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May 3, 2015

My Unexpected Journey Into Age Management Medicine

age management medicine
Photo courtesy of Pixabay

“Hey Dr. Joe, how did you get interested in age management medicine?”, I’m occasionally asked by patients.  Well it was quite unexpected. I had a very nice career practicing sports medicine and wasn’t looking to do anything different. But, that started to change in February 2007. Here’s my story.

In  2007 I was practicing with the Steadman-Hawkins Clinic of the Carolinas founded by two very prominent orthopedic surgeons and leaders in sports medicine; Richard Steadman, MD and Richard Hawkins, MD. In February of that year I was asked to give a talk on anabolic steroids at the Annual Steadman-Hawkins Sports Medicine Symposium which is held in June.

I already had a talk on anabolic steroids that I had given a handful times of before and contemplated saving myself a lot of time and simply give the same talk. My talk on anabolic steroids was similar to every talk I heard on the subject given by other physicians; anabolic steroids are dangerous and athletes should avoid using them.

Mindset of Anabolic Steroid Users

I figured I should to update my talk since it was about three years since the last time I gave the talk. Plus, I was intrigued by the fact that there are an estimated 5 million anabolic steroid users in this country and they all know anabolic steroids are “dangerous”. So why do they do them? It’s not like one gets a high from anabolic steroids like they might from the typical recreational drugs. So I wanted to devote some of the talk to the mind-set of the anabolic steroid user.

That decision to look into the mind-set of the anabolic steroid user changed everything for me. The same night I was asked to give the talked I embarked on what turned out to be a fascinating eye-opening journey that led to an additional 100 hours plus of research I never anticipated.

I started searching anabolic steroid websites that night attempting to learn from the people who abuse steroids. I saw a Google search with the name Rick Collins. I knew a little bit about Rick Collins. He’s a prominent attorney and leading legal authority on the law surrounding anabolic steroids. So I thought I may as well get his opinion, too.

Rick Collins’ Testimony

The Google search containing Rick Collins was linked to a Federal Hearing held by the United States Sentencing Commission to which Mr. Collins testified. The transcipts of the hearing are 99 pages long, but I only read those parts of the transcripts in which Mr. Collins testified. In his opening statement Mr. Collins made ten points regarding anabolic steroids – some of which I never heard before and a few that got me thinking in ways I never did before on this topic.

We have posted the transcript of those hearings in this article, Why is Testosterone a Controlled Substance?  To access the transcripts click here USSC April 12 2005 Collins Anabolic SteroidsHis testimony starts on page four but the core of his testimony begins on page eight where he begins to make the first of ten points regarding anabolic steroids.

The original federal government URL to those transcripts no longer exists though you can find a summary of the hearings. As fas as I know the only link to the entire transcipts of that hearing available online is on this website.

Mr. Collins made some revelations that I found quite shocking. He stated that prior to the passage of the Anabolic Steroid Act of 1990 that the FDA, DEA, AMA, and National Institue for Drug Abuse all opposed legislation to classify anabolic steroids as controlled substances. He discussed how the Controlled Substances Act was never intended for drugs like anabolic steroids that are not abused for psychoactive effects (the main purpose of the Act).

He pointed out that testosterone is the only hormone that is a controlled substance. Why? He suggested that anabolic steroids are, in fact, safer than more commonly used over the counter medications like aspirin, and that there has never been a long-term study on anabolic steroids to show that they are dangerous.

He implied that the real reason anabolic steroids are now a controlled substance had little to with adverse health effects, but rather had to do with cleaning up cheating in sports.

My first reaction to all of this was, “he’s an attorney, he’s lying”. I then spent most of those 100 additional hours of research verifying everything he said in that hearing. I could not find any point that he stated that was false, incorrect, or misleading.

I even obtained and read the 500 pages of transcripts from the Congressional Hearings on Anabolic Steroids that took place in 1989-90. I concluded that we as physicians “have been lied to”. At the very least, we and the public have been misled.

My Anabolic Steroid Talk

In June of 2007 I presented a talk on anabolic steroids I’m sure unlike any talk ever given before on the subject by a sports medicine physician to a group of sports medicine physicians, physical therapists, and athletic trainers. The comments on the evaluation of the talk ran the gamut from, finally a physician who speaks the truth about steroids” to “it is irresponsible for a physician to say that anabolic steroids are not dangerous”.

I actually never said they were not dangerous. Nor, did I suggest that their use be allowed in sports. I simply made the argument that they do not appear to be as “dangerous” as we may have been led to believe.

I provided medical evidence showing that anabolic steroids in the short-term are safer than other hormones like insulin and more commonly used drugs by athletes including non steroidal antiflammatory medications, acetaminophen, oral contraceptives, antidepressants, and safer than office surgical procedures like liposuction. And, that they are far safer than tobacco and alcohol which are abused for their psychoactive effects (yet they are not controlled substances).

I pointed out that the link between anabolic steroids and suicide is very weak. In a ten-year period spanning 1997-2007 I could only find seven case reports of suicide attributable or related to anabolic steroid use in athletes. The baseline suicide rate in this country is 10 per 100,000. If we have 5 million anabolic steroid abusers then in that population alone we should see 500 suicides a year – and that’s if they don’t do anabolic steroids.

If anabolic steroids increases that risk then there should be more than 500 suicides a year. Yet, there were seven cases of suicide in a ten year period possibly related to anabolic steroid use.

Interestingly, the suicides occurred when the athletes were off anabolic steroids (I have a theory on that but too lengthy to go into here). Given the attention and the widely held viewed that anabolic steroids increases the risk of suicide you would think that any time an athlete commits suicide one of the first questions that might be asked is “was he on steroids”. Not all cases of suicide are reported, but certainly there should be far more case reports if anabolic steroids are a serious risk factor.

The point is those seven cases probably reasonably reflect the actual number of suicides in athletes using steroids during that period. The reality is this. Overdoses from insulin (a hormone) have killed far more people than anabolic steroids have and birth control pills (also hormones) have killed far more women. In fact, there have been no reported deaths related to an acute overdosage of anabolic steroids and only one report of a complication from an acute overdosage.

I also pointed out the medical evidence present at Congressional Hearings leading up to passage of the Anabolic Steroid Act was weak with the strongest evidence against anabolic steroids being a case report of the three men admitted to the psychiatric ward after completing a cycle of anabolic steroids. That was it.

Not one long-term study on anabolic steroids was presented at those Hearings, because no such study existed. And, yet all we hear is how dangerous anabolic steroids are. Yet, we have 5 million users who apparently disagree with that view and who are not “dropping like flies” like the medical community said they would.

The research that went into that talk suggested to me this. If supra-physiolgoic doses of anabolic steroids (non-bioidentical and synthetic) are safe in the short-term then physiologic doses of hormone replacement therapy, especially bioidentical, is probably safe in the long-term. And, hormone replacement therapy next to nutrition and exercise is the cornerstone of anti-aging medicine.

The medical profession lost credibility (and has never regained it) with athletes on this topic of anabolic steroids when in the 1960s and 70s the medical community claimed that anabolic steroids did not enhance performance and even conducted questionably designed studies to show that (using too low of doses of steroids for instance). Yet, the athletes could tell they were working. They could see for  themselves they were getting bigger and stronger and recovering from workouts faster.

So the mindset of the athlete became this. “If the medical profession will lie about the performance effects of anabolic steroids, it will probably lie about any adverse health effects, too.” When it comes to anabolic steroids few athletes now believe the medical community.

Training in HRT in Age Management Medicine

This change in my thinking about anabolic steroids is part one of the story. The second part occurred in January of 2008. I was treating a mid-70 year old man with injections for arthritis of his knees. One visit he asked me, “why is it OK for women to receive hormone treatment, but not men?” Quite honestly I wondered that myself.

At the time I starting seeing ads in flight magazines featuring the 70 year old well chiseled male physician (Dr. Jeff Life) from a company called Cenegenics that did engage in male hormone replacement therapy. So I directed my patient to them. After doing so I figured I better learn more about them myself before referring patients to their website.

I discovered that it offered an age management medicine physician training program and also had physician practice opportunities. I received a package of information about their program in general, but also information on their physician training program with references to medical literature including studies by Abraham Morgentaler, MD who is the leading expert in testosterone deficiency. The training consisted of 60 hours of online work plus a week at their Las Vegas office.

In summer of 2008 I took their training program (since then I’ve taken at least a dozen other courses on hormone replacement therapy or HRT) and shortly thereafter started to offer hormone replacement to my middle-aged weekend warrior male patients that I was treating for orthopedic problems. In 2010 I took a position to work with Cenegenics full-time in its Dallas-Fort Worth office.

I stayed with Cenegenics for two years and provided HRT to men and women. But, Cenegenics placed as much emphasis on nutrition and exercise, especially strength training as it did HRT. I learned more about nutrition and strength training in those two years than all my previous years in medicine. Since then I have gone on to become a certified fitness trainer and have nearly completed work towards a sports nutrition certification.

HRT alone will deliver results. But, couple HRT with a low glycemic eating plan and strength training and the results are sometimes unbelievable. The Cenegenics program works. And, Dr. Life is real. Those ads of him are not photoshopped. If you work the Cenegenics plan it will work for you.

The Rewards of Age Management Medicine

Practicing anti-aging medicine or age management medicine, or whatever phrase you want to call it is professionally extremely rewarding – even more so than helping athletes get back to a high level of function. It’s rewarding to see patients transform themselves in front of you as they lose fat, gain muscle, regain their energy, become mentally crisper, get their mojo back so to speak, and get back to doing the things they really love but have been unable to do.

Plus, you work with patients so closely that you really get to know them as people and not just as patients.

In addition, nearly everything I learn in anti-aging medicine I can apply to my own health or my wife’s health. And, that motivates to me to keep learning more – my patients benefit from that, but I also benefit personally and professionally. That is rare in medicine.

Most physicians can only apply a limited part of their knowledge or their specialty/expertise to their own health. Think about that for a minute. How much of their specialty can a pediatrician apply to his/her own health, a radiologist to his/hers, or a male gyn to his, and so on?

As I’ve written in this post age management medicine is an advanced form of sports medicine with the target audience being the middle-aged and youthfully minded elderly who desire a high level of health so that they can enjoy a high level of life. Isn’t that what medicine should be about?

My journey into age management medicine was quite unexpected and it has had its challenges, but it has been a most worthy journey that has made me a better physician while providing me with additional strategies to improve the health of my patients.Now you know my story and I’m sticking to it.

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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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