Archive for March, 2012

Billboard Advertising of Physicians and Hospitals

March 31, 2012

Blog  #52        Andrew Siegel, M.D.

 Image

The image above is a billboard that I photographed on Route 4 in New Jersey, advertising kidney transplantation at St. Barnabas Hospital.  Now people, come on—if any of us ever need a kidney transplant, are we really going to pick our transplantation center based upon a billboard ad situated above a gas station and a Dunkin’ Donuts?

As I continued driving east on Route 4, I couldn’t help but see—or shall I say, be assaulted by—a huge electronic billboard, its flickering colored pixels advertising the merits of one of the local hospitals.  The subject matter changed every few seconds, the slide show shifting to the faces of local physicians, some of whom I know and others whom I don’t know.

I don’t care for any type of billboard insulting my visual field, much preferring nature, trees, and mountains as background, although there is not much of that in congested Northern New Jersey.  Although I am generally not amused by billboard ads, every once in a while a clever one from Kenneth Cole on the West Side Highway in Manhattan will draw a chuckle from me.  Aside from billboards being downright unsightly, they also can be real distractions, particularly the electronic ones that change images every few seconds.  Anything that distracts us from focusing on the road ahead is clearly not good.

In general, I am not very fond of traditional advertising for the medical field, whether it is print, radio or television; in particular, I harbor contempt and disrespect for billboard ads for doctors and hospitals.  I would never never ever ever choose a doctor or hospital on the basis of a billboard advertisement.  In fact, this style affronts me to the extent that I would actively avoid seeing a physician who resorts to this means of garnering new patients. Medical billboard ads just rub me the wrong way—there is something unprofessional, distasteful, unseemly, obnoxious, sleazy, and undignified about it.  Furthermore, advertising is downright costly—every time I look at these ads I think about how many other ways those resources could be more responsibly allocated, particularly with health care dollars getting scarcer and scarcer.

In my humble opinion, the best means of finding a capable doctor is via a referral from a person whose opinion you respect—that person may be a physician, nurse or health care worker whom you trust, or alternatively, a family member, friend or colleague.  The latter group, who have had experience with a physician but can’t necessarily render an opinion about their capabilities and knowledge as well as health care workers might be able to, at least can attest to their style, manner and communication skills.

Whenever I see a new patient, I inquire about how they found their way to my office.  Most commonly, it is a referral from another physician or patient.  Recently, I have noticed that I am getting more patients from cyberspace, since I have created an abundance of patient education materials including 40 or so videos on YouTube and numerous articles posted on my medical practice website. Last week, I had a husband and wife come in as new patients.  I saw the wife first and inquired as to their means of finding me as a physician.  She related that her husband was a member of the jury involved in a medical malpractice case in which I testified and that he was sufficiently impressed with my testimony such that he made a mental note that if he ever needed urological care I was the man!

Back to my sentiments on billboard advertising: I think I get it: seeing images of ourselves strokes our narcissistic tendencies, and doctors—some of whom possess rather substantial egos—may just relish driving down the highway and see themselves photo-shopped and smiling.  I am not sure if billboard advertising is cost effective or if it is a successful tool to find new patients, but I suspect that it is not.

There are many more tasteful, subtle and nuanced ways a physician or hospital can display themselves to the public. It can be done via public outreach educational seminars, participation or sponsorship in screening events and the creation of educational materials including brochures, booklets, books, online videos, and blogging.  But the best advertisement for a given physician or hospital is the patient who has been treated competently, respectfully and honestly.  That patient will go back to his or her primary care physician grateful for the referral.  Furthermore, that satisfied patient will become an advocate and will recommend the physician or hospital to family members, friends and colleagues.  A busy doctor’s office or fully occupied hospital happens on the basis of “walking the walk and not on talking the talk.”  No need for medical personnel and hospitals to wallow in the sleazy and grotesque world of oversized publicity.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

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Money and Medicine…An Evil Combination

March 22, 2012

Blog #51    Andrew Siegel, M.D.

There were three articles in yesterday’s (March 21, 2012) New York Times that each dealt with generic medications of proven benefit to humankind.  However, because of their generic status, ramifications have surfaced that are clearly not kind to humans.  The glaringly common theme among these articles is that the economics of large pharmaceutical companies (aka Big Pharma) clearly trumps patient care and public health.  Welcome to the United States!

On the front page appeared an article written by Katie Thomas entitled: Generic Drugs Prove Resistant to Damage Suits.  This reported that lawsuits against pharmaceutical companies that make generic drugs are being dismissed because of a Supreme Court decision last year that stated that generic pharmaceutical companies do not have control over their labels; they are therefore considered immune from suits regarding failing to alert patients to the risks of their drugs.  As a result, pharmaceutical companies that manufacture brand-name products take on the responsibility for drug risks, but generic companies are free of all such responsibilities.  By virtue of this Supreme Court ruling, if a drug causes significant harm to a patient, the manufacturer is indemnified by virtue of its generic drug status.

On page 9 of the front section was an article by Roni Caryn Rabin entitled: 2 Studies Link Daily Doses of Aspirin to a Significantly Reduced Risk of Cancer.  The bottom line is that based on two new studies, daily aspirin may significantly reduce the risk of many cancers—colon, lung, prostate, and esophagus—as well as help prevent cancers from spreading.  These findings conflict with two previous studies, which showed no cancer prevention with the use of aspirin.  Because of these contradictory studies and the potential risks of gastrointestinal bleeding and hemorrhagic stroke from aspirin, there is an urgent need for long-term clinical trials to test if aspirin can truly prevent cancers and determine if the potential benefits outweigh the risks.  Sadly, this study is never going to happen because of the astronomical expense of such a clinical trial and the fact that aspirin is a cheap generic drug.  There is nothing in it for Big Pharma except “good will toward men” given that all of humankind might potentially reap great benefits.

On page 11 of the front section was an article by Donald G. McNeil, Jr. entitled: A Cheap Drug Is Found To Save Bleeding Victims. Tranexamic acid, an inexpensive generic drug that blocks an enzyme that dissolves clots and hence stops bleeding, has been helping to save the lives of injured American soldiers engaged in war.  Clinical trials have shown that it can reduce the risk of fatal hemorrhage by 30% if given within three hours of trauma.  It has been available over-the-counter in Japan and Great Britain, where it is used for heavy menstrual flow.  Unfortunately, because it is generic, inexpensive, and not a potentially profitable drug, Pharma has not sought FDA approval.  As such, tranexamic acid is not available in hospitals and emergency rooms in the USA.  Simply stated, there is no financial incentive in it for Big Pharma, the powerful force that traditionally gets drugs to market via the FDA.   Without the lure of blockbuster profits, the manufacturer will not go forward, despite the drug’s ability to save lives.

In Tuesday’s New York Times, there was a profile on Drs. Arnold Relman and  Marcia Angell, former editors of “The New England Journal of Medicine”.  This husband and wife team has spent decades crusading against for-profit medicine, particularly the commercial insurance and drug manufacturing industries.  In 1980, in an editorial rail, Dr. Relman wrote: “We should not allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends; medicine must serve patients first and stockholders second.”

I am all for capitalism, free enterprise, meritocracy and incentives to help produce positive results.  Having stated that, I am also for pragmatism, social responsibility, public health and the greater good.  So have we completely lost our souls regarding generic medications?  If a generic pharmaceutical is a potential wonder drug, shouldn’t we able to find the means to get it FDA approved and bring it to market to help our fellow Americans in need?  Shouldn’t we be able to find a means to finance clinical trials to be able to test the efficacy of generics regardless of profit potential? Finally, just because a drug exists in a generic form, shouldn’t our citizens have recourse against the manufacturer in the event that a medication causes real harm?

We have a system marked by dishonorable, unprincipled and often unethical priorities that is sorely in need of repair.  A tragic collateral effect of the profit-making motives of the commercial drug manufacturing industry has been the exploitation of our “public” health, which becomes much less public and much more personalc when it impacts you, me and our loved ones. When the greater good gets undermined because of economic forces, it demands righting by some form of regulatory system.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

Bladder Infections In Women

March 16, 2012

 

 Bladder infections (cystitis) are relatively common occurrences among females.  Acute uncomplicated bacterial cystitis is an infection of the bladder that can cause burning, frequency, urgency, bleeding, urinating small volumes, incontinence, and pain (abdominal, pelvic, or lower back).  Lab studies usually show bacteria, white blood cells and red blood cells in the urine. 80-90% of cystitis is caused by Escherichia coli, 5-15% by Staphylococcus and the remainder by less common pathogens including Klebsiella, Proteus, and Enterococcus.

 Cystitis occurs when bacteria that normally inhabit the colon gain access to the urinary bladder. While cystitis is common among the female population, it is rare among the male population.  Anatomical differences that promote cystitis in women are the short female urethra and the close proximity of the urethra to the vagina and anus, areas that are normally colonized with bacteria.  The occasional occurrence of cystitis—while a nuisance and oftentimes uncomfortable—is usually easily treated with a short course of antibiotics.   When bladder infections recur time and again, it becomes a major source of inconvenience and suffering for the patient, and it becomes important to fully investigate the source of the recurrence.

 A urinary infection is considered complicated under the following conditions:  if it involves the kidneys; if it occurs during pregnancy; if the bacteria are highly resistant to antibiotics; if there is a structural abnormality of the urinary tract; if it occurs in immune-compromised patients, including diabetics; in the presence of a “foreign body” such as an indwelling urinary catheter, urinary stent or urinary tract stone.

 For an infection to develop, there has to be vaginal colonization with pathogenic bacteria (bacteria that can cause an infection and not the normal healthy bacteria that reside in the vagina); movement of these bacteria into the bladder; and finally, attachment of the bacteria to the cells that line the bladder.  Whether or not an infection develops is based upon the interaction of female protective mechanisms (“defense”) and bacterial virulence factors (“offense”). “Defense” factors include an acidic vagina, which inhibits the growth of the type of bacteria that cause infections while promoting the growth of “good” bacteria such as lactobacilli; the presence of a mucopolysaccharide layerthat protects the bladder lining; and immune cells present in the urine that block the adherence of bacteria to the bladder cells.  Additionally, the dilution action of urine production and the flushing effect of urinating can wash out bacteria before they have a chance to latch on to the lining of the bladder.  Bacterial “offense” factors include fimbriae, tentacle-like structures that promote attachment to the bladder lining cells and the capability of bacteria to evolve and develop resistance to antibiotics.

  Women aged 18-24 years old have the greatest prevalence of acute uncomplicated bacterial cystitis and sexual activity often is a factor in bacteria finding their way into the urethra and bladder, hence the term “honeymoon cystitis.”  The following are risk factors for cystitis: a new sexual partner; recent sexual intercourse; the use of spermicides, diaphragms or spermicide-coated condoms. Spermicides can change the vaginal “environment” and promote the presence of different bacteria from the normal flora. Being overweight can play a role in promoting cystitis because it is more difficult to maintain good hygiene under these circumstances.

  Cystitis also occurs with increased prevalence in the post-menopausal population, based upon changes that happen because of estrogen deficiency.  As a result of low levels of estrogen, there is a change in the normal bacteria (flora) of the vagina in which E. Coli replaces lactobacilli.  Topical estrogen cream has been shown to reverse vaginal colonization with E. Coli and helps prevent cystitis.  Other factors are an age-related decline in immunity; incomplete bladder emptying; and the not uncommon occurrence of urinary and fecal incontinence often managed with pads, which remain moist and contaminated and can promote movement of bacteria from the anal area towards the urethra.  The presence of diabetes (particularly when poorly controlled, with high levels of glucose in the urine that can be thought of as “fertilizer” for bacteria), neurological diseases, pelvic organ prolapse, obesity and poor hygiene further increase the prevalence of cystitis among older women

 It is important to distinguish a symptomatic urinary infection from asymptomatic bacteriuria, urethritis, vaginitis, and Painful Bladder Syndrome (PBS)/Interstitial Cystitis (IC).  Asymptomatic bacteriuria is the presence of bacteria within the bladder without causing an infection.  Asymptomatic bacteriuria does not require treatment, since treatment is most often futile and achieves nothing but selection of a resistant organism—in other words, by unnecessarily exposing bacteria to an antibiotic environment, bacteria can evolve and adapt to become modified in such a way that the antibiotic is no longer effective. Asymptomatic bacteriuria needs only to be treated in pregnant women and in patients undergoing urological-gynecological surgical procedures.  Urethritis is an infection in the urethra; vaginitis is a vaginal infection; and PBS/IC (Painful Bladder Syndrome/Interstitial Cystitis) is a chronic inflammatory condition of the bladder that can mimic the symptoms of cystitis.

 The diagnosis of cystitis is on the basis of urinalysis and culture.  A urine specimen is obtained after cleansing of the vaginal area with an antibacterial wipeand collection of a mid-stream voided specimen. At times, catheterization is necessary to obtain a specimen.  Dipstick is the fastest and least expensive means of screening for an infection, but it is not very accurate and fraught with false positives and negatives.  Microscopy is much more accurate, seeking the presence of bacteria, white blood cells and red blood cells.  The definitive test is urine culture and sensitivity, which will demonstrate the bacteria responsible for the infection, the quantitative bacterial count, and those antibiotics that are most likely to be effective.

    Treatment of cystitis is based upon antibiotics to eradicate the bacteria. In the case of recurrent cystitis, it is important to do an evaluation to rule out a structural cause. This generally involves imaging—often an ultrasound (using sound waves to obtain an image of the urinary tract)—and a cystoscopy (a visual inspection of the urethra and bladder with a flexible scope).  This will check the entire urinary tract, including the kidneys and bladder.  Findings may be a (cystocele) dropped bladder, a stone within the urinary tract, a urethral stricture (a narrowing in the channel leading out of the bladder that causes an obstruction), a urethral diverticulum (a pocket connected to the urethra), or a fistula (abnormal connection between the colon and bladder).

    After treatment of the acute infection, it is important to make changes in order to help minimize recurrent episodes of cystitis.  After urination or a bowel movement, it is important to wipe in a top-to-bottom direction to avoid bringing bacteria from the anus up towards the urethra.  It is also important to remain well hydrated to keep the urine from becoming very concentrated:  “The solution to pollution is dilution” applies well to urinary infections.  It is important to urinate on a regular basis over the course of the day, utilizing the natural flushing effect of urination to wash out the bladder and keep it from becoming over-distended.  Many workers such as nurses and teachers do not have the time to empty their bladders during the course of their days, and they often end up predisposed to cystitis.  It is very important to urinate after sexual activity to help flush out any bacteria that may have been introduced into the urethra and the bladder.

   One option for the management of recurrent cystitis is the self-administration of a short course of antibiotics when the cystitis symptoms first occur.  It is useful to first test your urine using a dipstick (although not perfect, it is great for home screening) when the symptoms of cystitis arise. This has proven to be safe, economical and effective.  Alternatively, a single dose of antibiotic can be administered just before or after sexual activity if the infections are clearly sexually related.  Another possibility is a single dose of antibiotic administered on a prophylactic basis every evening or every other evening to prevent recurrent cystitis.  Methenamine is converted to formaldehyde in the urine and can help prevent recurrent infections. Cranberries, lingonberries, and blueberries contain proanthocyanidins that inhibit the adherence of bacteria fimbriae to the bladder cells, acting as anti-adhesives and helping to prevent bacteria from attaching onto bladder cells and causing an infection.  There are formulations of cranberry extract available to avoid the high carbohydrate load of cranberry juice.  Estrogen cream applied vaginally can help restore the normal vaginal flora and thus help prevent cystitis.  Probiotics promote healthy bacteria colonization of the vagina, production of hydrogen peroxide that is toxic to bacteria, maintenance of acidic urine, induction of an anti-inflammatory response in bladder cells, and inhibition of attachment between bacteria and the bladder cells.

   In summary, bladder infections in females are common, annoying, but rarely serious.  They are very treatable, and those who suffer with recurrent infections can be nicely managed.

                      Pearls To Help Keep Cystitis Away

  • Wipe in a top-to-bottom motion after using the bathroom
  • Stay well hydrated to keep the urine dilute
  • At minimum, urinate every four hours while awake to avoid an over-distended bladder
  • Maintain a healthy weight
  • Urinate after sexual activity
  • If infections are clearly sexual related, an antibiotic taken pre or post-sexually can usually preempt the cystitis
  • If you are diabetic, maintain the best control possible
  • Topical estrogen can be helpful for the post-menopausal female
  • Seek urological consultation for recurrent infections to check for an underlying and correctable structural cause; if none are found, there are a number of means of managing recurrences, including self-diagnosis/self-treatment; daily antibiotic prophylaxis; daily methenamine; cranberry extract; probiotics

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

To view my educational video on bladder infections:

 

Low Caloric Density Diet: A Healthy Means Of Shedding Pounds

March 10, 2012

Blog #49     Andrew Siegel, M.D

 

Bottom line: Eating too much high caloric-density food has contributed to the obesity epidemic.  A diet consisting of low-caloric density foods will allow us to eat more food, but with fewer intake of calories.  This will keep us satisfied and limit the intake of excessive calories, promoting the maintenance of a healthy weight and general well being.

Density is defined as mass per unit volume.   For example, New Jersey is the densest state in the nation in terms of population, with the highest number of people per square mile.  All foods have a property called caloric density (energy density), which is defined as food calories divided by food weight.  Weight can be used as a substitute for volume since it is easier and more precise to weigh a food item than measure its volume.    

A major factor in high caloric vs. low caloric density is water content. Water serves to increase the volume of a food without adding any calories.  Another factor is fat content since fat packs a whopping 9 calories/gram as opposed to carbohydrates and proteins that are 4 calories/gram.  Thus, the less fat and more water content a food has, the lower its caloric density and the less amount of calories per unit weight it provides. For example, a given weight of vegetables has a lower caloric density than the same given weight of pizza.  Most fruits and vegetables have a very low calorie per weight measure.  On the other hand, many meats are high in caloric density.

One reason that we get fat is because we consume too many foods that have a high caloric density. One goal of a healthy eating plan is to eat foods that have a relatively low ratio of calories to weight–this will serve to keep our calorie count under control, yet the weight of the food consumed will keep us satisfied, if not full.  Dropping a few pounds simply becomes a matter of avoiding or minimizing high caloric density foods and replacing them with foods with low caloric density.  Additionally, combining low caloric density foods with high caloric density foods can lower the overall caloric density of a meal, making it healthier.  A classic example is raisins as opposed to grapes.  Twenty grapes have the same amount of calories as twenty raisins, but much more volume and weight.  It would be easy to hold twenty raisins in your palm and pop them into your mouth; doing the same with the identical number of grapes would be virtually impossible.  The difference is the presence of the increased water content of the grapes as opposed to the minimal water content of the dried fruit.  The water content of the grapes makes them occupy a much greater volume in your hand as well as in your stomach, which makes them much more satisfying than raisins in terms of quelling hunger as well as thirst.  It is difficult to get full on raisins since they are so dense, but easy to do so on grapes because they have so much volume.  It is therefore very easy to consume excessive calories munching on a box of raisins, but much more difficult to do so with a bowl full of grapes.  The greater volume lends itself to not only feeling satisfied, but also to built-in portion control.

As another example, let us compare fruit juices to whole fruit.  It is very easy to drink 12 ounces of orange juice, what in essence amounts to about 170 calories of less-than-healthy fiber-free sugar.  To get that kind of caloric load from nature’s whole product—the orange—you would have to eat almost 3 of them.  I can’t begin to imagine eating three oranges—the bulk and weight from the fiber is just too filling, plus the work involved in peeling the orange would certainly be a deterrent.  Additionally, the orange is a discrete unit that naturally lends itself to a defined volume of consumption, while there is absolutely no such clear-cut unit with the juiced by-product.

Most people eat a more-or-less consistent volume (weight) of food on a daily basis.  So, by choosing foods of less caloric density, one will feel fuller on a diet of fewer calories.  That is the principle behind a low-density, high-volume diet.  This is essentially the same concept behind drinking a glass or two of water before every meal.  This will not only quench thirst that can be confused with hunger, but can serve to stimulate the receptors in the stomach that trigger fullness. A low caloric-dense diet achieves the same endpoint by having the water content within the food itself.  Water adds weight and volume to foods, but adds no calories.

The same applies to air—it adds volume without calories.  When you froth up a smoothie in the blender, air is folded into the concoction, which increases volume without changing the weight or calories, and this extra volume will stimulate the fullness receptors in the stomach.

Calorie density counts of selected foods (Adapted from The Ultimate Volumetrics Diet by Barbara Rolls)

Food     /    Calorie density

Water 0.0

Celery 0.1

Salad greens 0.2

Cantaloupe 0.3

Peach 0.4

Apple 0.5

Lentil soup 0.6

Grapes 0.7

Cooked peas 0.8

Baked potato 0.9

Banana 1.1

Cooked whole wheat pasta   1.2

Avocado 1.6

Hummus 1.8

Lean broiled ground beef      2.2

Bread 2.7

Ice cream 2.8

French fries 2.9

Raisins 3.1

Hard pretzels 3.5

Brownie 4.1

Trail mix 4.3

Cooked bacon 5.2

Dark chocolate 5.7

Peanut butter 6.3

Olive oil 8.8

 

Pearls:

  • Beware of caloric-dense foods like dried fruit as it is much easier to overdo caloric consumption: raisins vs. grapes, prunes vs. plums, dried figs vs. whole figs, etc.
  • Start meals with soup, salad or cut up fresh fruit—this low-density caloric consumption will fill you up and minimize the chances of over-eating caloric dense entrees
  • Drink low caloric density beverages including water, seltzer or herbal teas instead of high caloric density, liquid calories from sodas, sweetened beverages or juices
  • Dilute juices with seltzer to decrease their calorie density
  • Drink light beer instead of full beers
  • Dilute thick soups with water to decrease the caloric density
  • Add chopped vegetables to pizza, pasta, casseroles, stews, meat loaf, macaroni and cheese and soups
  • Add pureed vegetables to sauces and toppings
  • Add extra carrots to carrot cake, extra zucchini to zucchini bread, etc.
  • Instead of ice cream as a dessert, have an assortment of fruits and add a small scoop of ice cream as a topping
  • Use less caloric-dense toppings on potatoes such as Greek yogurt as an alternative to sour cream
  • Use less caloric-dense bases for dips such as Greek yogurt instead of sour cream
  • Use less caloric-dense bases for salad dressings such as Greek yogurt instead of mayonnaise
  • Eat less caloric-dense snacks such as baked chips instead of fried chips
  • An apple is much less calorie dense than a piece of apple pie
  • Enjoy natural caloric-dense foods as an alternative to processed caloric-dense foods, e.g., a refrigerated dried fig or two as an alternative to candy for a sweet

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

Testosterone Replacement Therapy Vs. Performance Enhancing Drugs: A Whole Different Ball Game

March 3, 2012

 

Recently, an appeals court ruled that Alberto Contador, the three-time winner of the Tour de France, was guilty of “doping,” the use of anabolic steroids to gain an athletic advantage.  This was an additional blow to a sport that has been repeatedly tarnished by doping scandals involving the most elite cyclists in the world.  The court ordered Contador to be stripped of his victory in the 2010 Tour de France as well as twelve subsequent victories.

Doping is by no means unique to cycling, as professional athletes in many different sports—weightlifting, bodybuilding, baseball, football, martial arts, etc.—have tested positive for performance-enhancing substances in the last few years. Doping is banned by all of the major sporting governing bodies.  Not limited to professional athletes, many amateur athletes and bodybuilders have used anabolic steroids to try to improve their game and gain a competitive edge.

Many years before Barry Bonds became involved with doping, it was recognized that the male sex hormone testosterone played a major role in muscle mass and strength.  In the early 1950’s, Soviet Union and other Eastern Bloc Olympic weightlifting teams made use of such androgens, isolated from the testicles of animals, in order to enhance their performance in Olympic events.  Over the subsequent 60 years, the use of synthetic anabolic steroids increased substantially.  Anabolic steroids mimic the effects of testosterone, increasing protein synthesis in cells, causing muscle growth and an increase in lean body mass that results in a gain in muscle strength and thus, a competitive edge.

Anabolic steroids have two different types of effects—anabolic and androgenic.  Anabolic refers to the promotion of cell growth and includes the following effects: increased appetite, increased muscle and bone growth and increased production of red blood cells by the bone marrow, all of which result in increased strength. Androgenic refers to the development of masculine characteristics including oil gland production, libido and sexuality, deep voice and male-pattern hair growth.  Many effects and side effects of anabolic steroids are dose-dependent, in other words, in proportion to the doses used.

Along with the escalating use of synthetic androgens in athletes, there has been a parallel increasing awareness of testosterone deficiency and its treatment, particularly over the last couple of years.  Since testosterone (T) and performance enhancing drugs (PEDs) are both classified as anabolic steroids and each increases muscle mass and strength, they are often incorrectly thought to be one and the same.

T and PEDs differ in structure, biochemistry and use.  The medical use of T is for men with testosterone deficiency, usually manifested by fatigue, diminished sex drive and a constellation of other symptoms.  The goal of treatment is to improve symptoms by getting the testosterone into a normal range.  There are a variety of means of testosterone replacement including gels, creams, trans-dermal patches, pellets and injections.  All of these formulations are FDA approved and provide testosterone that is identical to that of the testosterone that is present in our bodies under normal circumstances.  Testosterone levels are checked periodically to ensure that the testosterone is in the normal range.

PEDs are most often manufactured clandestinely at small labs to avoid FDA scrutiny; they are sometimes obtained through veterinarians, pharmacists or physicians, and are often procured on the black market.  They are intended solely to build muscle mass, strength and improve athletic performance, so their use is beyond the domain of standard medical practice.  PEDs favor anabolic (muscle building) over androgenic (pertaining to the development of male characteristics) effects.

The vast majority of the time, PEDs are provided illicitly by a trainer without special expertise in this area.  The goal is a super-high testosterone level, often ten times or more than normal levels.  Dopers often use the equivalent of 1000 mg or greater of T per week.  PEDs are not the chemical equivalent of T and there is no medical monitoring of users.   Popular PEDs include nandrolone and stanozolol, which were FDA approved years ago, but now have no medical indications.  “Designer” PEDs are often concocted by modifying T; their advantage is that monitoring organizations lack the wherewithal to detect them because of their unique chemical formulations.   The two common patterns of PED usage are stacking and cycling.  Stacking is using two or more PEDs simultaneously whereas cycling is an on—off schedule of use.

PEDs have no medical indications and a risk profile that includes the following: elevated blood pressure; abnormal cholesterol and lipid profiles; altered blood glucose; cardiac muscle enlargement; mood disorders including aggression and violence (“steroid rage”); increased rates of homicide and suicide; liver dysfunction; spontaneous tendon rupture; and endocrine issues including severe and irreversible testicular dysfunction. This contrasts with the use of T, which provides medical benefits and a relatively benign safety profile.  Adverse effects of testosterone may include the following: acne; male breast growth; high red blood cell counts; testicular atrophy; prostate enlargement; decreased sperm production; ankle swelling.

In summary, testosterone deficiency is a genuine problem that can cause a myriad of quality of life as well as quantity of life issues.  When deficiency symptoms are apparent and blood testing confirms the deficiency, testosterone replacement with careful physician monitoring is capable of improving or resolving these issues.  On the other hand, the use of performance enhancing drugs for purposes of achieving anabolic benefits and thus conferring a sports advantage or edge is a very risky business and is not recommended.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

www.PromiscuousEating.com

Now available on Amazon Kindle

To view my ten-minute video on testosterone deficiency, go to the following link:

Credit to Dr. Abraham Morgentaler, Harvard Urologist and author of a good little book entitled Testosterone For Life, for providing much of the factual info for this blog.