Category Archives: Uncategorized

Boyfriend Has Low Testosterone. What Can Lu Do?


Lu posts these concerns to Metabolism.com

My boyfriend is in his early 40′s and has been taking testosterone therapy. Instead of his levels increasing, they have decreased…his total is now in the single digits. He takes very good care of himself as he is a fitness trainer and body builder (takes vitamins, etc.). Obviously, with his total level being in the single digits, he has all the “symptoms” of low-T and is frustrated that the therapy is having a reverse reaction. He also suffers from Migraines and has recently been in a car accident that he suffered brain trauma in. I’m wondering if there could be a connection between the trauma and low-T or lower T. Any advice or direction you can head us in would be much appreciated.

In reply Dr. Pepper writes:

Hi Lu

You can’t pour water into a cup and wind up with less water in the cup then what you put in. Likewise, if someone takes testosterone supplement they will have more testosterone in their body then they started with. However, some things can influence the blood levels so one person will have higher or lower levels then someone else taking an identical dose. I have seen a wide variation in how testosterone gels are absorbed through the skin. These products include Androgel, Androderm, Testim, Axilron and Fortesa. One person may not see much of an increase in blood levels of testosterone on one of these gels while another will see levels zoom up to a 1000. Absorption of testosterone that is injected with a needle is less variable. Levels go very high in the first few days after the the injection but after 2 or 3 weeks levels will be low again. Here’s an important point. Since testosterone replacement turns off the body’s production of testosterone, if you stop taking replacement your body will not be making testosterone for weeks to months after resulting in very low levels on blood tests. People who abuse testosterone know this and will have the doctor check their testosterone level a month or two after their last dose, so the doctor will see the low levels and give them a prescription for more medication.

Can head trauma effect the testosterone level? For that to occur the pituitary gland would have to be damaged and that will often be associated with other obvious brain damage. In children less severe trauma can hurt the pituitary.

Hope some of this information is helpful in trying to figure out what is going on with your boyfriend. Good luck.

Gary Pepper, Editor-in-Chief, Metabolism.com

Diabetes Medications, One Old and One New, Run into Trouble


A potential new treatment for type 2 diabetes, dapagliflozin, recently failed to gain approval from the FDA. What makes this rejection noteworthy is that the new medication works by a completely new mechanism causing the kidney to excrete sugar from the blood into the urine. Reasons for the rejection were the increased risk of bladde and breast cancer in those taking the medication, increased urine and genital infections and possible liver toxicity. That list of problems seems pretty convincing to me. This is unfortunate because the drug appears to cause weight loss and does not cause low blood sugar (hypoglycemia). However, a drug that works by “poisoning” the kidney so that it dumps sugar into the urine strikes me as a drug that is going to cause a lot of other problems.

The other established diabetes medication generating new warnings is Actos (pioglitazone). I have written a number of articles on the sister drug Avandia, defending its usefulness despite possible cardiovascular risks, but the cancer warning for Actos is a new angle on this class of drugs (thiazolidinediones). Actos has been withdrawn in France due to concerns that it may cause bladder cancer but no such action has been taken in the U.S. The FDA this month did issue a warning that individuals with bladder cancer or at risk for bladder cancer, should be advised not to use Actos. If Actos is hit hard by these actions this whole class of diabetes drugs will have been eliminated from use.
A sure sign of trouble for Actos is that a “google search” for Actos is now showing lawyer websites as the first 5 citations.

Being sick is dangerous. Treating illness also has dangers. I am concerned that our cultural zeal for uncovering scandals and for pursuing litigation will lead us to sterile treatment options and doctors who are unwilling to risk helping.

Gary Pepper, M.D.
Editor in Chief, metabolism.com

Avandia Law Suit Brings Out the Opportunists


The lawsuits against Avandia are being prepared and opportunists are lining up for a payday. Unfortunately, everyone else will wind up a loser, and here’s why.

Avandia, one of only two available medicines with unique properties to treat diabetes, was approved in 1999. From the very first day Avandia was approved a heated debate arose whether Avandia or its sister drug, Actos, was the better drug for diabetes treatment. Both had similar abilities to lower blood sugar and both had the same downside of causing significant weight gain and fluid retention. Avandia showed a slightly worse effect on cholesterol profiles which convinced many diabetes specialists to choose Actos over Avandia. The choice between drugs has also been heavily influenced by cost considerations such as whether the drug was covered by the patient’s insurance carrier. I personally treated numerous patients with both drugs and found them about equal in all respects.

The lawsuits against Avandia will contend that the medication caused heart attack or stroke. The truth of this contention is very much in question, but the murkiness of the water doesn’t stop the lawyers from trying to take a bite out of the flesh of GSK (GlaxoSmithKline), the maker of Avandia.

Several years ago research studies seemed to indicate a small increased risk of heart attacks in users of Avandia. Ever since there has been a heated debate about whether this was a true risk or just the result of overly aggressive interpretation of the available data. There are two major analyzes on the subject of heart attack risk with Avandia. One, written by a doctor on the payroll of a competing drug company, looked at results from 14 thousand patients on Avandia and found a small increased risk of heart attack or stroke and the other study analyzed another 14 thousand Avandia users and found no such association. Under pressure from the public, in 2007 the FDA placed a strong warning on the label of Avandia regarding the possibility of the drug causing heart disease, but Avandia was permitted to remain on the market. The FDA warning was updated and upgraded in 2010. The publicity surrounding Avandia’s potential risks basically halted the use of the drug in the U.S.

Now enter the opportunists. Advertisements fill my email in-box from lawyers looking for customers who want to sue the drug manufacturer in class action law suits. Try goggling “Avandia side-effects” and you will find the first several pages of results are ads looking for lawsuit clients. In the last month I received two requests for patient records from these lawyers. Both patients had heart disease at the time they started the medication. One patient who recently died was over 80 years old, and the other who had significant heart disease and other diabetes complication to begin with, is still alive more than 7 years after treatment with Avandia. I wonder how much benefit these patients received from the medication which allowed them to survive as long as they did despite all the other problems they had related to their diabetes.

Why should you care about whether a small army of opportunists each get a few thousand dollars from the drug manufacturer and a few lawyers become millionaires? Because it is just this sort of legal action which is convincing drug makers to back away from developing other potential diabetes treatments. It takes a decade and a billion dollars to bring a new drug in front of the FDA. This doesn’t include the cost of developing drugs which fail to even make it to FDA review. Then the FDA approval process is tortuous and uncertain. Passing this hurdle, any new drug can come under attack (like Avandia) for “possible” side effects making the company vulnerable to devastating legal costs and bad publicity. It isn’t economically feasible to develop new diabetes drugs in the United States. As a result, new drug development is grinding to a halt. We will all suffer due to lack of innovation, not only for diabetes treatment but for treatment of many other dangerous diseases.

Gary Pepper, M.D.
Editor in Chief, Metabolism.com

Adopted Children Experience Early Sexual Maturity


Puberty occurs when areas within the brain awaken beginning a cascade of hormone signals which conclude with the gonads (ovaries and testicles) increasing their production of the female and male sex hormones estrogen and testosterone. Under the influence of these hormones a child begins the transition from childhood to sexual maturity. In boys puberty is associated with a growth spurt, the appearance of facial, axillary (arm pit) and pubic hair, acne, deepening of the voice, growth of the testicles and penis while girls undergo a growth spurt, develop breasts, acne, pubic and axillary hair, and growth of the clitoris.

Historical data shows the average age of puberty today is many years sooner than in previous generations. Most experts attribute earlier puberty to better nutrition. A recent article in metabolism.com reviewed how “over-nutrition” accelerates obese children into puberty sooner (referred to as precocious puberty) than normal weight children. The latest studies on causes of precocious puberty suggests that a child’s social environment also exerts an important influence on the timing of puberty. Researchers in Madrid publishing in The Journal of Clinical Endocrinology and Metabolism 95:4305 2010 analyzed the age of puberty in normal children, adopted children and children whose families immigrated (children not adopted but subject to high levels of personal stress) to Spain. Adopted children were 25 times more likely than other groups of children to undergo precocious puberty (breast development before the age of 8 years in girls, and boys under 9 years of age with testicular growth). Over-all girls were 11 times more likely than boys to demonstrate precocious puberty.

Researchers speculate that socio-emotional stresses early in life of children who are later adopted result in changes in the brain that cause premature maturation of vital nerve pathways. This early brain maturation later results in stimulation of the pituitary gland, turning on the hormone pathways that cause puberty. This seems strange to me because various forms of deprivation in childhood can also delay puberty. For example, girls who have anorexia remain child-like in their body development and may fail to menstruate even into their late teens. A decade ago I studied hormone levels in adults during the stress of illness and surgery and found this lowered the sex hormone levels in their blood. This makes sense from an evolutionary point of view because during stressful conditions nature wisely cuts off the reproductive hormones. Why make babies if the environment is hostile in some way? Why the opposite occurs in children under stress of adoption is an interesting but unanswered question.

Gary Pepper, M.D.,
Editor-in-Chief, metabolism.com

The “HCG” diet…. the controversy continues.


I received several inquiries about the “HCG” diet and my first response is a question in itself.  “Do you know what HCG is?”  So far there has been no lay person that actually knew what HCG was or what the diet entailed.  I will make just a few brief remarks to start the conversation and you can add comments as we go.  First of all, HCG is “Human Chorionic Gonadotropin” hormone.  It is made either by a developing embryo, the woman’s placenta while pregnant (!) or by a tumor in the human body.  Think about whether or not that is something you want to take into your body!  Second of all, the original “HCG diet” is based on a 500 Calorie per day diet that is severely restricted and nutrient deficient.  Weight loss without appropriate nutrition support is a recipe for a detoxification disaster that can do much more harm than good.  So, let us know what you think of ingesting a hormone made by a tumor or  during pregnancy, while starving yourself on a nutrient deficient diet! OR consider a professional nutrition consultation here at Metabolism.com that will walk you through the steps necessary to achieve balance and healthy weight loss without any gonadotropin!

Dear Oprah, It was Fun While it Lasted!


It’s over between me and Oprah. If you are a regular reader of metabolism.com you probably know about my proposal to Oprah. Don’t get worked up, it wasn’t a marriage proposal. It was a proposal to create a Diabetes Lifestyles reality show for her new cable network. Here’s the background. Oprah is starting her “Own” network on cable and is hosting a contest for ideas to add to her line up. For the past 6 months visitors to Oprah’s website have been able to view all the ideas submitted by the public and vote for their favorite ones. My idea was to produce a Diabetes Lifestyle reality show called This Sweet Life. Over two months my idea acquired about 60 votes and was still in the running. The problem between Oprah and I started when she asked for a commitment. I’m not phobic about commitments but she asked for too much. In order to stay in the contest I had to commit to taking 6 weeks away from my medical practice to go to Los Angles to participate in filming of the conclusion of the contest. I’m sorry Oprah…I’m already committed to my medical practice so you can’t have me!

Maybe some other time. But it was fun while it lasted.

Gary Pepper, M.D., Editor-in-Chief, metabolism.com

More Egg Yolks Please!


I have another 2 cents to put in about egg yolks. For some reason they have been demonized and demoralized. People have been led to believe that if you eat egg yolks, or cholesterol for that matter, they will somehow cause a heart attack. NOT TRUE. For the majority of people, consuming cholesterol will actually cause a feedback loop to kick in and reduce your bodies own production for the day. Cholesterol is REALLY REALLY important for producing Vitamin D, cortisol, estrogen, testosterone and other hormones, as well as cell membranes and brain tissue! IF cholesterol gets oxidized (from too much pollution/toxins and too few antioxidants) then you may have a cholesterol problem. So cut down on toxins and increase antioxidants to address that problem!
BUT back to the yolk of the egg… that is where the MAJORITY of nutrients are found. The yolk contains omega 3 fatty acids (especially if the chicken is fed properly), vitamins, minerals, carotenoids and choline. Choline is essential for producing acetylcholine, the “memory” molecule. So, don’t forget to enjoy 1 or 2 eggs EVERY DAY to boost your intake of these essential nutrients. Eat whole, organic eggs high in omega 3 fatty acids to give your brain and your body a boost!