Against the Grain with Dr. Chad Edwards | Oklahoma Prolotherapy | Podcast 4 – Part 4
Dr. Chad: Correct.
Brian Wilkes: If you’re at 500, let’s say 800, you’re in a normal balance, but you feel like you need a little more energy. You’re okay with going to 1,000.
Dr. Chad: Correct, yeah.
Brian Wilkes: That’s not abuse.
Dr. Chad: That’s correct.
Brian Wilkes:As long as it’s monitored?
Dr. Chad:Correct. There’s risk. The first dictum of medicine is first, do no harm. Hippocrates said, “When a physician cannot do good, he must be kept from doing harm.” It’s that concept of doing harm that’s critical. We have to make sure above all else that we don’t screw anybody up, that we are being appropriate with what we’re doing and we’re not doing harm. Within that realm, let’s be as optimal as we can be. If someone comes in and we talked about these reference ranges for stuff on the …
Brian Wilkes:Yeah, guidelines.
Dr. Chad: … previous podcasts, yeah. If your normal testosterone is 800 and then you start feeling bad and you come and get it checked and now you’re at 310, is that normal for you? No. I would argue it’s not, especially if you’re exhibiting and displaying symptoms of low testosterone. The second piece of that is are you going to look, feel, and perform better with testosterone enhancement whether we do it naturally, or we give you testosterone replacement? Are you going to do better?
If you do better on testosterone replacement, then we can say with reasonable assurance that, “Okay, this is a testosterone related problem.” It doesn’t answer why. We always have to go back to that why. Appropriately managing testosterone, we have to look at all of those factors. Why could this be low?
Then, we would consider testosterone replacement. With testosterone replacement comes a whole litany of potential risks. There are things that we have to consider. I would argue that cardiovascular disease is not 1 of them. That’s a rocky topic. We’ll talk specifically about testosterone and cardiovascular disease in a future podcast.
There are studies showing that there is no cardiovascular disease risk increase. There are studies suggesting that there may be. I would argue that that just muddies the water a little bit. I believe it’s not only safe, but beneficial. Again, it has to be appropriately managed. You have things like testicular atrophy. That means the jewels shrivel. That happens. That’s just a …
Brian Wilkes: It means you didn’t lose your mojo, it’s just shrinking.
Dr. Chad:The testicles are shrinking. There are things that we can do to manage that.
Brian Wilkes:I got that, Chad.
Dr. Chad:We can adjust some things with that. That was too ….
Brian Wilkes:I don’t know if we need to edit that right out.
Dr. Chad:That was TMI.
Brian Wilkes:Yeah, doctor talk. They just get right to it don’t they?
Dr. Chad: It’s the reality. I get guys that come on testosterone replacement. The reason for their visit is, “Man, you got to do something about this. My testicles are too small.”
Brian Wilkes: They notice them.
Dr. Chad: There’s not necessarily a …
Brian Wilkes: Seinfeld shrinkage.
Dr. Chad: … exactly. There’s not necessarily a medical problem with that. It’s a problem for them. We can manage that, but it has to be managed. Testosterone doesn’t come without side effects. Again, you got to weigh the risks and benefits of that. When we give someone testosterone, there’s a chance that they may be dependent on testosterone long-term. The last thing that we want to do is initiate therapy that they’re going to be dependent on over time.
Brian Wilkes: I would assume, and not knowing the science behind it, if I have a let’s say a level of 3 or 400. I come in to you. I get regular injections. Is the body capable, over a certain time, of weaning off that and the testosterone levels stay at a higher constant level? Is that what you’re suggesting?
Dr. Chad: Sure. We see that in many patients. There is a chance that, I can’t say it’s 50%, or 80%, or 20%. We don’t know. There is a chance that you may be dependent. It’s 1 of those things that we just have a heart-to-heart conversation. “Is this something that you want to do long-term?”
The longer you’re on it, the more likely it is that you’re going to need to be on it long-term. If we do this for a couple of few months, we work on the underlying cause, we fix some things, we often get patients off of their testosterone and they do great. That 22 year old that I told you about …
Brian Wilkes: Really?
Dr. Chad: … he’s no longer on testosterone replacement; doing fantastic.
Brian Wilkes: Really?
Dr. Chad: Yeah.
Brian Wilkes: It’s a course correction if you will?
Dr. Chad: Correct.
Brian Wilkes: Talk to me about how that works in the body. I don’t understand. The body naturally begins. Do you lower the doses at each segment and the body has this repetition pattern …
Dr. Chad: You’ve got multiple ways of managing that. I tailor it for each patient. You have multiple tools in the toolbox. 1 of them is a slow taper. First, you got to fix the underlying cause. If you’re constantly bombarded with stress and crazy and all those things…
Brian Wilkes: Yeah, back to that.
Dr. Chad: … you’re probably not going to get anywhere. That was what caused this to begin with, or it could be what caused it to begin with.
You got to consider that. Then, you also have to look at things. What are other arrows in the quiver, so to speak? We can use things like HCG. We can use things like Clomid. All of those stimulate the production, or the work in the testicles.
The Clomid we use more for semen production. Another side effect would be you don’t make as much semen. If you’re trying to get pregnant, then you may not be making enough. I’m sorry, not semen production, sperm production. You may not be making enough sperm. That can cause some fertility issues.
I’ve got multiple patients on testosterone replacement that have no problems fathering children. It’s 1 of those things that we have to consider. What are all the potential things? This is not simply a matter of you’re tired, your testosterone’s low. Here’s an injection. Have a nice day. In my opinion, it’s inappropriate. You’re not looking at the big picture. Patients ….