Self Questionnaire Flow Chart for Future Care

Patients often ask me “when should I come back to see you?”

This is a difficult question to answer. In order to help patients self evaluate for their needs of future care, I have developed the following flow chart. Feel free to use it for your own purpose.

please review this Pain Sensation Chart before using the flow chart.

CLICK TO CALL:
1-250-589-6325

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The Benefits of Personal Challenges

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As we get older it is easy to tell ourselves to “slow down” and “act our age.” In some ways there is wisdom in these statements. However, many forty-plus year-olds  take this mantra too far. They stop playing their favourite sports because they do not want to take undue risks. Social circles can also take a hit as we become very career and family focused. Our worlds get smaller  and smaller. In a sense people in their forties begin to prepare themselves for death decades ahead of time. You may think this is a dramatic way of describing the natural process of aging but hear me out.

I understand that we have to be aware of the changes our bodies go through as we age. And hitting your forties does mean some things have changed. At 36 years of age I tore my inner calf muscle doing 42 inch box jumps. Now, I had warmed up and stretched and had slowly worked my way up to these over a period of years. But still, my muscle ripped. This would not have happened at 26. So I decided to omit highly ballistic exercises to forego anything worse happening. I adjusted to my age. Yet I still lifted very heavy weights. I also began to practice jiu jitsu. Having wrestled in school and university, grappling came natural to me and jiu jitsu is slower paced than freestyle wrestling. So even though I “slowed down” I didn’t downgrade my efforts or time spent pursuing fitness, I simply shifted my activity to something more intelligent. In May of 2017 I even competed in the highest profile jiu jitsu tournament in British Columbia. At age 42 I entered the 30 year-old division and won first place. The weight cutting and training camp was difficult and competing against athletes 10 years younger was daunting. But I took the challenge and succeeded. You don’t have to have that lofty of a goal, but it does highlight what is possible.

MMA fighter Randy Couture won the light heavyweight title at age 40 and defended his belt against a 28 year old challenger. He also won the heavyweight UFC title at 44 years of age against a much larger 32 year old opponent. Finally Randy retired at age 47 from professional MMA. Remember that long time NHL hockey player Chris Chelios played until he was 48 and even in his mid forties the Red Wings fitness coach said he was as fit as the 30 year-olds on the team! Jaromir Jagr is still playing NHL hockey at 46 and two years ago was one of the team leaders in points at 44 years old. At least two Olympian medalists during the 2016 Games in Brazil were in their forties. All this to say that you don’t have to hang up your hobbies just because you are in your forties. If you treat your body correctly, you can stretch your athletic prime farther than you think.

Now, let’s say athletics are not your thing, you can push your intellect instead. After finishing university in my twenties, I continued to read copiously. Instead of being “done with all that learning stuff” I put my skills to use in a more varied manner.

Credit: The Marmot (click image to visit).
Some rights reserved for image: https://creativecommons.org/licenses/by/2.0/

I read history, philosophy, science and religious texts. No longer being bound by tests and heavy class schedules, I was free to expand my mind. Even though our learning speed decreases after your twenties, the ability to make accurate decisions continues to rise until your late 60’s and usually is maintained for years afterwards if you use your brain. So instead of being done with learning, I was only beginning. And I continue to devour knowledge. One of the most common traps once our careers are established is to simply entertain ourselves during our down time. Instead, I choose to educate myself. “Use it or lose it” is a catch phrase for a reason. Continued mental challenges keeps your brain young.

I continue to challenge myself in the business field as well. I am planning on shifting my work to focus on both sports medicine (working with a professional team) and eventually to hold an academic position part time then full time. The continual shape shifting of my goals in all areas of life keeps me feeling, acting and thinking young.

As a father of four kids, I am also challenged in terms of energy and time. But I have taken this challenge head on and have reaped the rewards. Many people in their forties are really winding down and foregoing many activities and goals they could still do. But the body follows the mind. If you have decided to stop challenging yourself you will slowly convince your brain and body to get old quicker than it needs to.

Why would anyone ever do that?

Food Coupling? What?

For several months I suffered from “acidic gut.” The bottom of my abdomen was constantly painful and I had mild nausea and bloating most of each day. My condition was most likely brought on by a combination of strong anti-biotics, high sugar diet and stress. Either way, the end result was, I had too little good bacteria in my small intestines and therefore had a fungal overgrowth. With a high sugar diet, fungus is well fed and its colonies grow unabated. As a by-product of fungus feeding off sugar, the fungal bodies are producing acid, which hurts.

At this point, I worked with Liliana Tosic, a registered holistic nutritionist (RHN). Her evaluation gave me the diagnosis I needed and then the solution: food coupling. I must admit I was skeptical at first. It seemed too simple to cure several months of pain.

Food coupling is the notion that different foods are processed at different speeds. So by avoiding bad combinations, you alleviate stress to the digestive system. Further, some foods give off more or less acidic by-products. Which also needs to be taken into account.

Within 3 days of my food coupling diet I felt at least 40% better. I have been on a slow but steady improvement slope ever since. I was quite surprised at how simple and effective “food coupling” was.

In hindsight, this should not surprise me as I have many equivalent scenarios in my pain relief and rehabilitation practice. Many of my patients are incredulous when I say that adjusting how you sit and how you lift can alleviate the majority of disc pain within 2 to 3 weeks. Yet this is the reality. Which can be hard to believe if you have had months of debilitating pain.

If you have not worked with a good nutritionist and you have stomach or digestive problems, I would highly recommend giving Liliana a call.

To your health!

Doing Nothing…. Is Real Good For You!

North Americans are known for living some of the busiest lives in the world. Few other people (if any) have as many competing demands on their time than we do. A few years ago I became aware of how obsessed everyone was with being busy.
“How are things?” I would inquire.
“Oh, you know, super busy.” came the reply.
The way they would say it was one part complaint, three parts badge of honour. It was as though they wanted to signal that they too, were “busy.” Very, very busy.
After going through a very stressful time in my life, I began a journey to live a radically less stressful existence. This meant many things, including stopping the instinct to be busy. I was shocked at how hard my brain tried to keep pushing me back to my old ways. The ways of my culture. Breathless, constant busyness was portrayed at almost every turn. Whether it is the corporate ladder climbing heroine in a movie, the businessman in a magazine ad or whatever, we have absorbed a view of success that demands 24/7 scheduling of our time.
If we have a unifying religion in the West, it is Busyness. Interestingly, our brains and bodies seem to be suffering. Stress-initiated illnesses such as Irritable Bowel Syndrome, Anxiety/Depressive Disorders and Chronic Fatigue are sky rocketing. We are officially pushing ourselves beyond what we were designed to endure.
Some times in our lives are unavoidably busy. As the owner and operator of a busy clinic, a serving member of my church and married father of FOUR kids under 14 I am a busy man. We also do quite a bit of traveling throughout the year.
BUT…
I am no longer “busy.”
How did I pull this off? Allow me to explain. Research has shown that being active is healthy, but being negatively stressed is not. A few years ago, TED speaker and researcher Kelly McGonigal unveiled new research showing how our interpretation of our busyness can make the stress good or bad. Her evidence essentially showed that if we are overloaded by things we despise or dread, our bodies suffer. But exhaustion coming from activities we enjoy have seemingly positive effects on us.
Here is my secret to strategically removing bad busyness from your life:
1. Know Your Have-To’s and Make Them Fun: All of us have to do certain things. Work, cook, commute, etc. If you are lucky enough to do what you love, this won’t be hard. If you work a less than ideal job, well, make it fun. If prisoners in Auschwitz were able to find the good in their lives, you can to. This may take some time, but figure it out. No excuses. Your commutes can be times to plug into a podcast or other enjoyable audio experiences. Be hands-free on the phone with a loved one while cleaning/cooking.
2. Know Your Strengths and Grow Them: All of us have a unique contribution to make to this world and our generation. All of us. As a Christian, I believe very strongly that we bring something to the table of humanity that no one else in history could. If you are not engaged regularly in your passion, you will suffer. Just Do It.
3. Balance Your “3 Passions”: I recently discovered a wonderful piece of advice: “Have 3 passions in your life. One that makes you money. One that keeps you healthy. One that let’s you be creative.” Find those and work them into your life. Take up jiu jitsu or biking. Get into it. Do it. Start drawing. Playing the piano. Blogging. Expand your mind and influence.
4. Embrace Doing Nothing: If you wake up on a Saturday and immediately feel the urge to “do something,” you are caught in the Cult of Busyness. Your body and brain are accustomed to always trying to do something. Make money, clean the house, prepare for some future disaster, etc. The survival instinct is in overdrive in most North American minds. Interestingly, it has been proven that being overly busy destroys productivity. For me, the Art of Nothing comes in 2 forms.
ONE, several times a day, even in busy clinic times, I take a 3 to 5 minute break. Either I close the curtain on a treatment table and nap or I watch a funny video on youtube. Just a smidgeon of “nothingness” to alleviate my body and soul. Just living, breathing, existing, being.
TWO, for at least a full day each week, I do “nothing.” I can’t necessarily lay there all day because I have 4 children and a wife. But, I don’t do anything on impulse of “I have to.” I will lay in bed as long as I can before I get up. I only do the bare minimum of “have to’s.” I will chose the activities that I want to do, none that I don’t. I will not push the kids to be “doing something.” I will fight my brain’s push to get me to “BE PRODUCTIVE.” No. I don’t want to produce. I want to just exist.
I am still an amateur when it comes to this. I am no master. And I am constantly shocked at how hard my mind and body fight “just being.” But I am improving. I am coming closer to going back to those childhood days in which there was zero guilt attached to going with the flow of your imagination and interests without checking to see if I was any good at a task or if it was “productive.”
Good luck!

Medical Marijuana – a review

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Medical marijuana is a hot topic nowadays. Justin Trudeau’s Liberal party is playing peekaboo with the possibility of legalizing marijuana and certainly helping grow the number of “medical” marijuana dispensaries throughout the country.

One look at social media and google and you get thousands of messages about the miracle healing capacity of Cannabis Sativa. It appears there is nothing a little pot won’t cure. Claims range from pain relief to cancer prevention. Remarkable!

My question is, are these claims true? Or are they a good dose of wishful thinking to help make the bitter pill of legalizing drugs taste better?

Let’s take a closer look.le-microscope

First, you have to realize that less than 7% of all studies done on marijuana are researching its medicinal purposes. This is probably due to the fact that most marijuana research is funded by government agencies and these tend to relate to drugs in a negative sense. Government has a vested interest in understanding the negative effects of drugs in order to treat addicts and form drug use prevention methods. Pro marijuana advocates will say that the big pharmaceutical companies and the government are both invested in the continued ban of legal marijuana and so will continue to only look in the negative direction and downplay positive research. 

Is this true?

In part, I would agree that a large amount of research done by medical schools and even universities are funded by drug companies. And these companies have much less interest in finding natural cures than they do in validating synthetic drugs as the core of health care. Furthermore, there are a growing number of areas in which our culture is becoming aware of the plethora of natural cures available that Big Pharma drugs are not able to out-perform. Natural alternatives to anxiety, depression, blood pressure issues, pain management, etc are emerging as we better understand nutrition, exercise and cognitive behavioural therapy as well as other natural remedies. And if you delve into the realm of anecdotal evidence (both in your circle of friends and online) you will run into some convincing cases in which a marijuana compound was found more effective than a pharmaceutical alternative. I have not problems with the notion of finding natural alternatives to health issues, even in the Cannabis Sativa plant.

But how confident can we be that marijuana has very strong medical benefits? And are there any side effects worth knowing about?

poppy-seeds-texture

poppy seeds

For thousands of years mankind has used both Cannabis Sativa and the poppy seed for its felt effects. In regards to poppy seeds, they have long been known to help induce sleep. Likewise, cannabis has been known for the intoxicating effects of its most famous cannibinoid compound: THC. For at least the past 5,000 years, humans have known how to extract opium from poppy seeds. And since 1804, we have known how to extract morphine from the poppy seed as well. To this day, morphine continues to be our most potent pain killer. And it is a completely natural extract. My point? Poppy seeds have a very specific medical use that works universally: pain killing. No one can doubt or disprove this. There is no need to hunt through conflicting anecdotal and peer reviewed accounts to see what (if any) are the medically useful aspects of poppy seeds. In contrast, even though we have been experimenting with cannabis for as long as we have been with poppy seeds, we know of only two universal effects that come from marijuana: intoxication and appetite stimulation.

Since at least the 1980’s, hospitals have been giving synthetic THC to cancer patients undergoing chemotherapy because of its remarkable ability to stimulate appetite even in extreme circumstances. But the effectiveness of marijuana for the entire host of claims made online remain tenable and less than solidly proven. There are hundreds of cannabinoid compounds in marijuana, THC is only one of them (and the only real psychoactive one). Cannabidiol is another of these and it has little to no intoxicating effects, making it less controversial. Cannabidiol has been touted mainly as an anti-psychotic and anti-convulsant. Yet its effects are nowhere near universally true (in contrast to morphine) or even very repeatable. Some studies have shown some value in cannabidiol for sleep inducement as well as pain killing and muscle relaxants for Multiple Sclerosis and epileptic patients. But the strength of the evidence is not overwhelming at this point. More time is needed because studies have gone in both directions. Cannabis simply does not have a singular, universal medical value that can be proved conclusively.medijuana

As for THC, it does indeed decrease fluid pressure inside the eyes and so will relieve glaucoma symptoms. But the effects only last a short while and because THC is psychoactive, intoxication co-exists with the effects, making it unlikely to be safe or helpful for people who have to go to work with their glaucoma medication. To be under the effects of THC all day is not a recommended lifestyle. Especially when safe, non-intoxicating and long lasting drugs do exist for glaucoma sufferers. THC also dilates the small airways in the lungs, bringing relief to those with asthma, COPD and other chronic lung conditions. Again, this effect is short lived and comes with intoxication and alternative exist in both the natural and pharmaceutical realms.

All in all, the effects of marijuana on a variety of medical conditions is not cut and dry. Even when positive studies are found, they are not very strong and often you will find other studies that failed to replicate the findings. However, if an individual is finding success with a cannabinoid compound, I am not against its use. I support the right for doctors to oversee and prescribe a variety of cannabinoids (often with little to no THC) in the few cases in which better alternatives do not seem to exist. I don’t see, however, how wholesale legalization has to come hand in hand with the few cases in which genuine medical marijuana usage can be rationalized. It is also curious that it is mainly the psychoactive THC that gets most of the attention from medical marijuana activists. Could it be because it is marijuana’s main intoxicant? And that rationalizing its use would excuse chronic intoxication? Maybe. Just maybe.

Before closing this brief article, I have to speak about the negative side effects of THC and marijuana.Since the 1980’s, the percentage – by weight – of marijuana that is THC has arisen in the United States from an average 3% to approximately 12%. This has not occurred naturally but is the result of synthetically manipulating the strains. sad-woman-1347879026vylMuch the same way men have bred animals and plants over the centuries. Obviously, the main drive for increasing THC concentration is to maximize intoxication in chronic users who are now desensitized to former dosages. This phenomenon occurs with all artificial intoxicants. And the 12% figure is an average in the U.S., not worldwide. Some strains have been found to be as high as 35% THC by weight. A staggering dosage that is not in the least naturally occurring.

With the rise of THC percentages in recreational marijuana we have seen a rise in the ill effects of this drug. The most susceptible — as is always the case — are youths. Studies in both the U.S.1 and Canada2 have shown — with functional MRI’s, blood work, psychological evaluations, brain mapping and sociological research — that a developing brain exposed to marijuana use well before the age of 17 is at risk of cognitive, mood and behavioural disorders. Further, the higher the usage, the lower the youth’s chances are of attaining financial health and independence in adult life. Chronic early use is needed to truly trigger serious disorders but the risks are still ominous. Considering the growing push to render marijuana use socially acceptable combined with the sharp rise in THC concentrations it should be no wonder that health care facilities are reporting more and more issues with adolescent and young adult marijuana use.

Proponents of marijuana legalization will say that alcohol is also a drug and that it causes more carnage in our culture than marijuana. Both claims are true. However, alcohol use is much, much higher than marijuana use. Partly because it is legal and mostly because it is culturally acceptable. If marijuana use reached the same levels of use in North America the societal ills caused by this drug would not diminish, they would only grow exponentially. Unleashing another negative substance on our youth and culture is not an improvement by any means. I cannot comprehend this version of the pro-legalization argument.

bar-back-alcoholRemember that alcohol can be used in moderation. A glass or two of wine can even be beneficial in every way to your health with zero side effects. It is much harder to use marijuana without intoxication or side effects unless you strip it of its psychoactive compounds (which I do not see any medical marijuana dispensaries doing as this would most likely curb sales downward). And before singing the praises of local dispensaries, realize that a Journal of American Medical Association study, John Hopkins Medicine study as well as a Globe and Mail investigation found that the labels on pot products from such stores were grossly inaccurate. Shedding a poor light on the ability of such outlets to regulate the quality and safety of their drugs. Considering the negative side effects of THC and the shakily established “medicinal” value of Cannabis Sativa, pushing for nation-wide legalized marijuana on every street corner – a la neighbourhood liquor store — seems to be a thinly veiled attempt at plainly and simply legalizing an intoxicant for the pleasurable effects it produces. Arguments can be made as to the economic consequences of legalizing pot, yet this is a different argument than the medicinal one.

All things considered we have pain-killer drug addictions and alcoholism rates on the increase so why should we legalize yet another intoxicant on our future generations? For those who truly derive benefits from cannabinoid compounds, let hospitals monitor and administer dosages such as they do with the all natural morphine and other opioids. In my honest opinion, at this juncture, any other call to wholesale legalization is not supportable by hard clinical science. It would also dangerously fool youth into sinking into potentially life altering disorders if they follow the pied piper down the unrestrained use of a drug that is now getting a make over as “super healing compound.”

Be wise. Be prudent. Be informed.

 

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Set goals… and actually reach them

1-1266409857RRS3The Olympics are over and the new school year is around the corner. I don’t know about you, but watching world class athletes run, jump and swim at peak performance inspires me.

I love goal setting. Yet in the past, I set too many goals with too many deadlines. I started on a lot of journeys that did not end where they were supposed to. So I refined my goal setting methods.

One thing I tossed out was the big deadline. This is that “etched into stone” date at which you want something completed. I see this as the biggest motivation killer. What happens if you get sick? Or injured? Or have a family or personal crisis? Have a goal in mind for your journey, but do not add a set date.

Instead, make a weekly routine up that is broken down into daily tasks. Make them reasonable. For example, if your goal is to increase hip flexibility and the amount of weight you can squat, start small.

MONDAY: squat with same weight you have been using but add 3 reps. Stretch for 12 minutes instead of 10. squats

Then, every time you squat, add either 1 rep, or 2.5 lbs per side (5 overall). Usually do both, back and forth. If you hit the wall, don’t add anything for two or more weeks, just keep squatting without going backwards on your reps or weight. Slowly add 30 seconds here and there to your stretching.

Off you go on a slow but risk-free and fully realistic journey towards constant improvement.

People often over shoot their goal setting and force unrealistic changes onto their lives. Life does not work this way. Change has to be gradual but constant. So slowing down the demands actually increases the speed of results. If you are driving a car and you want to make a 90 degree turn, you cannot go immediately to a 90 degree without turning the wheels 1, 2, 3… 10… 25… 75 degrees and so on. Life is about increments, not instantaneous results.

If you can introduce a slow, flexible, daily routine towards improved performance, you will successfully change your long term life style towards your goals. Whether they be financial, relational or health oriented.

Dream big, act small. Get there!

What is Maintenance Care?

Young woman with pilates gym ball on white bacground

Most of my patients come to see me when they are in pain. This is understandable. Why spend money on treatment if you don’t need treatment? If you are feeling good and you are exercising, then you don’t need therapeutic care.

But what about “Maintenance Care?”

If you are active, healthy and not in significant pain your body is still accumulating micro-trauma. Left unchecked, this will eventually lead to pain and inflammation and then you’ll be in my office receiving therapeutic care. Which is more expensive and time consuming — and less pleasant. But what if you were to receive sporadic maintenance care visits to prevent ever needing therapeutic care?

Maintenance care is a visit to the clinic on a regular schedule (I usually recommend once per month or every 6-8 weeks depending on the patient) when you are actually feeling good. The goal is to rid you of the effects of micro-trauma and to keep the body running in its prime zone. Every day living creates the slow accumulation of scar tissue and inflammation which begin to hamper the fluid movement of the body. This occurs below the pain threshold so you won’t notice it. Eventually this creates a negative cycle that slowly but surely promotes malfunctioning joints, muscles and tendons. At the very least, this will prevent optimized functioniniStock_000018996121XSmallg (and if you are an athlete, this will cost you in competition) and at the worst, lead to injury and the need for more extensive care.

We get our oil checked in our vehicles before anything bad happens to our precious engines. We run spyware on our computers to keep them clean and functioning at maximum capacity. We brush our teeth twice per day to prevent cavities and gingivitis. As you see, we practice maintenance care on all the things we value.

Why not treat the body as something worth protecting?

When patients get maintenance care, I can also check up on their exercise routines and ergonomics and update these if necessary. Keeping the body in the “high performance zone” has positive mental as well as physical effects that will optimize all areas of your life.

If you value your body and mind as the most precious machines you own, think about a small investment in keeping them functioning at the top of their game!

See you soon,

Dr Parenteau

Smart Rest

lionrest

If you’re a professional or amateur athlete, or you’re just a fitness fanatic, you may want to consider resting more…

Over-training is a phenomenon that is becoming better understood. Many enthusiastic athletes forget to listen to their body as they pursue excellence. But this will serve to decrease performance in the long run, not improve it. Many fitness participants follow gruelling schedules and push themselves hard. If you are in the category of people who train regularly you will want to realize when over training begins to set in and you’ll also want to adopt a “smart rest” program as part of your training.

The first goal of being well rested and therefore in peek performance condition is to ensure you are not already in the state of over-training. Here are the most obvious signs of this condition:

  • often getting ill/sick
  • low mood, feeling depressed
  • low motivation
  • trouble sleeping despite feeling exhausted
  • chronic fatigue
  • injured often
  • constant thirst
  • performance decreasing even though training harder
  • a resting heart rate (first thing in morning before getting out of bed) that is faster than normal for you

If you have 4 or more of the above (especially the resting heart rate), you qualify as being over-trained. It’s high time to take some time off. A solid 3 weeks of no exercise followed by one or two weeks of very low intensity, part time exercise will do you much good. Then head into a 2 week period of moderate exercise and then finally, take another full week off.

OVERTRAIN REST

Be warned, if you are drastically over trained however, it could take several weeks — even a few months — to recuperate. Which is why you want to listen for the beginning signs of over training and not the drastic symptoms.

If you are not over trained (have less than 4 — or none — of the above symptoms) you will want to incorporate “smart rest” techniques to ensure you never get over trained.

What is Smart Rest?

Very simply put, smart rest is pro-active breaks in your training that allows your body to recuperate before you ever go near the over training zone. As we train hard, week in and week out, our multiple body systems can start to fall behind in recovery. This can be our nervous system, our psychological state, our immune system or our musculoskeletal system. Depending on what other stresses are going on in our lives and how well nourished we are, any one of those systems can start lagging behind and cause over training to set in. By pro-actively resting before anything falls far behind, we are protecting ourselves from over training.

How Do I Implement Smart Rest?

Once every 6 to 10 weeks (you decide by listening in on how your body and mind are feeling), take an entire week off training. During this time, you can go for walks, but no exercise. None. You will want to push the fluids more than usual during your week of rest and you will want to stay away from alcohol and high sugar foods. Nutrition, hydration and rest are the antidotes to over training. Make sure you are going to bed early and on time during this week of rest.

smart rest chart

Not only will smart rest prevent over training but it keeps your body and mind working at their peek. This will prevent mental burnout as well as injury. Remember, you are not to wait until you are starting to over train to implement smart rest, you are supposed to inject one full week of rest once every 6 to 10 weeks regardless of how well you feel. This is what maintenance looks like. You are building a fence at the top of the hill instead of having an ambulance at the bottom.

Try it out and see for yourself the benefits of smart rest!

Testosterone Replacement Therapy (TRT): the fountain of youth?

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Since the ancient alchemists of Egypt, mankind has been looking for the “fountain of youth.” A substance, supplement or incantation that will keep us in the prime of life for… well, forever. Modern man is no less obsessed with pursuing never-ending vitality. Over the past several years a new candidate has emerged for the title of verified “fountain of youth.” It is abbreviated “TRT” but stands for Testosterone Replacement Therapy.

Testosterone: what does it do?

Among many other functions, the hormone testosterone performs the following:

1. increases bone density
2. increases energy levels
3. increases muscle mass
4. increases production of red blood cells
5. increases mental acuity
6. increases aggression

As men hit their fifth decade of life (40-49 years of age) they lose about 1% of their overall testosterone production per year. Not surprisingly, it is common for 40-year old men to seek testosterone replacement therapy in order to compensate for lowered sexual, work and/or sports performance.

Testosterone Replacement Therapy (TRT)

TRT is usually administered at 125 mg per week. This is considered the “physiological dose” as it mimicks the average production of testosterone in the average male. At first, this dosage is assisted by the man’s already naturally produced testosterone. So the early usage of TRT will be felt more acutely. As time goes on, however, the male testes produce less and less due to the incoming testosterone from the therapy. This is one of the down sides to TRT: your body loses its ability to produce its normal, maximum amount of testosterone and you are forced to take TRT long-term to keep from experiencing unusually low testosterone levels.

Before going on TRT you should have your testosterone levels checked. Some people warn that you should make sure the lab you use knows the difference between free-testosterone and total body testosterone. Free-testosterone is the only testosterone you have in your body that you can actually access, the rest being bound up and non-available. Personally, I don’t think this is necessary as I don’t know of any condition that would give you a high total body testosterone count but a low free-testosterone count. They come in combination. If one is high, so is the other. If one is low, so is the other. A normal total body testosterone count for males ranges from 225 to 1,110 nanograms of testosterone per deciliter of blood (ng/dl). The average being about 650 ng/dl. So if you are below the 225 ng/dl limit, you may want to talk to your doctor about TRT. However, if you are a man and have a “low” testosterone count but are not experiencing any of the following symptoms:

  • chronic lethargy
  • inability to get or maintain an erection
  • low sex drive
  • breast tissue growth (gynecomastia)
  • balding

…then you may be fine with the levels of testosterone in your body. This may be natural for your genetics. If you have both a low count (below the normal range) and have the above symptoms, TRT may be right for you.

Are There Any Risks with TRT?

Yes.

However, they are not well known or well established. Because testosterone increases red blood cell production it has been found to increase stroke and heart attack risks. The reason for this is simple. When your hematocrit count increases (number of red blood cells per given volume of blood plasma) the thickness and “stickiness” of your blood also increases. With chronic synthetic testosterone levels comes chronic increases in blood thickness and “stickiness” which makes the heart work harder to pump blood and puts more pressure on vessel walls. It also increases the chance of blood clot formation. A November 2013 article in the Journal of the American Heart Association stated that testosterone replacement drugs increased chances of heart attack in men by 30%. And a January 2014 article by the UCLA research department (in conjuction with the National Institute of Health) made the dramatic statement that shortly after use, men under 65 who were on TRT had twice the chances of heart attacks. More time will have to pass before we know the full correlation between TRT usage and heart health, but we do have some red flags thus far. TRT drugs have now surpassed Viagra in total yearly sales in the U.S. (according to drugs.com). Millions of men take TRT-type drugs every year in the U.S. so we are bound to start picking up trends as time goes by.

Many urologists warn of the possible increase in prostate cancer risks for men using TRT. This has not been as well established as the above mentioned heart health issues. Actually, it is mainly based on theory. For years, oncologists and urologists have seen that men with low testosterone have better chances of recovering from prostate cancer. This has led to the long held belief that high testosterone equals higher chance of developing prostate cancer. However, this link is, so far, only theoretical.

What is my advice?

I do not give medical advice as I am not a medical doctor. What I tell you is only my professional opinion and I stress that you should make this decision with your medical doctor as well as your own thorough research. You are making long term health decisions and so you should be involved in the data gathering process.

However, my advice is to stay away from TRT if you are not genuinely suffering from hypogonadism. This accounts for most people. Having a lower testosterone count can be like having a high or low score on the Body Mass Index (BMI). In short, it does not mean much. I am of average height for a male but I am muscular for my age, so I score as “moderately obese” on the BMI. But anyone who looks at me will know that I am perfectly healthy. And my blood work and endurance would prove it as well. Therefore, if you feel good and do not have any symptoms of hypogonadism I would not be bothered by your total testosterone count unless it is much lower than the 225 ng/dl bottom limit.

Most TRT users are males in their 30’s and 40’s who want to perform athletically and sexually at their peak levels. They are young enough to remember what they used to feel like energy-wise and how they used to be able to train harder and recover more quickly. In short, it appears most TRT users are not truly hypogonadic. I can understand the attraction of having a veritable “fountain of youth” at your disposal, but I also know that there is no truly natural way to cheat Father Time.

Be aware of the risks, be informed and then be at peace with your decision.