Study on Risks of Testosterone Replacement Therapy with Advanced Age and Underlying Heart Disease

Healthy HeartA study published January 29th, 2014, “Increased Risk of Non-fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men,” by Finkle Et. al. (you can read it here… ) was brilliant in methodology but the title is misleading.

What this huge study of over 55,000 men placed on testosterone actually found was that testosterone replacement therapy was actually protective (fewer heart attacks) for men under 55 and men under 65 who did not have prior history of heart disease.  For men over 65, this study shows an increased risk of heart attacks in the first 90 days after starting testosterone replacement therapy, with that risk increasing with age.  There was also increased risk for those men over 55 with prior heart disease.

I am seeing an increased number of young men suffering debilitating symptoms of lost libido, anxiety, fatigue, loss of energy, poor exercise tolerance, and inability to build muscle, many of whom have testosterone levels of an 80 year old man or even levels similar to those of women.  The cause of this is not completely understood, but we do know toxins such as endocrine disrupters (plastics, phthalates, pesticides, and herbicides) along with drugs of abuse (THC, alcohol, opiates, methamphetamine) have been known to lower testosterone levels in men.

While it is true that more and more prescriptions for testosterone are being written, it is also likely that many more younger men (under 55) who desperately need testosterone replacement, are not being properly evaluated or diagnosed. Many are being placed on antidepressants and anti-anxiety medications when in reality what they need is testosterone.

This is an important study, and should cause those physicians starting testosterone replacement therapy to use caution when treating men over 65 or those over 55 with underlying heart disease.

There are numerous studies showing the benefits of testosterone replacement therapy.

I list for you below links to many of the articles showing the health benefits of testosterone replacement therapy for those with low testosterone:


Testosterone Treatment and Mortality in Men with Low Testosterone Levels

Conclusions: In an observational cohort of men with low testosterone levels, testosterone treatment was associated with decreased mortality compared with no testosterone treatment.


Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes

Conclusions: Low testosterone levels predict an increase in all-cause mortality during long-term follow-up. Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes.


Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men

European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study

Conclusions— In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease.


Low free testosterone predicts mortality from cardiovascular disease but not other causes: the Health in Men Study

Conclusions: Low testosterone predicts mortality from CVD but is not associated with death from other causes. Prevention of androgen deficiency might improve cardiovascular outcomes


Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study

Conclusions: Lower testosterone and higher E(2) levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk.


Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis

Conclusions: Low endogenous testosterone levels are associated with increased risk of all-cause and CVD death in community-based studies of men


Low serum testosterone, arterial stiffness and mortality in male haemodialysis patients

Conclusions: We showed that testosterone deficiency in male HD patients is associated with increased CVD and all-cause mortality and that increased arterial stiffness may be a possible mechanism explaining this association.


Testosterone deficiency syndrome (TDS) and the heart


Low serum testosterone and mortality in older men

Conclusions: Testosterone insufficiency in older men is associated with increased risk of death over the following 20 yr, independent of multiple risk factors and several preexisting health conditions.


Plasma total testosterone and incident cardiovascular events in hypertensive patients

Conclusions: Our results show that low plasma testosterone is associated with increased risk for a MACE (Major Adverse Cardiovascular Events) in hypertensive patients.


Low free testosterone is associated with heart failure mortality in older men referred for coronary angiography

Conclusions: Low levels of FT are independently associated with increased CHF mortality.


Relationship Between Low Levels of Anabolic Hormones and 6-Year Mortality in Older Men

Conclusions: Age-associated decline in anabolic hormone levels is a strong independent predictor of mortality in older men. Having multiple hormonal deficiencies rather than a deficiency in a single anabolic hormone is a robust biomarker of health status in older persons.


Testosterone: a metabolic hormone in health and disease

Clinical trials demonstrate that testosterone replacement therapy improves the insulin resistance found in these conditions as well as glycaemic control and also reduces body fat mass, in particular truncal adiposity, cholesterol and triglycerides


Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels


Dr. Paul



Marijuana’s Affect on the Amygdala Explains it’s Effects on Anxiety, Brain Damage on PET Scans

marijuanaOh do I get tired of hearing all the pro-marijuana folks argue about it’s virtues (it’s natural, it helps my ….. this that or the other … it’s my medicine,…it’s better than alcohol which is legal, it helps my anxiety, it helps me sleep, etc.)

Problem is it is also the leading cause of anxiety, depersonalization, and that can happen the first time you try it, the 10th time of the 1000th time. There is no guarantee, just because you are ok with it now, that you will always be ok.  Often once brain damaged, it is a struggle to get your normal brain back.  Taking THC or marijuana is like playing roulette with your brain and mental health.  The very conditions you are “treating” with THC, like anxiety or insomnia, are the very conditions it creates.  Try stopping and if it’s difficult, that is all the more reason you should.

The first study (which you can read here… )  “Multiple Mechanistically Distinct Modes of Endocannabinoid Mobilization at Central Amygdala Glutametergic Synapses,” demonstrated the mechanism by which THC alters the stress response and emotional learning.  What studies are showing is that we all have an internal endocannabinoid system that regulates anxiety by dampening the excitatory signals that involve the neurotransmitter glutamate. Acute and chronic stress and emotional trauma can reduce the natural internal buffering of the endocannabinoids resulting in anxiety. Marijuana works to reduce stress short term by the external application of cannabinoids thus reducing (for a time) anxiety and the stress signal, but paradoxically, chronic use down-regulates the receptors which increases anxiety.  Like most addictions, the initial desired effects of the drug eventually disappear leaving you worse off than you were when you started.

In a second study (found here… ) PET scans of cannabis users showed a 20% reduction in CB1 receptor activity, showing the brain damage caused by the chronic use.  Thankfully this study showed the damage to be reversible when participants stopped using cannabis.

Results of the study show that receptor number was decreased about 20 percent in brains of cannabis smokers when compared to healthy control subjects with limited exposure to cannabis during their lifetime. These changes were found to have a correlation with the number of years subjects had smoked. Of the original 30 cannabis smokers, 14 of the subjects underwent a second PET scan after about a month of abstinence. There was a marked increase in receptor activity in those areas that had been decreased at the outset of the study, an indication that while chronic cannabis smoking causes down regulation of CB1 receptors, the damage is reversible with abstinence.

If you are pregnant, think long and hard about the damage you are causing your unborn child.  The third study (seen here… ) shows permanent neurobehavioral and cognitive impairments from the binding of THC to the fetal brain, with repeated exposures disrupting the endocannabinoid signaling and has the ability to rewire fetal brain circuits. If you are the dad or other adult around a pregnant woman, you have no idea the damage you are causing, and don’t expect the pregnant woman to do what you can’t do.  Sorry to sound “Big Daddy” here, but I’ve seen too much damage not to make a strong statement on this point.  You only get one chance in the womb to do everything you can to minimize harm and maximize the nutrition for your growing baby.

Even if marijuana (pot, THC) is legal, that does not mean it is safe.  This study, (found here… ) “Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users,” adds to many others showing that earlier onset of frequent pot use triggers earlier psychosis (schizophrenia, bipolar, psychotic episodes). The study looked at more than 400 adults who were admitted to the hospital for their first psychotic episode.  Those who started using cannabis at age 15 or younger or who preferentially smoked high potency cannabis more often had earlier onset of psychosis than those who started after age 15.  Male users of cannabis had their first psychotic episode at average age of 26 compared to age 30 for non-users.  For women cannabis users, the first episode was at 29 compared to 32 for non-users.

Just as alcohol and tobacco are associated with significant health problems for frequent users and abusers, cannabis is associated with significant psychiatric morbidity. As states and governments look at the question of legalization, the bigger question should be whether or not legalization increases or reduces the use and abuse of this health hazardous product.

In the study published in the periodical Schizophrenia in 2013, (which you can find here… ) brain abnormalities and memory problems were found in individuals in their early 20’s, two years after they had stopped smoking marijuana suggesting there is persistent damage to important regions of the brain. Memory-related structures of the brain appeared to shrink and be collapsed inward, possibly reflecting loss of neurons/ brain cells.

In our push as a society to legalize marijuana, will this result in more or less intoxicated drivers on the road?  We already have 25% of teens who smoke marijuana acknowledging driving under the influence of marijuana. You can learn more about that here…

We now have a new cannabinoid to worry about: K2/ Spice which resulted in 28,531 emergency room visits in 2011.  These synthetic cannabinoids are frequently associated with psychosis.

In the study published in the journal Neuron, (and found here… ) schizophrenia symptoms were found to be linked to a faulty “switch” connecting  two important regions of the brain, the insula and the lateral frontal cortex. Drug use, particularly cannabis and stimulants are 3- 4 times (300-400%) more likely to go on to develop psychosis or schizophrenia.






Dr. Paul


Autism Genetics Not So Simple, Think ENVIRONMENT! & Tips to Stay Healthy and Avoid Autism, Cancer, and Heart Disease

autismrainbowThe study, “Whole-genome sequencing of quartet families with autism spectrum disorder,” published in Nature January 2015 (and found here… ) shows that it is really the environment and not specific genes. In this study, they sequenced entire genomes of 85 families (340 genomes) and found that 69% of siblings had little to no overlap in the gene variations known to contribute to autism.  Put another way, sibling pairs shared the same autism-associated genes 31% of the time.

Researcher Dr. Scherer says, “We believe that each child with autism is like a snowflake – unique from the other”.

The evidence keeps pouring in.  Autism is not a single disease any more than obesity, cancer, or heart disease.  These are conditions that result from exposure to environmental risk factors.  Sure, some of us are more vulnerable than others. For example, some of us might carry the MTHFR genetic defect.  In that case, we would be more vulnerable to toxins and to all three of the diseases I just mentioned.

But being vulnerable doesn’t mean you need to suffer from those diseases.  This is where lifestyle and choices come in.

Since autism hits mostly in the first two years of life, we must do all we can to avoid toxins during the 9 months in the womb and the first two-three years of life.

Here is your list of what to do and what not to do:

  1. Eat organic, drink filtered water, and for those sensitive to it, avoid gluten, sugar, and grains all together for some.
  2. If pregnant, take your prenatal vitamin, iodine, vitamin D at 4-5,000 IU a day, methyl-folate and methyl-B12.
  3. Don’t receive vaccines while pregnant.
  4. Don’t give your newborn the Hepatitis B vaccine unless birth mom has Hepatitis B.
  5. Vaccinate carefully, not giving more than one aluminum containing vaccine at a time.
  6. Wait on the MMR until age 3 unless you will be in a measles outbreak area (3 or more cases linked in the same area)
  7. Get moving (exercise to the point of being a little short of breath) at least 30 minutes a day, 3-4 days a week.


Dr. Paul


Study Shows Huge Increase in Vaccine Side Effects When Premature Infants Vaccinated

premie  I have always questioned the wisdom of vaccinating the extremely vulnerable premature infants in the NICU when they weigh less than a typical newborn and have not even reached their due date. The practice of giving vaccines as usual to premature infants has been going on for the past few decades, for as long as I have been a pediatrician.  It was assumed to be safe. Presented here, is a huge study, “Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants,” June 2015 in JAMA Pediatrics. You can read it here…

The study looked at 13,926 extreme-low-birth-weight (ELBW) infants born at 28 weeks gestation or less, who were discharged from January 1, 2007, through December 31, 2012 from 348 NICU’s. They looked at the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death. The findings should put an immediate halt to this practice, as clearly there is an association with harm and even death.

The results showed that 91.2% of the 13,926 infants received 3 or more immunizations. The incidence of sepsis evaluations increased 370%. The need for increased respiratory support increased 210%, and intubation increased 170%. There were 5 deaths around the time of vaccination.

Given the extremely low possibility of premature infants in a NICU getting infected with the diseases that we typically vaccinate against (pertussis, diphtheria, tetanus, haemophilus, pneumococcus, polio, and hepatitis B and rotavirus), I can only make one conclusion from this study: Do NOT vaccinate your extremely low birth weight infant while in the NICU on the usual schedule based on birth date. I would recommend a modified schedule, only covering those diseases the infant is at risk for and vaccinating right before discharge from the NICU. Newborns whose mothers don’t have Hepatitis B are not at risk for Hepatitis B. That vaccine should definitely wait, until your baby is closer to being sexually active. Polio and rotavirus can wait. Consider not giving the DTaP and Prevnar at the same time as they both have way too much aluminum.



Dr. Paul

1 2 3 4 5 38