Testosterone in Texas: Was There Ever Any Doubt? NPR takes on Texas Centers for Testosterone

This morning on NPR, the Phantom heard a story which worked on so many levels he was barely able to keep his car on the road.

A former "joint surgeon" in Texas, Dr. Bill Reilly, who now heads forty five clinics--the Phantom was driving and may have got that number wrong--dispenses testosterone to thousands of Texas men who he has found could benefit from it.  When asked how he could claim expertise, he bristled and he said he is a doctor and any doctor can prescribe testosterone and besides, he knows more about testosterone than the urologists and endocrinologists on whose turf testosterone therapy has traditionally dwelt.   

He denied that he simply handed out testosterone to any man walking through the door, like some bogus medical marijuana clinic, but rejected those men who were not truly deficient. How he defines truly deficient was not addressed in the broadcast. What was addressed was the vast numbers of patients he is treating and the, presumably, vast profits he is raking in. Again, even going to the NPR blog, the Phantom could not tease out the exact numbers, but it sounded like a happening thing in Texas. 

The reporters tried to get at the possible risks of testosterone therapy in men who did not actually need it, but they clearly had not asked the right questions of the right people and so the broadcast slid around the central issues and, of course this being a story about testosterone, it missed the more important story about how medicine for profit is driving healthcare in these United States. 

The truth is, replacing testosterone, at replacement levels, that is levels which normal men normally achieve by the exertion of their own (endogenous) testicular production,  likely does not harm most men in any obvious way. It simply transforms them from human beings who are perfectly capable of making their own testosterone into human beings now entirely dependent on bottled testosterone for the rest of their lives.  But no study comparable to the Women's Health Initiative, which studied 20,000 women on estrogen for decades has been done for men and testosterone.

The testosterone that comes out of bottles, pumps, aluminum packages is not delivered in the elegant diurnal rhythms with which normal men release testosterone, but that may not matter beyond the testicular atrophy constantly sustained testosterone causes. 

What the gym rats (pictured above) achieve with industrial doses of testosterone is industrial levels of testosterone in the blood and the muscle mass they achieve is commensurately higher. What that does to bone, brain, blood vessels is unstudied because academic centers are not allowed to study it. This is unfortunate.

The truth is, for about 80% of men who have genuine deficits of testosterone, testosterone is not the best option for therapy--at least that's what most endocrinologists suspect. For these men the problem is not that their testicles cannot produce testosterone but the problem is their pituitaries are not sending the signal to the testicles to tell them to do this. There is an old drug, clomiphene, which can do this, but it has not been systematically studied and evaluated in men over time, so it is not FDA approved and just try getting this drug, which has been used with FDA approval to induce ovulation, try getting that approved for longterm use by men by your insurance company.  Fat chance.

Doctors who have prescribed this drug "off label" are taking a chance, both for their patients and for themselves. 

Clomiphene is a generic and no drug company would make money on it, unless the law allows for a generic drug to be patented for a new use--for which there may be precedent.  That is important because the only way the needed studies will get done is with drug company money. The National Institutes of Health has shown no interest in funding such studies. 

Now back to Dr. Reilly, of the glossy Texas Centers for Testosterone. Just go on their website. You want to see glossy, that's glossy.  The former surgeon may have said to himself, "This is easy money."  He can set up centers, pay salaries and rent and still net huge profits by treating that new found epidemic of patients with low testosterone.

Once the Texas Centers for Testosterone get wind of the potential for clomiphene, The Phantom imagines, those entrepreneurs in the Lone Star state will corner the market on the stuff as sure as the Hunt brothers cornered the market on silver. Or maybe they'll set up factories in China, or maybe just across the border in Mexico. Then they can extend the franchise, like Texas Roadhouse steaks, into the rest of the country. It's all good. It's the profit motive after all. Isn't that what makes American medicine the envy the the world?

Actually, ask the Europeans what they think of American medicine. Not so much envy.

And, like so many things, low testosterone is relative. After all, it's a bell shaped curve, where those normal ranges come from.

And in Texas, is your testosterone ever high enough?