of my own children still avoid vegetables if given the option, and many still prefer processed foods … I feel like a failure as a parent!  I have no moral of the story here, just that you make an attempt to remove poor choices from the options.  That way, regardless of what style you choose, they end up eating real food and healthy food choices.

What to do for those really picky eaters who seem to struggle just to get anything down?  I might recommend you consult your physician or an Occupational Therapist who works on feeding issues and try food play.  The child gets to play with a variety of foods to remove the stress over food and sometimes some of it gets into their mouths.  For a child beyond infant times (over age 1) you might also consider some healthful smoothies. There are many options here.

In my office, I offer three powders (meal replacements/supplements) for sale:

  •    Total Meal Daily Advanced that I had formulated by a top medical nutrition company.  This is non-GMO and gluten free with pea/rice protein, phytonutrients, fiber, and 25 essential vitamin/minerals.
  •    Paleo Vegan Lean Therapy from almsbio. This is legume and grain free, as well as gluten free, with protein from organic pumpkin and cranberry seeds, Arabinogalactan, and coconut powder
  •    Complete Green Energy form almsbio. This is free of gluten, corn, soy, dairy, and GMO and made from greens, vegetables, and antioxidants  with enzymes.


In addition to these, I recommend you consider vitamin D and fish oil for all children. We carry the tastiest fish oil on earth, from almsbio.  Come by for a taste!

If you are patients of mine, or live in the Portland Oregon area, and wish to try any of these products, swing by and buy a can.  You can add fruit or mix with almond or coconut milk, and this can add a great amount of nutrients to your child’s diet.

For those who need more professional help and want a referral to a feeding specialist, do make an appointment with your physician so you can get help with this.

There is a higher level of anorexia in the teenage years for those children who never get these issues addressed.



Dr. Paul




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