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Statin Choir Boy Turns Disbeliever

Statin Choir Boy Turns Disbeliever

by Jeffrey Dach MD

For many years, Stephen Sinatra believed in statin drugs and prescribed them as a cardiologist in Connecticut. He gave lectures to other cardiologists on the merits of statin drugs at medical meetings on behalf of the drug companies. However, after a time, he became disillusioned and was transformed from a “Statin Choirboy” to a “Statin Disbeliever”.

Dr. Stephen Sinatra’s Observations:

1) many patients with low cholesterol will go on to develop heart disease.

2) In many patients with cholesterol above 280, angiograms show normal coronary arteries. They don’t have heart disease.

3) Population studies discredit cholesterol. For example, the French have the highest cholesterol levels in Europe of 250, and they also have lowest incidence of heart disease. On the Greek Island of Crete, average cholesterol is well over 200, yet there was not a single heart attack there in ten years.

4) Half of all heart attacks occur in people with normal total cholesterol.

Cholesterol and statins

A Vending Machine for Statin Drugs?

I refer you to Dr. Stephen Sinatra’s excellent article in the Townsend Letter in which he remarks that drug companies Merck and Pfizer have transformed the medical profession into one big vending machine for statin drugs.(4)

The Old Lipid Panel is Obsolete

Dr. Stephen Sinatra also tells us that the old Cholesterol blood test ordered by your primary care doctor is now obsolete, and has been replaced by the more sophisticated lipoprotein panel, providing a wealth of more information. What is this added information? In addition, the Calcium Score is more sensitive and accurate test than serum cholesterol for determining heart disease risk.

LDL Particles – Not All Sizes are Equal

Firstly, the new test provides LDL particle size. Small LDL particle size is the dangerous one associated with increased risk of heart disease. Large buoyant LDL particle size is the safe one, with less heart disease risk. Secondly the Lipoprotein profile includes Lipoprotein (a), a marker of high risk for heart disease risk.

[image error] Left Above Image: LDL particle with cholesterol ester in the center (yellow arrow) surrounded by phospholipid outer coating (white arrow).. APO-B Protein at top (red arrow)

Significance of Total Cholesterol

Steven Sinatra says total cholesterol doesn’t mean much unless you have a level over 320 which increases risk of stroke. Reducing cholesterol can be accomplished with weight reduction and increasing dietary fiber. Dr Sinatra would not prescribe a statin drug unless you are a male with documented heart disease.

Low LDL?

Dr. Sinatra says that low LDL below 80 is associated with adverse side adverse side effects of cancer, aggression, cerebral bleeding, amnesia, and immune dysfunction.

Just Don’t Do It

Below you will find Steven Sinatra’s advice if your doctor tells you to take statin based on the standard cholesterol panel:

1) Don’t do it. Ask for a Lipo-protein Subfraction Test such as the NMR LipoPorfile (LabCorp) or Cardio-IQ (Quest)

2) If you are a 50-75 year old male with small dense LDL, then go for the statin drug. It’s a good idea. If you are over 75, don’t take a statin drug as the drugs cause increased mortality in the elderly.

3) If you are a woman, avoid statins, as no statin drug study has ever shown a benefit in all-cause mortality for women by lowering cholesterol, and adverse effects of the drugs are horrendous.

4) If you have elevated lipoprotein (a), do not take a statin. The drugs don’t work for this. Instead use Niacin (B3) 500-2000 mg per day, Fish oil 2-3 grams per day, and Nattokinase 100 mg per day.

The Greatest Scientific Deception of the Century

Data from the Framingham Study was the basis for the cholesterol theory of heart disease, the theory that elevated cholesterol levels causes heart disease, and reducing cholesterol levels with diet or drugs prevented heart disease. A Biochemist and participant in the Framingham study, George V. Mann, later said in his memoirs,

” Saturated fat and cholesterol in the diet are not the causes of coronary heart disease. That myth is the greatest scientific deception of this century, perhaps of any century.”(7,8)

I Stopped My Statin Drug – Now What ?

What replaces the statin drugs once patients gets off? What lifestyle modifications and nutritional supplements are used to prevent or reverse heart disease? There is an entire program devoted to this called is the Track Your Plaque Program devised by William Davis MD, a Wisconsin cardiologist .

William Davis MD Warns About the Evil Trio

If total cholesterol is not useful as a predictor of heart disease risk, what is? Which lipoprotein markers are the ones to look for? Davis tells us the lipoprotein profile sometimes reveals an evil trio of abnormalities strongly predictive of heart disease, often leading to advanced heart disease at an early age.(6)

Here is the evil trio:

1) Low HDL–generally less than 50 mg/dl.

2) Small Particle Size LDL–especially if 50% or more of total LDL.

3) Lipoprotein(a)–an aggressive risk factor by itself.

If you have the evil trio, rather than robotically prescribe a statin drug, Davis recommends lifestyle modification and dietary supplements. Davis remarks that some of his greatest heart disease reversals have been in patient with this evil trio, which responds well to the regimen listed below. Reversal of Heart disease is determined by reduction in coronary calcium score (or less of an increase).

Here is Dr Davis’ program for Reversing Heart Disease and the Evil Trio

1) Niacin–increases HDL, reduces small LDL, and reduces Lp(a)

2) Elimination of wheat, cornstarch, and sugars–Best for reducing small LDL; less potent for Lp(a) reduction.

3) High-fat intake–Like niacin, effective for all three.

4) High-dose fish oil–Higher doses of EPA + DHA 3000 mg per day.

Here are a cases from the office of people on statins that I see very day. Statin Case Reports From the Office:

Number One – Chronic Psoriatic Rash from Statins:

Dan is about 65 with no history of heart disease and has been on a statin drug for a cholesterol of 220 about two years. His major problem is a red raised rash on his forearms, and hands and forehead which looks a lot like psoriasis, present for about 2 years. Dermatologists have been stumped and of no help.

Dan’s Lipoprotein Profile show large buoyant LDL particles indicating low risk for heart disease. His coronary calcium score was 75th per centile indicating only mildly above average risk of heart disease (50% per centile is average risk).

I told Dan that the rash was most likely a reaction to the statin anti-cholesterol drug, and advised a two week trial off the drug to see if the rash resolves. Three weeks later Dan returns to the office, and reports the skin rash is gone.

Number Two- Lupus-like Skin Lesion from Statins

Sarah is an 82 year old with no history of heart disease and on a statin drug for a cholesterol of 235. She had been to the dermatologist because of skin lesions on her face near the temple areas which were biopsied and reported by the pathologist as inflammation in the skin suggestive of lupus erythematosis. Sarah is concerned she has Lupus and cam to see me for a second opinion. I told Sarah she did not have Lupus and advised her that the skin eruptions were a reaction to the statin drug. Sarah stopped the statin drug and three weeks later reported the skin had returned to normal.

Number Three- Early Alzheimer’s from Statins

Lori is a 52 year old post menopausal with chief complaint of memory loss, cognitive dysfunction and severe fatigue. She had no history of heart disease and been on a statin drug for many years for a cholesterol of 230. I advised her to stop the statin drug. However, her cognitive dysfunction and memory loss continued unchanged. She was unable to find the office for a follow up visit, gave up and drove home.

A study by Muldoon showed virtual 100% of patients on statin drugs have some element of cognitive impairment, ranging from mild to severe symptoms of amnesia and cognitive dysfunction. (5) I have found this to be the case in actual clinical practice.

Number Four- Wheelchair bound non-healing deep infections from statins

Jim is a war veteran and was paralyzed from a roadside bomb many years ago, and has since been wheelchair bound. Although there is no history of heart disease, his doctor placed him on a statin drug for a cholesterol of 245 about two years ago. Shortly thereafter, Jim developed non-healing chronic decubitus infections at the ischial tuberosities at the site of pressure sitting in the wheelchair. Jim has had numerous surgical procedure and drainages, debridements, and multiple courses of antibiotics for these chronic infections which refuse to heal. In this case, the statin drug prevents healing of chronic infection. Jim stopped the statin drug, began an intensive nutritional program to boost immunity and healing ability and reported improvement after 6 weeks.

Credit and Thanks to Stephen Sinatra MD and William Davis MD for most of the information in this article.

Articles with Related Interest:

Reducing Calcium Score with Aged Garlic

Cholesterol Lowering Statin Drugs for Women, Just Say No

CAT Coronary Calcium Scoring, Reversing Heart Disease

Cholesterol Lowering Drugs for the Elderly, Bad Idea

Heart Disease, Ascorbate, Lysine and Linus Pauling

Saving Tim Russert and George Carlin

Lipitor and The Dracula of Modern Technology

Reversing Coronary Calcium Score

Heart Disease Part Two

Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie Florida 33314

954-792-4663

http://www.drdach.com/

http://www.naturalmedicine101.com/

http://www.truemedmd.com/

Links and References:

(1) http://www.spacedoc.net/stephen_sinatra_1

Dr. Stephen Sinatra – From Cholesterol Choirboy to Non-Believer

(2) http://www.spacedoc.net/stephen_sinatra_2

Dr. Stephen Sinatra – How to Determine if You Really Need a Statin

(3) http://www.spacedoc.net/stephen_sinatra_3

Dr. Stephen Sinatra – Statins, CoQ10, and Carnitine

If we have to prescribe a statin we always make sure the patient takes an ample amount of supplemental CoQ10 – at least 100 mg daily and taken with a meal.

4) Townsend Letter, Clearing Up the Cholesterol Confusion by Steven Sinatra, MD A well-known cardiologist explains why he doesn’t think lowering cholesterol is the answer for preventing heart disease, and debunks the routine prescription of statins for all but specific cases.

5) http://www.ncbi.nlm.nih.gov/pubmed/10806282

Am J Med. 2000 May;108(7):538-46.>

Effects of lovastatin on cognitive function and psychological well-being. Muldoon MF, Barger SD, Ryan CM, Flory JD, Lehoczky JP, Matthews KA, Manuck SB. Center for Clinical Pharmacology (MFM), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

CONCLUSION: Treatment of hypercholesterolemia with lovastatin did result in small performance decrements on neuropsychological tests of attention and psychomotor speed.

(6) http://heartscanblog.blogspot.com/2009/05/lethal-lipids.html

Lethal lipids-Heart Scan Blog William Davis MD

There’s a specific combination of lipids/lipoproteins that confers especially high risk for heart disease. That combination is:

Low HDL–generally less than 50 mg/dl

Small LDL–especially if 50% or more of total LDL

Lipoprotein(a)–an aggressive risk factor by itself

Total Cholesterol and Heart Disease

Dr Malcolm Kendrick (MbChB MRCGP) MD qualified in Aberdeen Scotland. He has worked in family practice for almost twenty years, and learned that treating patients is not like treating textbooks. He has specialized in heart disease and set up the on-line educational website for the European Society of Cardiology.

Disclaimer click here: www.drdach.com/wst_page20.html

The reader is advised to discuss the comments on these pages with

his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

7) http://www.nejm.org/doi/pdf/10.1056/N...

Mann, George V. “Diet-heart: end of an era.” New England Journal of Medicine 297.12 (1977): 644-650.

8) http://www.epi.umn.edu/cvdepi/essay/i...

Heart Attack Prevention A History of Cardiovascular Disease Epidemiology U of Minnesota

“It Isn’t Always Fun.” – A Mann Apart A Biographical Story

Saturated fat and cholesterol in the diet are not the causes of coronary heart disease. That myth is the greatest scientific deception of this century, perhaps of any century.

Link to this article:http://wp.me/p3gFbV-4hr

Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie, Florida 33314

954-792-4663

http://www.drdach.com/

http://www.naturalmedicine101.com/

http://www.truemedmd.com/

http://www.bioidenticalhormones101.com/

Disclaimer click here: http://www.drdach.com/wst_page20.html

The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship.

Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

Copyright (c) 2014 Jeffrey Dach MD All Rights Reserved

This article may be reproduced on the internet without permission, provided there is a link to this page and proper credit is given.

FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of issues of significance. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.

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Published on December 25, 2016 07:16

Statins Reduce Peri-Operative Mortality Surely You Must Be Joking

[image error] Statins Reduce Peri-Operative Mortality, Surely You Must Be Joking

Another Medical Hoax

I was intrigued by Dr London’s report in December 2016 JAMA of decreased peri-operative mortality in statin users.(1) This result does not seem immediately intuitive. Statin drugs inhibit an enzyme in the liver called HMG-CoA reductase involved in cholesterol production, thereby reducing cholesterol levels. Left Image: Surgeons by Reginald Brill 1934 courtesy of Wikimedia Commons.

Higher Cholesterol is Protective of Post Operative Sepsis

Higher cholesterol in the surgical patient is protective of endotoxemia, a dreaded complication of non-cardiac surgery which carries a high mortality rate. According to Dr Wilson writing in Critical Care 2003, ” lipoproteins can bind and neutralize lipopolysaccharide, hypocholesterolemia can negatively impact outcome.” (2)

Severly ILL Patients Have Low Cholesterol

Another observation made by Dr Wilson is that severely ill patients tend to have low cholesterol. If so, then these severely ill patients would not be good candidates for statin drugs in the days prior to their surgical procedure as their cholesterol levels are already low. No need to give a drug to make it lower. On the other hand non-critically ill patients tend to have higher cholesterol values which does make them good candidates for a statin drug.

The Cholesterol Endotoxin Hypothesis

This explains the spurious findings of the JAMA article. The patients not taking statins were sicker with lower cholesterol values, a marker for increased mortality from sepsis.

Conclusion:

Low cholesterol is an excellent marker for increased mortality from sepsis. (3-7) Therefore driving down serum cholesterol with a statin drug is not a way to reduce surgical complications, most of which are related to post op sepsis. This Study in JAMA by Dr London is therefore a medical hoax, a result of patient selection bias, not due to any imaginary benefits of statin drugs, which are non-existent.

The damage of this JAMA article could produce is frightening, since some surgeons may actually believe it and give their patients statin drugs. This would be a catastrophe of monumental proportions.

Jeffrey Dach MD

Articles with Related Interest:

Low Level Endotoxemia and Cholesterol

Jeffrey Dach MD

Links and References:

1) Association of Perioperative Statin Use With Mortality and Morbidity After Major Noncardiac Surgery. Martin J London, JAMA Dec 19 2016.

Question Is exposure to a statin in the early perioperative period associated with reduced postoperative complications after noncardiac surgery?

Findings This observational cohort analysis of veterans linked risk and outcome data from the Veterans Affairs Surgical Quality Improvement Program database to statin prescriptions in 180 478 patients and evaluated the associations of early statin exposure on 30-day mortality. After adjustment for risk, other medications used, and potential selection biases, 30-day mortality was significantly reduced in the statin-exposed group.

Meaning Perioperative statin use may be beneficial in reducing 30-day mortality, although the effects of selection biases cannot be excluded.

Abstract

Importance The efficacy of statins in reducing perioperative cardiovascular and other organ system complications in patients undergoing noncardiac surgery remains controversial. Owing to a paucity of randomized clinical trials, analyses of large databases may facilitate informed hypothesis generation and more efficient trial design.

Objective To evaluate associations of early perioperative statin use with outcomes in a national cohort of veterans undergoing noncardiac surgery.

Design, Setting, and Participants This retrospective, observational cohort analysis included 180 478 veterans undergoing elective or emergent noncardiac surgery (including vascular, general, neurosurgery, orthopedic, thoracic, urologic, and otolaryngologic) who were admitted within 7 days of surgery and sampled by the Veterans Affairs Surgical Quality Improvement Program (VASQIP). Patients were admitted to Department of Veterans Affairs hospitals and underwent 30-day postoperative follow-up. Data were collected from October 1, 2005, to September 30, 2010, and analyzed from November 28, 2013, to October 31, 2016.

Exposure Statin use on the day of or the day after surgery.

Main Outcomes and Measures All-cause 30-day mortality (primary outcome) and standardized 30-day cardiovascular and noncardiovascular outcomes captured by VASQIP. Use of statins and other perioperative cardiovascular medications was ascertained from the Veterans Affairs Pharmacy Benefits Management research database.

Results A total of 180 478 eligible patients (95.6% men and 4.4% women; mean [SD] age, 63.8 [11.6] years) underwent analysis, and 96 486 were included in the propensity score–matched cohort (96.3% men; 3.7% women; mean [SD] age, 65.9 [10.6] years). At the time of hospital admission, 37.8% of patients had an active outpatient prescription for a statin, of whom 80.8% were prescribed simvastatin and 59.5% used moderate-intensity dosing. Exposure to a statin on the day of or the day after surgery based on an inpatient prescription was noted in 31.5% of the cohort. Among 48 243 propensity score–matched pairs of early perioperative statin-exposed and nonexposed patients, 30-day all-cause mortality was significantly reduced in exposed patients (relative risk, 0.82; 95% CI, 0.75-0.89; P

Conclusions and Relevance: Early perioperative exposure to a statin was associated with a significant reduction in all-cause perioperative mortality and several cardiovascular and noncardiovascular complications. However, the potential for selection biases in these results must be considered.

2) Wilson, Robert F., Jeffrey F. Barletta, and James G. Tyburski. “Hypocholesterolemia in sepsis and critically ill or injured patients.” Critical Care 7.6 (2003): 1.

3) Leardi, S., et al. “[Blood levels of cholesterol and postoperative septic complications].” Annali italiani di chirurgia 71.2 (1999): 233-237.

Hypocholesterolemia seems to represent a significant predictive factor of morbidity and mortality in critically ill patients. The authors, on the basis of recent literature data, aim to clarify the possible correlation between preoperative hypocholesterolemia and the risk of septic postoperative complications .205 patients undergoing to surgery for gastrointestinal diseases were the object of the study. Patients undergoing “minor” abdominal surgery or video-laparoscopic surgery and classified ASA III-IV were excluded. In all the patients, we considered retrospectively risk factors for postoperative septic complications as follows: preoperative blood concentration of cholesterol, malnutrition, obesity, diabetes, neoplasm, preoperative sepsis, type and duration of operations, antibiotics and regimen of use. Type and incidence of postoperative local or systemic septic complications were recorded. The patients have been stratified according to blood concentration of cholesterol and to the presence or absence of other risk factors. The incidence of postoperative sepsis was 35.1%. The highest incidence of postoperative septic complications (72.7%) was encountered, significantly (X2 = 7.6, p < 0.001), in the patients (11 cases, 5.9%) with cholesterol levels below 105 mg/dl). The results of this study seems to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.

4) Marik, Paul E. “Dyslipidemia in the critically ill.” Critical care clinics 22.1 (2006): 151-159. Total and HDL cholesterol levels fall at the onset of acute illness and the cholesterol levels normalize as the patient recovers. Hypocholesterolemia may predispose the critically ill patient to sepsis and adrenal failure. Early enteral nutrition and tight glycemic control accelerate the recovery of the cholesterol levels.

5) Chiarla, Carlo, et al. “Severe hypocholesterolemia in surgical patients, sepsis, and critical illness.” Journal of critical care 25.2 (2010): 361-e7.

After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of hypocholesterolemia. In human sepsis, the poor implications of hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.

6) Biller, Katharina, et al. “Cholesterol rather than procalcitonin or C-reactive protein predicts mortality in patients with infection.” Shock 42.2 (2014): 129-132.

Serum cholesterol procalcitonin (PCT) and C-reactive protein (CRP) levels were measured consecutively in 76 critically ill patients at admission to the intensive care unit. The presence of infection was defined according to the CDC (Centers for Disease Control and Prevention) criteria; in-house mortality, underlying diseases, and severity of sepsis were monitored. Nonsurvivors had significantly lower cholesterol levels compared with survivors (69 mg/dL [range, 37-88 mg/dL] vs. 96 mg/dL [range, 71-132 mg/dL], P = 0.006) whereas no significant differences were noted for serum PCT and CRP levels. In a cohort of patients with cholesterol levels of 50 mg/dL or less, 82% did not survive as compared with patients with cholesterol levels of 100 mg/dL or greater (mortality, 21%). In a control group without infection, no difference of cholesterol, PCT, or CRP was found between survivors and nonsurvivors. Our data show that low cholesterol levels in patients with infectious disease have a prognostic value and may be useful markers to identify high-risk patients already at admission.

7) free pdf Thomas Whitney Serum cholesterol Superior Prognostic Marker Sepsis Mortality in ICU 2015 Thomas, Whitney. “Serum cholesterol: A Superior Prognostic Marker of Sepsis Mortality in the ICU Compared to Procalcitonin or C-reactive Protein.” (2015).

Total cholesterol may be a useful and superior prognostic marker of mortality for patients admitted to the ICU with sepsis secondary to infection compared to its CRP and PCT counterparts. Serum cholesterol could provide ICU clinicians a more sensitive screening tool for identifying those patients at highest risk for morbidity and mortality irrespective of other underlying comorbidities, whereas CRP may be more useful for monitoring response to therapy. Cholesterol pathophysiology may also yield insight on experimental therapy including the use of statin medications in septic patients in the ICU.

8) Sandek A., Utchill S, Rauchhaus M. The endotoxin-lipoprotein hypothesis-an update. Arch Med Sci. 2007;3(4A):S81. The endotoxin lipoprotein hypothesis Anja Sandek 2007

9) Pajkrt D, Doran JE, Koster F, et al. Antiinflammatory effects of reconstituted high-density lipoprotein during human endotoxemia. J Exp Med. 1996;184(5):1601-8.

10) Vreugdenhil AC, Rousseau CH, Hartung T, et al. Lipopolysaccharide (LPS)-binding protein mediates LPS detoxification by chylomicrons. J Immunol. 2003;170(3):1399-405.

11) Statin Drugs Tied to Better Surgery Outcomes By NICHOLAS BAKALARDEC. 21, 2016

12) Shock. 2016 Jan;45(1):10-5. Incidence of Sepsis and Mortality With Prior Exposure of HMG-COA Reductase Inhibitors in a Surgical Intensive Care Population.

Schurr JW1, Wu W, Smith-Hannah A, Smith CJ, Barrera R.

1*Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, Massachusetts †St John’s University College of Pharmacy and Health Sciences, Queens, New York ‡Department of Surgery, North Shore-LIJ Health System Long Island Jewish Medical Center, New Hyde Park, New York.

The anti-inflammatory properties of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may reduce the risk of developing sepsis in surgical intensive care patients and improve outcomes in those who do become septic. The objective of this study was to assess whether surgical intensive care unit (SICU) patients with prior exposure to HMG-CoA reductase inhibitors had a lower incidence of developing sepsis and improved outcomes. A retrospective cohort study was conducted. Patient demographic data, statin use, sequential organ failure assessment (SOFA) scores, vasopressor requirements, ventilator days, length of SICU stay, and mortality in septic patients were collected. Incidence of development of sepsis was determined using systemic inflammatory response syndrome criteria. Patients were grouped into cohorts based on whether they met the sepsis criteria and if they had previously received statins. Cohorts of patients who did and did not become septic with prior statin exposure were compared and an odds ratio was calculated to determine a protective effect. The setting was a SICU. The study comprised of 455 SICU patients and had no interventions. Among the 455 SICU patients, 427 patients were included for the final results. Patients receiving statins verses not receiving statins were similar in demographics. Previous statin exposure had a protective effect in the development of sepsis (9.77% on statins vs. 33.6% without statins; odds ratio 0.203, confidence interval 0.118-0.351). Of those patients who developed sepsis, there was a statistically significant decrease in 28-day mortality in patients with prior statin exposure (P = 0.0341). No statistical difference was noted in length of stay, vasopressor requirements, or days on mechanical ventilation. Prior exposure to statins may have a protective effect on the development of sepsis and decrease mortality in critically ill surgical patients.

13) McAuley, Danny, Pierre-Emmanuel Charles, and Laurent Papazian. “Statins in patients with sepsis and ARDS: is it over? We are not sure.” (2016): 1-3.

link to this article: http://wp.me/p3gFbV-4gE

Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie, Fl 33314

954-792-4663

www.jeffreydachmd.com

http://www.drdach.com

http://www.naturalmedicine101.com

http://www.truemedmd.com

Disclaimer click here: http://www.drdach.com/wst_page20.html

The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of issues of significance. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.

Serving Areas of: Hollywood, Aventura, Miami, Fort Lauderdale, Pembroke Pines, Miramar, Davie, Coral Springs, Cooper City, Sunshine Ranches, Hallandale, Surfside, Miami Beach, Sunny Isles, Normandy Isles, Coral Gables, Hialeah, Golden Beach ,Kendall,sunrise, coral springs, parkland,pompano, boca raton, palm beach, weston, dania beach, tamarac, oakland park, boynton beach, delray,lake worth,wellington,plantation.

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Published on December 23, 2016 12:22

Testosterone Therapy Prolongs Life and Improves Survival

Testosterone Therapy Prolongs Life and Improves Survival

by Jeffrey Dach MD

Unfounded Fears

More recently, in the past few years a flurry of articles and studies have come to light by Drs Traish and Morgentaler debunking the two unfounded fears regarding testosterone therapy in androgen deficient males.(7-13)

The first unfounded fear is the false medical myth that testosterone therapy somehow causes prostate cancer. This has been shown to be false.(7,8)

The second unfounded fear is that testosterone somehow increases cardiovascular disease. Not only is this false, the exact opposite is true. Testosterone therapy in androgen deficient males decreases cardiovascular mortality in numerous studies.(7,8) Indeed, Dr Traish makes the plea to the medical community to treat more androgen deficient men.(7,8) He says” “There is an urgent need among the medical community for greater awareness of the impact of TD on general health in men with TD.” (7,8)

Testosterone Treated Group Shows Improved Survival

Left image shows mortality rate In Diabetic Males with Normal or Low testosterone. Note the increased mortality in Low Testosterone untreated group. Mortality rate of androgen deficient group returns to Normal after testosterone treatment.(13)

Above Left image courtesy of Muraleedharan, Vakkat, et al. “Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes.” European Journal of Endocrinology 169.6 (2013): 725-733.

Conclusion: Low testosterone in males is associated with loss of libido, depression. metabolic syndrome , increased coronary artery disease and increased mortality. (4,5,7-13) These are all prevented or reversed by testosterone therapy. The great tragedy of modern medicine is that many androgen deficient males are either ignored or denied treatment. Hopefully this will soon be rectified. Our mission at TrueMedMD is to treat every androgen deficient male with testosterone therapy.

Related Articles:

Low Testosterone Increases Mortality

Testosterone Prevents Heart Attacks in Older Men

Low Testosterone – Diagnosis and Treatment

Symptoms of Low Testosterone

Does Testosterone Cause Prostate Cancer? by Jeffrey Dach MD

PSA Prostate Cancer and Testosterone Part Two

PSA Screening for Cancer, the Failed Medical Experiment by Jeffrey Dach MD

Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie, Florida 33314

954-792-4663

http://www.drdach.com/

http://www.naturalmedicine101.com/

http://www.truemedmd.com/

http://www.bioidenticalhormones101.com/

Links and References

(1) http://www.ncbi.nlm.nih.gov/pubmed/16908801

Low Serum Testosterone and Mortality in Male Veterans Arch Intern Med. 2006;166:1660-1665 Molly M. Shores, MD; Alvin M. Matsumoto, MD; Kevin L. Sloan, MD; Daniel R. Kivlahan, PhD .Conclusions Low testosterone levels were associated with increased mortality in male veterans.

(2) http://jcem.endojournals.org/cgi/content/full/93/1/68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190742/

The Journal of Clinical Endocrinology & Metabolism 2008 Jan;93(1):68-75.

Low Serum Testosterone and Mortality in Older Men. Gail A. Laughlin, Eliza beth Barrett-Connor and Jaclyn Bergstrom. Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093

Results: During an average 11.8-yr follow-up, 538 deaths occurred. Men whose total testosterone levels were in the lowest quartile (

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.

(3)http://abcnews.go.com/Health/ActiveAging/story?id=3247773&page=1&page=1

Low Testosterone Could Kill You. Low Levels of Male Hormone May be More Dangerous Than Previously Thought By SUPINDA BUNYAVANICH, M.D. ABC News Medical Unit June 6, 2007

Low testosterone may lead to a greater risk of death, according to a study presented Tuesday at the annual meeting of the Endocrine Society in Toronto.

Men with low testosterone had a 33 percent greater death risk over their next 18 years of life compared with men who had higher testosterone, according to the study conducted by Dr. Elizabeth Barrett-Connor and colleagues at the University of California at San Diego. “It’s very exciting and potentially a groundbreaking study,” said Barrett-Connor. “But it needs to be confirmed.” The study tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years.

4) http://www.medicalnewstoday.com/articles/153822.php

Testosterone Replacement For Men With Low Testosterone Improves Liver Function, Metabolic Syndrome. Testosterone deficiency, which becomes more common with age, is linked not only to decreased libido but also to a number of medical problems. These include the metabolic syndrome a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke and type 2 diabetes.

5) http://www.news-medical.net/news/2008/03/04/35897.aspx

Low testosterone levels linked to depression in older men March 2008

Older men with lower free testosterone levels in their blood appear to have higher prevalence of depression, according to a report in the March issue of Archives of General Psychiatry.

6) Malkin, Chris J., et al. “Low serum testosterone and increased mortality in men with coronary heart disease.” Heart 96.22 (2010): 1821-1825. low-serum-testosterone-and-increased-mortality-in-men-with-coronary-heart-disease-malkin-chris-heart-2010 Background To examine the effect of serum testosterone levels on survival in a consecutive series of men with confirmed coronary disease and calculate the prevalence of testosterone deficiency.

Design Longitudinal follow-up study. Setting Tertiary referral cardiothoracic centre. Patients 930 consecutive men with coronary disease referred for diagnostic angiography recruited between June 2000 and June 2002 and followed up for a mean of 6.9±2.1 years.

Outcome All-cause mortality and vascular mortality. Prevalence of testosterone deficiency.

Results The overall prevalence of biochemical testosterone deficiency in the coronary disease cohort using bio-available testosterone (bio-T) Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%), p=0.002). The only parameters found to influence time to all-cause and vascular mortality (HR ± 95% CI) in multivariate analyses were the presence of left ventricular dysfunction (3.85; 1.72 to 8.33), aspirin therapy (0.63; 0.38 to 1.0), β-blocker therapy (0.45; 0.31 to 0.67) and low serum bio-T (2.27; 1.45 to 3.6).

Conclusions In patients with coronary disease testosterone deficiency is common and impacts significantly negatively on survival. Prospective trials of testosterone replacement are needed to assess the effect of treatment on survival.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 2016

7) Traish, Abdulmaged. “Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?.” Investigative and Clinical Urology 57.6 (2016): 384-400.

Although testosterone therapy in men with testosterone deficiency was introduced in the early 1940s, utilization of this effective treatment approach in hypogonadal men is met with considerable skepticism and resistance. Indeed, for decades, the fear that testosterone may cause prostate cancer has hampered clinical progress in this field. Nevertheless, even after considerable knowledge was acquired that this fear is unsubstantiated, many in the medical community remain hesitant to utilize this therapeutic approach to treat men with hypogonadism. As the fears concerning prostate cancer have subsided, a new controversy regarding use of testosterone therapy and increase in cardiovascular disease was introduced. Although the new controversy was based on one ill-fated clinical trial, one meta-analysis with studies that utilized unapproved formulation in men with liver cirrhosis, and two retrospective studies with suspect or nonvalidated statistical methodologies and database contaminations, the flames of such controversy were fanned by the lay press and academics alike. In this review we discuss the adverse effect of testosterone deficiency and highlight the numerous proven benefits of testosterone therapy on men’s health and debunk the myth that testosterone therapy increases cardiovascular risk. Ultimately, we believe that there is considerable scientific and clinical evidence to suggest that testosterone therapy is safe and effective with restoration of physiological levels in men with testosterone deficiency, irrespective of its etiology.

TD is associated with increased incidence of metabolic syndrome, obesity, sexual dysfunction, impaired fertility, reduced motivation, increased fatigue, depressed mood, loss of bone and muscle mass, anemia, decreased energy and vigour, insulin resistance, diabetes, inflammation, dyslipidemia, sarcopenia and frailty, reduced quality of life (QoL) and increased mortality [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 40, 41, 42, 43, 44]. A substantial body of evidence indicates that coronary artery disease incidence and severity, carotid intima-media thickness, atherosclerosis is inversely correlated with serum T concentrations [45]. There is an urgent need among the medical community for greater awareness of the impact of TD on general health in men with TD.

8) Traish, Abdulmaged M. “Testosterone therapy in men with testosterone deficiency: are the benefits and cardiovascular risks real or imagined?.” American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. Vol. 311. No. 3. American Physiological Society, 2016.

In the adult male, testosterone (T) deficiency (TD) also known as male hypogonadism, is a well-established medical condition, which has been recognized for more than a century. T therapy in men with TD was introduced as early as 1940s and was reported to improve overall health with no concomitant serious adverse effects. A wealth of recent studies demonstrated that T therapy in men with TD is associated with increased lean body mass, reduced fat mass and waist circumference, improvement in glycemic control, and reduced obesity. T therapy is also associated with improvements in lipid profiles, amelioration of metabolic syndrome (Met S) components, reduced inflammatory biomarkers, reduced systolic and diastolic blood pressure, and improvements in sexual function. More importantly, T therapy is associated with amelioration of diabetes and reduced mortality. However, few studies, marred with serious methodological and analytical flaws reported between 2010 and 2014, suggested that T therapy is associated with increased cardiovascular (CV) risk. As summarized in this review, a thorough and critical analysis of these studies showed that the risks purported are unsubstantiated and such studies lacked credible scientific and clinical evidence. Moreover, recent observational, registry studies, clinical trials, and meta-analyses, all revealed no increase in CV risks in men receiving T therapy. In this review, the benefits of T therapy in adult men with TD and the lack of credible evidence suggesting that T therapy is linked to increased CV risks are discussed. It should be noted that the literature is replete with studies demonstrating beneficial effects of T therapy on CV and overall health.

Of importance, the study by Snyder et al. [3] and the resolutions of the consensus panel on T [2] debunked the notion that age-related hypogonadism is not a clinical condition and should remain untreated. As reported in the study [3], T therapy in older men has several benefits and age-related hypogonadism is a clinical condition worthy of treatment. We hope that the findings of this large and well executed study [3] and the summary provided by the consensus panel [2] will serve as a reminder to those who are beating the drums of fear and hysteria on the dangerous use of T in the treatment of men with TD and reassure men suffering from TD and their physicians that such fears and hysteria are unfounded.

9) free pdf Anderson Jeffrey testosterone replacement myocardial infarction low testosterone 2016 Anderson, Jeffrey L., et al. “Impact of testosterone replacement therapy on myocardial infarction, stroke, and death in men with low testosterone concentrations in an integrated health care system.” The American journal of cardiology 117.5 (2016): 794-799.

The aim of this study was to assess the effect of testosterone replacement therapy (TRT) on cardiovascular outcomes. Men (January 1, 1996, to December 31, 2011) with a low initial total testosterone concentration, a subsequent testosterone level, and >3 years of follow-up were studied. Levels were correlated with testosterone supplement use. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of death, nonfatal myocardial infarction, and stroke at 3 years. Multivariate adjusted hazard ratios (HRs) comparing groups of persistent low (742 ng/dl, n = 1,694) achieved testosterone were calculated by Cox hazard regression. A total of 4,736 men were studied. Three-year rates of MACE and death were 6.6% and 4.3%, respectively. Subjects supplemented to normal testosterone had reduced 3-year MACE (HR 0.74; 95% confidence interval [CI] 0.56 to 0.98, p = 0.04) compared to persistently low testosterone, driven primarily by death (HR 0.65, 95% CI 0.47 to 0.90). HRs for MI and stroke were 0.73 (95% CI 0.40 to 1.34), p = 0.32, and 1.11 (95% CI 0.54 to 2.28), p = 0.78, respectively. MACE was noninferior but not superior for high achieved testosterone with no benefit on MI and a trend to greater stroke risk. In conclusion, in a large general health care population, TRT to normal levels was associated with reduced MACE and death over 3 years but a stroke signal with high achieved levels suggests a conservative approach to TRT.

10) Saad, Farid, et al. “Testosterone Deficiency and Testosterone Treatment in Older Men.” Gerontology (2016).

Gerontology Testosterone Deficiency and Testosterone Treatment in Older Men Saad F.a, b · Röhrig G.c, d · von Haehling S.e · Traish A.f, g

aGlobal Medical Affairs Andrology, Bayer AG, Berlin, Germany;

Frailty is a clinical condition related to changes in metabolism, to sarcopenia, and to decline in muscle mass and strength, bone mineral density, and physical function with aging. The pathophysiology of frailty is multifactorial and associated with comorbidities. Testosterone is implicated in regulating metabolic functions, maintenance of muscle and bone, and inhibition of adipogenesis. In older individuals, reduced testosterone is thought to contribute to an altered state of metabolism, loss of muscle and bone, and increased fat, leading to sarcopenia, sarcopenic obesity, and frailty. While no direct relationship between testosterone deficiency (commonly known as hypogonadism) and frailty has been established (due to the multifactorial nature of frailty), clinical evidence suggests that testosterone deficiency is associated with increased sarcopenia and obesity. Testosterone treatment in frail older men with limited mobility and with testosterone deficiency improved insulin resistance, glucose metabolism, and body composition. These changes contribute to better physical function and improved quality of life. Because frailty increases disability, comorbidities, and the risk of hospitalization, institutionalization, and mortality in older men, it is warranted to explore the potential usefulness of testosterone treatment in frail men with hypogonadism in order to attenuate the progression of sarcopenia and frailty. In this paper, we will discuss the impact of testosterone deficiency on frailty and the potential role of testosterone treatment in ameliorating and reducing the progression of frailty. Such an approach may reduce disability and the risk of hospitalization and increase functional independence and quality of life.

11) free pdf Morgentaler Abraham Testosterone therapy and cardiovascular risk Mayo Clinic 2015

Morgentaler, Abraham, et al. “Testosterone therapy and cardiovascular risk: advances and controversies.” Mayo Clinic Proceedings. Vol. 90. No. 2. Elsevier, 2015.

a modest number of randomized controlled

trials (RCTs), indicate that low serum T concentrations

are associated with increased CV

risk and mortality and that T therapy may

have clinically relevant CV benefits

Established benefits of T therapy in hypogonadal

men include improved sexual desire

and function,12-15 improved energy, mood,

and vitality,15-19 increased lean mass,14,19-22

decreased waist circumference,23-27 reduced

total body fat mass,19-22 and increased bone

mineral density.28-31 Promising new data

reveal that T therapy improves insulin sensitivity32-

34 and reduces blood glucose23,25,35

and hemoglobin A1c (HbA1c)23,25,27,35 levels

in men with type 2 diabetes or obesity.

In summary, we find no scientific basis for

the suggestion that T therapy increases CV

risk. In fact, as of this date, we are unaware

of any compelling evidence that T therapy is

associated with increased CV risk. On the contrary,

the weight of evidence accumulated by

researchers around the world over several decades

clearly indicates that higher levels of T

are associated with amelioration of CV risk

factors and reduced risk of mortality.

12) Sharma, Rishi, et al. “Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men.” European Heart Journal (2015): ehv346.

Aims There is a significant uncertainty regarding the effect of testosterone replacement therapy (TRT) on cardiovascular (CV) outcomes including myocardial infarction (MI) and stroke. The aim of this study was to examine the relationship between normalization of total testosterone (TT) after TRT and CV events as well as all-cause mortality in patients without previous history of MI and stroke.

Methods and results We retrospectively examined 83 010 male veterans with documented low TT levels. The subjects were categorized into (Gp1: TRT with resulting normalization of TT levels), (Gp2: TRT without normalization of TT levels) and (Gp3: Did not receive TRT). By utilizing propensity score-weighted Cox proportional hazard models, the association of TRT with all-cause mortality, MI, stroke, and a composite endpoint was compared between these groups. The all-cause mortality [hazard ratio (HR): 0.44, confidence interval (CI) 0.42–0.46], risk of MI (HR: 0.76, CI 0.63–0.93), and stroke (HR: 0.64, CI 0.43–0.96) were significantly lower in Gp1 (n = 43 931, median age = 66 years, mean follow-up = 6.2 years) vs. Gp3 (n = 13 378, median age = 66 years, mean follow-up = 4.7 years) in propensity-matched cohort. Similarly, the all-cause mortality (HR: 0.53, CI 0.50–0.55), risk of MI (HR: 0.82, CI 0.71–0.95), and stroke (HR: 0.70, CI 0.51–0.96) were significantly lower in Gp1 vs. Gp2 (n = 25 701, median age = 66 years, mean follow-up = 4.6 years). There was no difference in MI or stroke risk between Gp2 and Gp3.

Conclusion In this large observational cohort with extended follow-up, normalization of TT levels after TRT was associated with a significant reduction in all-cause mortality, MI, and stroke.

13) Muraleedharan, Vakkat, et al. “Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes.” European Journal of Endocrinology 169.6 (2013): 725-733.

Objective Men with type 2 diabetes are known to have a high prevalence of testosterone deficiency. No long-term data are available regarding testosterone and mortality in men with type 2 diabetes or any effect of testosterone replacement therapy (TRT). We report a 6-year follow-up study to examine the effect of baseline testosterone and TRT on all-cause mortality in men with type 2 diabetes and low testosterone.

Research design and methods A total of 581 men with type 2 diabetes who had testosterone levels performed between 2002 and 2005 were followed up for a mean period of 5.8±1.3 s.d. years. Mortality rates were compared between total testosterone >10.4 nmol/l (300 ng/dl; n=343) and testosterone ≤10.4 nmol/l (n=238). The effect of TRT (as per normal clinical practise: 85.9% testosterone gel and 14.1% intramuscular testosterone undecanoate) was assessed retrospectively within the low testosterone group.

Results Mortality was increased in the low testosterone group (17.2%) compared with the normal testosterone group (9%; P=0.003) when controlled for covariates. In the Cox regression model, multivariate-adjusted hazard ratio (HR) for decreased survival was 2.02 (P=0.009, 95% CI 1.2–3.4). TRT (mean duration 41.6±20.7 months; n=64) was associated with a reduced mortality of 8.4% compared with 19.2% (P=0.002) in the untreated group (n=174). The multivariate-adjusted HR for decreased survival in the untreated group was 2.3 (95% CI 1.3–3.9, P=0.004).

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.

Several longitudinal population studies have reported that a low testosterone at baseline is associated with an increase in all-cause mortality (1). Some individual studies have specifically identified increases in cardiovascular, respiratory and cancer deaths (2, 3, 4). A meta-analysis of published research papers with a mean follow-up period of 9.7 years confirmed that low testosterone was associated with increased risk of all-cause and cardiovascular mortality in community based studies (1). Men with specific co-morbidities such as proven coronary artery disease and renal failure have also found that low testosterone predicts an increased risk of earlier death than those with the same condition and are testosterone replete (5, 6).

In summary, this is the first study to demonstrate that low testosterone levels are associated with an increase in all-cause and cardiovascular mortality in men with type 2 diabetes. This study demonstrates that long-term testosterone replacement is not only safe in terms of mortality but may also improve survival in men with type 2 diabetes and hypogonadism.

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Published on December 20, 2016 07:06

Low Testosterone Associated with Increased Mortality

Low Testosterone Associated with Increased Mortality

by Jeffrey Dach MD

Forty Per Cent More Likely to Die

Two reports published in the recent medical literature showed that low testosterone is associated with increased mortality.(1)(2)(3) Upper Left Image: Chemical structure of human, bio-identiical testosterone courtesy of wikimedia commons.

In the first study from 2006, low testosterone was found to be associated with increased mortality among veterans. (1) . A low testosterone level was a total testosterone level of less than 250 ng/dL and 858 men were followed for 8 years. Those with low testosterone levels had an increased mortality rate (hazard ratio, 1.88). (1)

Left chart from Arch Int Med 2006 Molly Shores (1) Low Testosterone group (Green Line) had highest mortality rate.

In the second study published in 2008 tracked nearly 800 men, 50 to 91 years old, living in California. Their testosterone level was measured at the beginning of the study, and their health was then tracked over the next 20 years. Low testosterone symptoms reported by these men included decreased libido, erectile dysfunction, fatigue, loss of strength, decrease in bone density and decreased muscle mass. Also, these men tended to be overweight or obese, and at higher risk for cardiovascular disease and diabetes. Men with the lowest testosterone, below 241 total serum level, were 40% more likely to die.(2)

A third study published by Dr Malkin in Heart 2010 showed that men with known coronary artery disease commonly had low testosterone levels which was associated with double the mortality rate compared with men with normal levels. (6) Dr Malkin says: “Excess mortality was noted in the androgen-deficient group compared with normal (41 (21%) vs 88 (12%)”

Conclusion:

Low testosterone in males is associated with increased mortality from coronary artery disease. Androgen deficiency is also associated with increased rate of depression. metabolic syndrome and low libido.(4,5) Testosterone supplementation in androgen deficient males is therefore beneficial.

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Jeffrey Dach MD

7450 Griffin Road Suite 190

Davie, Florida 33314

954-792-4663

http://www.jeffreydach.com/

http://www.drdach.com/

http://www.naturalmedicine101.com/

http://www.truemedmd.com/

http://www.bioidenticalhormones101.com/