Monthly Archives: January 2016

Real Men Eat Quiche and Do A Lot More

real men

This great article written by my wife, Jennifer Sault, MFA,MD/Eds, LMHC, Guided  Imagery Guide, Certified Hypnotherapist, taught me so much that I feel the need to put it on my blog site. Some of the ideas she taught me I have also included in my book.

We All, men and women, are made up of both masculine and feminine energy. Yang, or masculine energy is the archetype of focus, direction and goal orientation. It is assertive, logical, left-brain and linear, and it is associated with doing. Yin, or feminine energy is the archetype of openness, flow, intuition, and creativity and is associated with the state of being. It is compassionate, and nurturing and right-brain and holistic. These energies are both  necessary! Purely yin energy might be highly intuitive and creative, but the ideas never make it into physical form. Purely yang energy is full of zip and enthusiasm, but lacks the creativity to give it structure. All of us, men and women, are somewhere along the continuum of yin and yang dominance, and a rare few have found the place of balance in the middle.

Until relatively recently, society has assigned masculine and feminine roles according to gender, without understanding that our physical and emotional health, as well as our spiritual development, depends upon creating a balance of the masculine and feminine energies within us, whether we are male or female.  The archetype of the male was the provider, the decision maker, a strong, largely silent, dependent presence, Fatherhood was mostly a matter of setting an example of what the male was expected to do and to be, a somewhat distant role rather then an intimate daily involvement with his children.

The women’s movement of the nineteen seventies was a drive towards creating a more healthy balance within women. The feminist pioneers were dissatisfied and unfulfilled with being limited to a traditional feminine role of wife and mother and being dependent. Assertiveness training, one of the tools of the movement is about developing healthy yang energy, to complement,not replace, the highly developed yin.

A generation latter there is a sizable movement towards the development of healthy yin energy within men. There are fathers who want to be a nourishing presence in their children’s lives, husbands who want a balanced partnership and shared responsibilities,, men who want the freedom to express a full range of emotion. There are other men who are feeling lost, who don’t know any more what their role is or what is expected of them. As women began to explore their power of choice, these men were faced with a situation for which they had no models and no experience. Traditional man, the provider and protector, the head of household and primary decision maker, began to be something of an anomaly.

In our culture, which sex we are largely conditions our gender identification and therefore the dominance of yin or yang. The people around us are likely to encourage certain behaviors based on whether we are little boys or little girls. A girl, for example, born to parents with traditional ideas of gender roles, may be called a “little princess” from the moment she emerges into the harsh lights of a delivery room. She may be coddled and protected and given overt and covert messages conveying the impression that she deserves and requires protection. She may internalize those messages and grow up believing that it’s not okay to develop and express her masculine energy. A small boy gets the message that it’s not manly to cry, which often becomes internalized as a belief that it is not acceptable to express., or even to feel the tender emotions, He learns to channel that energy into physical activity, or violence. As a culture we may not like or want to encourage anger in males, but we do not say it is unmanly to cry or to be afraid.

Jennifer (one of my preceptors to life writes: I had a conversation with an attorney once at a neighborhood party. His specialty, he said, was “to make money

Criminal law: drug dealers and DUIs.” I recently had my first experience to the legal system with a client who was a battered wife, and I wondered how in the world attorneys and others who work at the courthouse deal with the toxic energy there. “By shutting down,” he said. He mentioned several times that his shutting down had created difficulties in his marriage.

A shutting down of the emotions often resulting in marital discord is not a monopoly of the legal profession.  “E” was married to an emergency department physician, and over five or six years she watched him shut down his compassion and empathy because he had never learned how to be compassionate and detached at the same time. The only way he knew how to protect himself from the cruelty and pain he experienced every day was to cut himself off.

The inner yearning for balance is manifest in our relationships. Our choice of partner indicates the qualities that we believe, at a deep level of mind, we are lacking. We are seeking wholeness and completion in another person, when in fact we need to find wholeness within ourselves.  A woman, who lacks the self confidence to make her own decisions and take care of  herself will remain emotionally immature if she seeks a mate to take care of her instead of developing her yang aspect. Likewise, a man who denies his feminine aspect – the nurturing , compassionate, intuitive aspect of his being-and allows his partner to express all the emotions in a relationship, will not  be healthy and whole, emotionally or physically.

Client T was in his early forties. In terms of the success criteria of our culture the had it all, respect, wealth, attractive home, lovely wife, handsome son. Yet, he was desperately unhappy and suffering physical and mental problems of increasing severity.  Yin and yang roles within his marriage were clearly defined along traditional lines. He was the provider,, the decision-maker, and head of the household. His wife was his helpmeet, his dependent, the homemaker and nurturer.  As her due, as part of their contract, she enjoyed the fruits of his successful professional life, and he felt it was his duty to continue to provide them for her.

T reached the very bringk of physical and mental breakdown before he was willing to question the foundations upon which he had built his life. Through courageous self-exploration he healed the wounded yin, the feminine side of himself that had been locked away since he was a small child undergoing male acculturation from his father. He had been taught that  a real man, first of all, makes a lot of money. He never shows weakness, fear or indecision. There had been no room in T’s life for art or music; there was no” woman’s intuition” in his way of being, no “woman’s touch” in the stark white walls and utilitarian furniture of his office. As he integrated his feminine aspect, his physical and emotional health improved dramatically and he experienced a spiritual awakening that gave his life deep meaning.

Yin and Yang speak different languages. Learning to speak each others language, learning to empathize with each others world view, is part of development on all levels and vital to creating not only an intimate relationship with another, but a deeper understanding of self. It is not that any relationship ever reaches the point where he speaks fluent yin and she speaks fluent yang and they live happily ever after finally.  It is a journey not a destination, rediscovered at each way station. It is the journey itself that nourishes growth and wellbeing. When partners in a relationship fail to understand that, each partner can become locked into  the misery of misunderstanding and feeling misunderstood.


P was an ex-marine in his early 50s. He had tried his best to be what our culture and time, and no doubt the Marines, had taught him a man should be. Strong!

Taking responsibility! Making decisions! Doing his duty~ He had done his duty, providing for ones wife’s children by another man, paying off various wives’ debts and being the family provider while pushing his personal dreams onto the back burner.
Underneath the John Wayne façade he was wounded. Wanting and needing to love and be loved but not having any idea how. He had a pattern of choosing women who were needy, wanting to be taken care of, wanting to abdicate responsibility for their lives, probably younger, probably very attractive. But he never managed to create the satisfying relationship that he wanted.

Opening the heart can be a terrifying experience for such as P, because it means exploring realms of emotion that have never before been acknowledged. He had always disregarded pain, physical or emotional. He was proud of his ability to go back to work  immediately after knee surgery or a serious accident. When a wife let him down he left her, secure in the belief that that he had done his duty and she was wrong. He nursed his pain in solitude, never sharing it with anyone, never nurturing himself in any way.

The series Star Trek in its various incarnations, examined the issues of our time in the context  of a future culture that has survived the nuclear age and learned to transcend the eye-for-an -eye ethos. One of the ways in which the series confronted contemporary challenges was to take some of our cultural archetypes and express then in extreme form. Vulcans are pure Yang, our cultural veneration for reason untempered by yin. But where our culture simply disparages emotions and considers them a sign of weakness, Vulcans banished them completely to a deep and heavily fortified region of the psyche and live solely according to the dictates of logic and reason. They believed themselves superior to humans because their decisions were uncontaminated by emotion, or yin energy.

Subsequent variations on this theme, as the series developed were Commander Data and the Doctor, a machine and a computer-generated hologram respectively. Unlike Mr. Spock they recognized  their lack of wholeness and tried, in ingenious and often entertaining ways, to become “more human” by exploring and developing the non-rational aspects of humanity: emotions, or yin. So far we are able to program a computer to do left brain functions, but the right brain includes intuition and inspiration qualities that are indefinable and unprogrammable and a vitalpart of who we are.

The first men in space were scientists, engineers, fighter pilots, pure yang. And yet as they gazed on the ineffable beauty of our planet, a blue glowing jewel against the black infinity of space, they became poets and mystics.  There is no language in yang for the response of the soul to such experiences, and yin finds a way – at those moments of transcendence – to make her presence and power felt.  Most of us have known such moments, however fleeting, as we read a poem, heard a particular piece of music, or watched a sunset; moments when we knew, deep within, the harmony of creation. Whether we heed the call, whether we pay attention and work to integrate the moment of balance into a lifetime of harmony once the moment passes, that is our choice and our challenge.

Alan J. Sault MD, ABHM-Dpl

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it,vampires


Myth:Testosterone causes cancer

The belief that testosterone causes cancer of the prostate is a myth from the old school. I was also taught this myth 50 testpsterone mythsyears ago in medical school. If it were true then men at twenty when testosterone is highest would have prostate cancer or at least starting to show differentiation of cells that could be a precursor to cancer. It is now known that it is estrogen [especially in excess] that contributes to the cause of prostate cancer in men and not testosterone: and of course life style. There are many reasons that a male can have higher then normal estrogen levels which I wrote about in my book and in a blog on anti-aging (

All fetuses at first are female and have a uterus until the genetics kick in to change an individual to a male. At this point the prostate becomes the organ instead of a uterus. However what would have been the uterus now exists inside the prostate as a vestige of the uterus called a utricle that has estrogen receptors. (This is the same hormone that contributes to  breast and uterine cancer in women ). This is why we need to get estrogen levels prior to initiating testosterone therapy and then again months latter to see if the client is converting the testosterone to estrogen, called aromatization due to the aromatase enzyme that does this. We do this even sooner if there are any signs or symptoms that suggest this aromatization so that we can stop it.

While there is a continuing difference of opinion among doctors as to whether testosterone will speed the growth of an already existing cancer of the prostate, since it is a growth hormone (anabolic hormone), it does not cause the original cancer (, “Testosterone and prostate cancer: an historical perspective on a modern myth”, April 13, 2007).

I believe a short history of how the myth of Testosterone replacement therapy (TRT) and prostate cancer (pCA) evolved. It started in 1941 with a poorly unscientific study by C. Huggins and CV Hodges (Cancer Res. 1941; 1:293-297) in a study on two men. One being castrated and the other on estrogen therapy. They stated that the administration of testosterone (of coarse it was synthetic testosterone) caused the pCA to grow. Actually what they showed was that acid phosphatase increased in these two men when a daily injection of testosterone propionate was given. There was no following of PSA or free PSA in 1941. (Acid phosphate being a product of the prostate that goes up with pCA). Therefore, their conclusion was based on acid phosphatase and not other evidence. Another fault in this paper was the men already had very aggressive and metastatic pCa. For another these studies were able to be duplicated. Unfortunately from this non-evidence based study and (no control done with it) the medical community has traveled down a path that is  definitely contra to the scientific method.

I always recommend certain tests before beginning a person on testosterone and then repeating them in the near future. The latter depends on the client and circumstances. After a long interview I determine if other laboratory tests are necessary besides those below. These are:

  1. CBC with differential

  2. PSA (if male)

  3. Liver function tests (a healthy liver detoxifys any excess estrogens which can occur with a poorly functioning liver.)

  4. Estradiol (for men and women)

  5. Testosterone – both free (to see what will get into the cells) and total. A total T is a waste by itself since like any hormone it is what gets into the cells (free T) that is important.

  6. SHBG-(sex hormone binding globulin)-which can tie up the testosterone if too high. I often get this when I repeat these tests in about 4-6 weeks.

This pCA as stated already is rare in men in their younger years when testosterone is at peak levels. The rebuttal or thought about this may be that it takes many many years for the cancer to manifest itself. This latter statement maybe true but because of the restraint of doing research on this by the National Cancer Institute and the US National Institutes of Health we do not know the answer to this. But if it does take 30-40 years for testosterone to cause pCA then obviously there should be no problem in offering it to men ( especially if they have no symptoms nor signs of pCA) in their 60s and older if they are manifesting the symptoms and signs of testosterone deficiency which could be quite depressing both mentally and physically (see other blogs on testosterone therapy). Also, I wish the reader to keep in mind when I write about hormone replacement therapy I only use human bio-identical hormones and not synthetics such as testosterone proprionate, ciprioante or ethonate which are commonly used in studies.

The studies so far have been scant and synthetic T is the T of choice for the studies.. Also the studies are most often done with men that already have invasive pCA or even metastatic pCA. There have been, however, some studies showing that pCA is not related to the use of T hormone therapy. For example, Prout and Brewer (Cancer. 1967;20:1871-1878) showed that T injections on men with pCA “Most of these individuals experienced an increase in sense of well being and some noticed vague diminution in pain.” The same two also stated that the acid phospahtase response to T injections was “extremely variable.”  Remember that men not taking T supplementation get pCa. There now is  a lot of literature suggesting  that in most cases surgical intervention is not necessary. Still I believe that certain tests should be done if the patient and the physician have any doubts if pCa is present and of the aggressive type.  (See blog on BPH and prostate cancer at

As I wrote in my book, T developed a bad reputation for side effects because of athletes taking huge doses of synthetic T with other growth enhances. A good holistic physician does the appropriate lab work and studies it so that he can individualize the dose and have it made by a compounding pharmacist so the it is a bio-identical testosterone for the individual.

So to summarize why T is scary to the medical profession and the myth is the following:

1. No reliable marker was used that started this myth such as PSA

    1. Control groups were not incorporated  often in the different studies.

    2. In the past 25 years there have been no studies that replicate the findings that have brought the original myth into the medical field showing that T causes pCA.

    3. Synthetic T is the testosterone that is used in studies which of itself could cause pathologies. An example of this is the Woman’s Health Initiative study done on women with synthetic estrogen and progestin. Progestin  is not a really progesterone) which had to be stopped very early due to all the dangerous cardiovascular and cancer side effects that the  women were getting. The study was stoped early with these synthetics but the FDA still has them on the market and physicians are  using them instead of bio-identical hormones. Human Identical Testosterone (HIT) made by a an experienced compounding pharmacist is what our bodies have evolved to recognize and use.

    4. More studies using bio-identical testosterone on men with pCA both new pCA and advanced and also in men without pCA (the latter in long term studies to see its effects compared to long term non users of testosterone) need to be done.

       Alan J. Sault MD, ABHM-Diplomat

Book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it


andropause IILike any other hormone deficiency (thyroid, insulin, estrogen-progesterone) deficient testosterone in men will interfere with a healthy and vigorous life. Natural, bio-identical testosterone is available but is often avoided because of misunderstandings and myths about the role of this vital hormone. Please see my other blog: Testosterone and anti-aging.

A lot of men do not realize why they are experiencing certain symptoms and signs as they age; why they seem to have gained weight even though they exercise, or why their breast are larger and flaccid.  Other symptoms can be depression, irritability, mood swings, loss of morning erections. erectile dysfunction, poor focus and concentration. loss of incentive both for work and for things that thy once enjoyed, loss of muscle tone and yes, some even experience night sweats. (See my blog on comparing menopause to andropause or my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

As men grow older we produce less testosterone. This actually begins to happen at the age of about 30-35, but in men it is a slow, subtle, process until about 50-60 years of age (unlike women who go through a more rapid menopause in 1-8 years).

Many people think of testosterone as a man’s hormone created to annoy women, but much academic work shows  the remarkable physiological role testosterone plays in our lives in both males and females. Obviously men have  much more testosterone then females. Because it is the main muscle and bone builder it is why men do not get osteoporosis until  much later than women – but we do get it. Evidence shows that there exists 3-4  times more testosterone receptors in the heart cells than in the gonads, showing that nature intends for testosterone to give the heart protection. Testosterone also helps to produce more nitric oxide, which, like synthetic nitroglycerin helps to expand the vessels and give better circulation.

There are also testosterone receptors in the brain. Using functional MRI (fMRI which shows what part of the brain is being used for a specific function) it has been shown that men (and women) with low testosterone levels were more ” foggy brained.” In fact, when the levels were real low the ability to fantasize was lost.  Other studies have shown that lower testosterone levels are a factor to increase the  likelihood of developing Alzheimer’s disease. A study of men with Alzheimer’s demonstrated that taking testosterone dramatically  slowed the progression of Alzheimer’s although it did not cure it. All these studies demonstrate that there are receptors for testosterone in the brain. (All these facts are documented as evidence based medicine in my book’s biography).

Studies have indicated that as much as 65%-70% of depression in men over 50 could be due to low testosterone levels, so there is often no need for antidepressants  and their possible side effects. I believe it is necessary to always check testosterone levels when a man has consistent depression.

Testing for testosterone is a simple blood test, but it’s important to get the right tests and interpret them properly.  One not only wants to know the total testosterone but also the amount getting into the cells (free testosterone).  Obviously if a hormone is not getting into the cells it is like not being there. Also, testosterone can bind to a protein called Sex Hormone Binding Protein (SHBG) ; so this test should be done if the physician believes this is one of the problems. If the testosterone levels seem good but the SHBG is high the testosterone is not going to perform its job since it is being tied – up.  A man’s estrogen level must be examined since testosterone can convert to estrogen  (aromatization)  through an enzyme called aromatase.  This enzyme is found in adipose tissue and as men get older they gain more fat (often because of the lack of testosterone). Also, other tests may be appropriate, but certainly a PSA (prostate specific antigen) is necessary. (See my blog or book on prostate evaluation).

Testosterone levels in the “low Normal” range can be misleading (400ng-1000ng).  For a real low level the physician may say they are in the norm. They may be normal for an eighty year old, but the signs and  symptoms presented by an eighty year old are not particularly desirable.

The belief that testosterone causes cancer is a myth and of the old school.  If it were true then men at twenty when testosterone levels are the highest would be more prone to prostate cancer or have signs of future development of the cancer.  It is now known that it is estrogen that contributes to prostate cancer (the same hormone that contributes to breast and uterine cancer in women) along with life style. This is  because inside the prostate is a vestige of the uterus called a utricle  that has estrogen receptors. To simplify, all fetuses begin as female but may change to male due to genetics but this vestige gets locked inside the prostate. If the utricle is constantly hit by estrogen excess cancer may occur. Statistically overweight men have a higher rate of prostate cancer, probably aromatization contributes to this.

There are several ways to take testosterone, one should always and only use bio-identical hormones. These are made by a compounding pharmacist (not a big chain pharmacy) and are made specifically for the individual since each person is different then another. The two ways I prefer are creams that are absorbed through the skin, and tiny pellets that are inserted into the buttocks and  last for about  5-6 months. I do not use  oral testosterone since the levels fluctuate too much and they can be harmful to the liver as can injectable testosterones. I must repeat her that I only believe in bio-identical hormones since this is what nature has put into our bodies.

So one does have to get older but one does not have to age. It is not only longevity but also quality of life.

I have written out all tests for both males and females that are necessary for hormone testing in the appendices of my book along with many other helpful charts pertaining to hormones. The book and charts will help you have intelligent discussions with your physician. Also this subject is expanded in layman’s terms for a more didactic but easily understood education.

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of  how stress affects your well – being and what  you can do about it.