Author Archives: Alan Sault MD, ABHM

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.



Too Much Knowledge – ? Fear

fear & knowledge

For a long time I have been wondering about the boundaries that separate knowledge from fear. I have given up on the news media because they generate fear and by not giving factual knowledge.  In general the egocentric commentators are no longer fact- investigative reporters. I can also apply this to our presidential candidates unfortunately. Having health information is really important but  it too can create scare tactics crossing the line of health to illness? We are just inundated with information about toxicity of foods, heavy metals, phatalates, etc..( See my blogs or read 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).  We are told that we should do this or take that  for our health or else. Yes it is necessary to have knowledge about how to protect our health. I just wonder how many of us due to this information end up with depression, anxiety & stress from being told that we are drowning in our environment (our foods, water, air).  All this stress can negate the good energies of trying to be healthy at each meal, in the grocery store or even drinking a glass of water. Maybe one of the solutions is what I am still learning; that there is no way of avoiding all of our environment toxicities & therefore stress from the environment (news media); and also some of the holistic healers that  preach doomsday if we are not taking  specific supplements (of which they sell the best).  One of these known holistic physicians I analyzed: all that he says he does with shopping and preparing healthy foods and then the exercises for his body and brain each day. I figured that he would need to be awake at least 24 hours/day; and then have another 7 – 8 hours to his day since he proclaims each individual should sleep 7-8 hours/day. Then start his day with meditation of some sort. Maybe he is not a parent raising children or having unexpected crises pop up! Also, onw must recognize that a lot of the suggestions of physicians and healers are good to know about, but each person is an individual. Generalizations are just that – generalizations. Most people know the basics of good health: exercise, nutritional live foods, stress relief programs that build a good self-image of oneself.  Yes, I know the last of these is difficult in these stressful times and that is one reason I wrote my book, because the last part of the title is so important:  ……..what you can do about it.

Remember it is not always the stress but how we respond to the stress. I try to surround myself with positive people and try to avoid the emotional vampires both human and external.  As far as environmental toxicities I do what I can by using organics within our economic means, and avoid buying Chinese products as much as we can (which saves a lot of money since most USA products come from China). If one did every health option presented by health experts we would be bankrupt, have more stress and no guarantee that we would not have an illness, disease, or accident. There are no guarantees in life (except taxes, death & political mayhem). Watching funny films & laughing is a great antidote. Each day I try to write down 3 positive things that I did well or that happened to me.

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.



96The father of western medicine, Hippocrates, said: “Let your food be your medicine and let medicine be your food.” Good nutrition provides the building blocks the body needs to create healthy bone and tissue; and helps not only to cure ailments but prevent future ailments. (For example, nutrition plays an enormous role in cancer prevention and cure.) And of course it is possible to have good nourishment and at the same time enjoyable foods. The days of “health food” that was without color or taste are long gone. With good nutrition it is also possible to grow older without aging. Each individual is unique. Therefore, no single diet can fit everyone and it is the task of the physician and the patient working together to figure out an ideal eating program. It is good for both to remember that sometimes a specific diet for a specific purpose is necessary; but and a big but ( pun intended), that diet may be good only until the person is alleviated of the problem. After being better that same diet may not be appropriate for different reasons and a new diet may be the best route. As an aside I have found the same to be true with pharmaceuticals and supplements. When a person follows a healthy routine it is always a good idea for the healer after awhile to see if the benefits of the medicines are still necessary and beneficial. When the person is following a whole different life style they may not need what they originally needed. This is often over – looked by the healer and the client is kept on substances that they no longer need and the expense of them. In the case of pharmaceuticals this can even lead to grave side affects.

Again we must watch out for overdoing too much of certain foods, especially true of red meats and dairy. People can develop allergies from eating the same food all the time even if they never had an allergy to this food. There is a difference of intolerance to certain foods and a true allergy. Some people just cannot digest certain foods well and get gas, bloating etc when they eat them. Allergies have a more severe affect such as vomiting, headaches, dermatological reactions etc..

Certain “food myths” should be discussed, for example “all fats are bad for you”. Certain fats, such as the omega 3 fatty acids, are essential to our well-being. A certain amount of cholesterol is essential because its basic chemical structure is the basic building block of forming all the sex hormones, cortisol, aldosterone and vitamin D.  Too low of cholesterol in the body can alter all the latter productions and the symptoms that go with a decrease of them. (Please see my book or my blogs about cholesterol myths.

There are four premises for good nutrition: nutritious non-toxic foods (often referred to as whole foods or live foods), digestion, absorption, and elimination.

  1. Nutritious, non-toxic foods: An appropriate balance of protein, complex carbohydrates, healthy fats and plenty of water is the foundation of a healthy eating program, utilizing foods that are produced without artificial hormones or pesticides and now non GMO. Processed refined foods (referred to in holistic circles as the Standard American Diet or SAD & dead food) do not provide the vitamins and trace minerals that the body needs to form enzymes, hormones and building blocks to rejuvenate the body. It is not only the latter point I have discovered that brings on poor health. If one is eating “junk food” then they have no room for nutritional food. Sought of like the child that is permitted to eat sweets before dinner and then cannot eat their dinner. I also believe in whole grains which some physicians are against. Whole grains (non-GMO) if one is not a celiac person I believe are healthy. Even for a celiac person there are enough other grains to choose from besides rye, oats, barely and wheat. The physician must also consider celiac disease, which leads to an intolerance for products containing gluten. There are very accurate blood tests that can give the client an answer whether they are celiacs or not; of course one can also experiment by cutting gluten foods out of their diet for a month and see how they feel. I usually tell people to eat colors which gives them the vegetables and fruits of variety. Also, if it comes in a plastic bag it is probably a good hint that it is processed.

My belief is not to be too strict with diets in most cases. Why, because in general the client will not stick to it after a short time. At first the human is excited about a healthy diet and after a short while bored.  Certain items in specific cases must be eliminated, that is true: But most people want to enjoy life and eating is part of that joy. People eat not only for nutrition but also for social reasons and this needs to be remembered since it can be a stress reducer (until the bill arrives). Therefore, the healer must judge the personality of the client and work with this, which may includes a lot of of explanations.

  1. Digestion: This is the process by which food is broken down into a form which can be used by the body. Maldigestion due to inadequate digestive enzymes can lead to the discomfort of indigestion and other diseases because of needed nutrients not being supplied to the vital cells.. Some people can have an inadequate amount of stomach acid which very often is caused with aging; while some people can have none. This can be corrected with supplements such as adding hydrochloric acid with the meal routine (betaine HCL, pepsin).  One  can develop poor digestion by eating too fast. In fact, some people swallow so much air when drinking fast they they constantly feel bloated. This is called aerophagia. It is also seen with people that are stressed out either hyperventilating or/and gulp in air when crying (babies can get colic from crying so much and bottle feeding giving aerophagia). Another thing that affects the stomach are people that eat too much and are taking antacids so they can eat and eat. If the antacids happen to work for the person they are masking the natural message that what you are doing is not good for you. A similar situation is presented to the stomach when people take aspirin (any thing that is salicylic acid [salicylates] related) for pain. They are really taking an acid that as it is relieving the pain while it is eating the lining of the stomach to give one gastritis. It is one of the top causes for ulcers. some  ant – acids contain salicylates and even aluminum. The TV adds that show people “pigging out” and then using such and such antacids are a disgrace and shows how little marketing cares about a persons health.
  2. Absorption: It is often said that we are what we eat. It would be more accurate to say that we are what we absorb. If something is interfering with the absorption of good nutrients, even if we are following a healthy diet and taking supplements we do not derive the full benefit from them. The healthy natural food and the expensive supplements simply pass through the system and are eliminated. Malabsorption can be due to dysbiosis. Dysbiosis is the term for bad microbes of the intestine taking over the necessary good microbes of the intestine. There exists in the intestine 3 types of microbes. The good ones that help absorption and produce certain vitamins like some of the B vitamins and vitamin k. Then there are the “opportunistic” microbes lurking and waiting for when the good microbes are gone or diminished to fight them and take over. Then there are the plain nasty, bad microbes that flourish when opportunity lets them or they are introduced by oral means. So when the small intestine has an overgrowth of pathological flora it is called dysbiosis. The final result of this dysbiosis is leaky gut syndrome. When this is created the small intestine lets through its wall molecules that it should not, and blocks the nutritional molecules that it needs The good microbes were guarding our borders but defeated by antibiotics and poor nutrition. Also to be considered is the common possibility of having intestinal candidiasis (an overgrowth of yeast in the intestine). Both of these situations often happens when a person has been on antibiotics or steroids. Even if the event was years before the yeast flourished or dysbiosis developed and manifested symptoms. While these events are taking place the person may generate more gas as bloating, erudition (burping), flatus, feeling tired and full as if s/he just ate a big meal. This is why if I put a person on antibiotics I always and immediately also put them on probiotics – which is really just giving back the good bacteria. I actually suggest taking probiotics all the time because of the environmental toxins we swallow and the difficulty of escaping some junk foods continuously. Just a good thing to do.
  3. Elimination: Poor elimination is often the cause or result of unhappiness and/or intestinal pathology. Both constipation and loose bowel movements can be caused by not taking in the right foods and/or taking in the wrong foods (There is a difference in the latter two). Either way these can lead to dysbiosis, leaky gut syndrome and malnourishment.
  4. Poor nutrition:Nutritional counseling: Nutritional counseling for weight loss, muscle enhancement, disease cure and prevention, involves a personal and family history and identification of the client’s goals and the best way to achieve them. Fortunately, most problems can be corrected and one can age gracefully. The person must take responsibility without procrastination for their own health. A good healer can only guide you and be there for problem solving.
  5. Yoga: Big and taut muscles are great; but if your joints, tendons, ligaments are a limiting factor yoga is both restorative and preventive for arthritic problems.  Looking good is not good enough it is only part of the whole picture. But yoga also helps restorative properties not only to the joints and muscles but to your internal organs that are needed for good digestion. Yoga also alleviates a lot of stress, and stress is a big target to hit for proper digestion. This for the reasons that under stress most people eat or drink the wrong substances (and some do not eat). Also under stress when cortisol is released inappropriately it interferes with the stomach processing protein into amino acids that are essential for proper reparations of the bodies tissues and hormonal production. Stress is also pulling your blood supply into the muscles for flight or fight and taking this source from non-essential organs for flight or fight, the stomach being one.

Alan J. Sault MD, ABHM-diplomat

The Placebo Effect

PlaceboMany years ago in the ER I proved to myself that the placebo affect is real. I had one person that was in the ER very often (who I called a frequent flier). After a few times I emptied samples and gave the plastic shells to her. I gave her specific instructions and also told her that they were of  high potency and therefore could be dangerous so follow my instructions. She always got better and would only come on my shift since I knew the right medication.

Switching to being an Holistic physician and seeing the results of hypnosis (and self hypnosis) and Interactive Guided Imagery taught me that illnesses can heal without drugs in many instances (BP for example). A lot depends if the person has a negative or positive outlook on either the ailment or life itself. It is known that exercise is equal to pills for mild to moderate depression. I believe this is so not only for the increased hormonal affect but due to the socialization of being with others and their energies; and also being proud of oneself for achievement.

Holistic medicine includes the triad of mind-body-spirit and finding the cause and not just alleviating an ailment whether with pharmaceuticals or alternative medicine. I believe one must note that alternative medicine in many instances is successful also due to the placebo affect it is not just allopathic pharmaceuticals that should be accused. There is a place for both allopathic & alternative medicine; but there is always a place for self-exploration of why one has acquired an illness and what they can do to not only cure or alleviate it but also to prevent future occurrences of it and others. This is why I stress the stress factor and the immune system in my book.  One must realize that it is not the stress but how we react to a stress. Also when a person starts to be pro-active with working on stress solutions they are modulating their life style and therefore their health (and working with the healer).

Part of the placebo effect is having confidence and respect for your healer. One that the client can relate and that takes the time to relate to the client. My theory is: the physician is teaching the client and the client is teaching the physician. The physician is their to guide and for being a life-guard when necessary.

The mind can keep us healthy and heal and the mind can make us sick. The choice and options are ours. It takes a lot of work to clean up our inner negativities and fears. I have been working on this for myself for > 40 years using self hypnosis and Interactive Guided Imagery (and slowly progressing – the dance of 2 steps forward and often one step back). I have treated many patients with chronic diseases including cancers for years and have seen the differences when a person is positive or negative. Even if they came to me with a late stage terminal disease prognosis but positive energies they can still die with quality of life playing with their grandchildren. Often with IV alternative treatments they avoid their death diagnosis. I was one of these 10 years ago. So often the physician tells a person that they have a 60% chance of dying and never gives the positive that they have a 40-50% chance of living. I often wonder if the death sentence that is proposed by the healer and the client goes and spends all their savings and then lives another 10-20 years; are they glad about the extension of life, or angry about not having any money due to a the death prognosis (or wrong diagnosis-it happens). I myself am fortunate since my wife is an expert in both hypnosis and Interactive Guided Imagery. For example,I have sent people to her after my interview that just wanted BP meds and have her do hypnosis (for free) on the person. So frequently they drop their BP because stress is the cause of the vascular problem. So we work from that point on with both my medical and her psychology.

Much of the above seems to get off the subject of the placebo effect but the point is that it is the mind  that cures  with a positive outlook on the treatment.  Therefore one can have both, a medicine (whether pharmaceutical or alternative) that helps plus the placebo effect. As an aside, sometimes giving a person a supplement or pharmaceutical does not cure them for two reasons: 1-they feel they have carte blanche to keep their harmful life style and the medicine will be the panacea: 2-They are alleviating a situation instead of finding the cause and working on this.  This is especially true for delving into stress and its relationship to dis-ease.

Alan J. Sault MD, ABHM-Diplomat

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



Because I have been an holistic MD for the last 25 years and anti – aging is one of my specialties, I have an interest in both exercise and nutrition. On the subject of exercising for health, it is impossible to separate nutrition, and stress. You can work out religiously but if you are not eating wisely the full health benefit is not reached, because the body is not receiving the nutrients it needs in order to build healthy tissue and the cellular components for energy renewal. By the same token, if you eat healthy foods but do not exercise the health benefits are diminished. Muscle has to work to maintain or increase its mass. Now if one is doing both of the latter but the routines of either one or both are resulting in stress this can also defeat progress and health. For this blog I will concentrate on exercise; the next blog will be on nutrition. Stress is always a factor in health to me. Not the stress itself but how we react to stress.

After years of abuse, both poor nutrition and lack of exercise can have chronic consequences on the body. This is especially true if proper nutrition has not been followed for long periods of time while the body was under physical stress, such as intense sports training. Mental stresses have similar negative effects because of the constant adrenal – cortisol response to mental stress. (Please refer to my other blogs on stress – A quick reminder is that the body – mind cannot discern between physical and mental stress. The response to both are equal to cause the same output of cortisol for flight or fight protection and the consequences of chronic stress.

I do believe that both aerobic exercise and resistance (weight) training are necessary to keep a healthy body. The resistance is necessary to build strong muscles and bones and to prevent osteoporosis deflating muscles and to keep strong tendons: the aerobic for cardiovascular health. I have  a lot of experience in both and now share my ideas and experience with patients. I find this helpful because many people are either afraid of starting or have no idea of how to start. Stretching both before and after exercise keeps the muscles toned and helps prevent injury. When I was teaching karate I would emphasize to the students that having big muscles is no advantage if the joints do not react properly and are prone to different types of tendon-joint injuries. This is especially true as one advances in age. Exercise does not have to be either strenuous nor boring. In fact, I like to call exercise “funacise.” Today there are many different types from which to choose. Some people would benefit from joining a gym so that the exercise is structured, the equipment is there and varied, instructors are available, and the possibility of a social atmosphere is present. The latter can be especially helpful for those that do not have the incentive to exercise and to those that have depression so they are with other people. (A caveat to this is the many scientifically based studies that demonstrate that exercise is as effective for mild to moderate depression as the pharmaceuticals).There are numerous classes offered in different forms of exercise. Other people prefer to exercise at home, using their own equipment and/or videos. The problem with this is that one may not be using proper form if no one is watching, correcting and teaching and therefore prone to cause injury. It can be beneficial to have an exercise partner so that you can keep each other’s motivation high as well as having time to enjoy the company of each other. The type of exercise that works for you is the one you enjoy. Once in the habit of your choice you may branch out to other forms. Sometimes motivation is diminished because of boredom of the same repetition each time. There is no reason for this. If it is aerobic exercise that one does for 20 minutes or more it is not necessary to do a continuation of the same exercise. One can do 5-10 minutes of bicycling and then switch to rowing or treadmill, Etc.. Of course you can do different aerobic exercises on different days or join certain classes of different types. Walking is still one of the best and least physically invasive forms of aerobics if the person is not a “dawdler.” Your favorite music will help as you can sing with it even if you have a voice no one else wishes to hear (my own personal experience). For myself, I like to combine weights and aerobic by not stopping lifting but rather go right into a different muscle group even if using light weights. This cuts down on the time I spend “funacising” to about 20 – 30 minutes with all the benefits of both. Of course, it is important first to learn good form so you do not injure yourself while trying to improve your health. For those that dislike exercising, especially resistance exercise, you can get around this and be finished quickly if you do the eccentric method. This is done by taking a light weight and doing the extension part very, very slowly. For example, biceps: lift up a weight you consider lighter then normal for yourself but let it down (with good form) to the count of 12 or more. You will ache after 3-5 reps. You can do this eccentric exercise for any group of muscles.

There is a caveat to any form of exercise be it resistance or aerobic.! If you know you are an obsessive and/ or compulsive personality, or competitive personality you need to watch stressing yourself to the point of defeating the purpose of exercising. Why? Because exercising is to relax your mind as you become physically fit. It is not meditation but a form of moving meditation in the sense that you are escaping from the everyday stresses for the time that you are exercising. You do not need to add another stress to the day. When I was running a mile for each round that I fought I would get so aggravated if I did a poor time or was not progressing in my time/mile. This is competitive-obsession. My wife would ask me why do I run and I would say to relax – duh. When I would come home from my emergency-room shift and be “up- tight” and volatile before I was allowed to sit down and eat with my son and wife one or the other would say first go down to the basement and jump rope for half an hour-to-forty-five minutes. It worked every time to get rid of the ER mind trauma so I could enjoy my family meal.

When one starts to do resistance exercise they may get really severe muscle aches the first few times they are working out. Some refer to this as good aches “No pain, no gain.”. This latter is only true if you are going into this for body building and do not care about future osteoarthritis. DOMS (Delayed Onset Muscle Syndrome) is the proper term. They use to believe that these aches were due to lactic acid buildup from the workout. It is really the muscles healing from the nano tears that are a  result of a proper workout. It is the repairing and building up of the muscle. When it occurs be thankful and happy that your body is responding properly. They will not occur after you get through the beginners part except when you decide to start a new plateau or new type of funercise. Sometimes when you leave go of the exercise for a long time and start again DOMS will hit but for a shorter time. Do not forget that form for each muscle group is so important. Above all ”Do no harm!”

Some people tell me that they do not have time to exercise or even relax. Think of it this way; taking time for yourself is doing something.
I point out that they have time to be caretakers each day for their spouse, boss, children, etc, but not an half hour per day for themselves. This is sending a subconscious message to their brain that everybody else is worth their time but they feel they do not deserve time for themselves. “Today I will love myself enough to exercise.”

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

Prostate Specific Antigen = PSA

prostatePSA is a subject that is often brought up to me during my seminars and with private consultations. To most men it is only initials for a test that states whether they have cancer, potentially have cancer, benign prostate hyperplasia (BPH=enlarged prostate) or they can be relieved to go home feeling free of prostate disease. The answers to these initials (PSA) are not complicated, but should be understood, so a discussion of the prostate can be discussed intelligently with the physician and most often relieve the client of unnecessary anxiety.

PSA (prostate specific antigen) is a protein that is produced almost exclusively by the cells of the prostate. Its function is to keep the prostate fluid (semen) watery so the sperm can swim. Another purpose of this protein is to dissolve the cervical mucous cap to allow the sperm to enter. Although present in large amounts in prostate tissue and semen, it has been detected in other body fluids and tissues. Interestingly PSA is found in concentrations of female ejaculate roughly equal to that found in male semen. It is also found in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium (uterus lining), normal breast tissue and salivary gland tissue. In addition PSA is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.

In the male PSA is normally found in the blood but at low levels (about 0-4ng/ml = nanograms/millimeter= one ng=one billionth of a gram). PSA levels can be increased by prostate infection- irritation, digital rectal examination (DRE), benign prostate hyperplasia (BPH), and recent ejaculation. All the latter can produce a false positive result. Ejaculations should therefore not be present for 24 hours before a PSA test and a DRE should not be done before blood is drawn for this test. Exercise within 24 hours of the PSA exam can also give e a false positive (high). There is also a urological debate whether the PSA normally goes up gradually with age and therefore different normals should be considered. The prostate gland generally increases in size and produces more PSA with increasing age; it is normal to have lower levels in young men and higher levels in older men. Age-specific PSA levels are as follows (age group, upper normal): (40 – 49years, 2.5), (50 – 59years, 3.5), (60 – 69years, 4.5), (70 – 79years, 6.5). But keep in mind that age related normals are still controversial and in practice the 0-4ng/ml is the gold standard.

So in the former paragraph one can see that besides from the cause of cancer and BPH the PSA can rise from other causes. I have already mentioned the PSA can rise just from having intercourse or any ejaculation before the blood serum is drawn or from exercising before the blood is drawn. It can also be elevated due to testosterone converting to the stronger testosterone, dihydrotestosterone (DHT). This latter can happen if the man is on an anti-aging regimen of taking testosterone and he is one of the rarer males that will convert the testosterone to DHT. It happens but the conversion can be stopped either with pharmaceutical intervention,with natural supplementation or with tweaking the testosterone regimen.

Increased levels of PSA may suggest the presence of prostate cancer. But if mildly elevated 7 out of 10 men will not have the prostate cancer. However, prostate cancer can also be present in the complete absence of an elevated PSA level, in which case the test result would be a false negative. Statistically 2.5 percent of men with prostate cancer will have a negative PSA. Obesity has been reported to reduce serum PSA levels; therefore, this can also give a false negative and delay early detection. This may explain the worse outcomes in obese men that have the pathology of prostate cancer but no symptoms, signs or elevated PSA.

Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of PSA screening outweigh the risks of follow up diagnostic tests and cancer treatments when the test is positive.. For example, the PSA test may detect small cancers that would never become life threatening. This situation, called over-diagnosis, puts men at risk of complications from unnecessary treatment. The procedure used to diagnose prostate cancer (prostate biopsy) may cause harmful side effects including bleeding and infection. Prostate cancer treatments, such as surgery and radiation therapy, may cause incontinence (inability to control urine flow),and erectile dysfunction (erections inadequate for intercourse), So the best way to use the serum PSA is to have a base line as an index to refer to for future PSA tests. If this baseline test is normal but the next test goes up about 2 points then suspicion should be heeded by the physician and the test repeated in 2-4 months along with watchful waiting. For example: If my PSA is 1.4 for the first test then one year latter it is 3.6 this is looking a little suspicious. Watchful waiting and a good history plus symptoms and signs that can raise the PSA should be questioned.

Then there still exists the debate at what age is the PSA elevated naturally. But I believe that the above paragraph with the PSA rising more then 2ng/ml in one year is a good indication that further testing and observation should be taken seriously. Also if the man is on testosterone this should be stopped for a few weeks and certain tests should be retaken and reviewed. There are some blood test markers for prostate cancer and a retesting of hormones if the man is on testosterone therapy. Then if so desired by the client and with the consultation of the physician testosterone can be restarted but possibly with a different regimen. There, are different ways of using the anti-aging testosterone that can be tailored to this situation and followed and as mentioned altered to stop testosterone converting to DHT. But in a different blog I will show the evidence based information of why testosterone is not the cause of prostate cancer but rather estrogen is the cause. Note that I only believe in bio-identical testosterone produced by a compounding pharmacist. By doing so I can have the testosterone made specifically for the individual and tweaked if necessary. Also, the body does not know what to do with synthetic hormones since the cells were evolved only for human bio-identical hormones.

So further testing would include a free PSA. Most PSA in the blood is bound to serum proteins. A small amount is not protein bound and is called free PSA. In other words the PSA protein can exist in the blood by itself unattached, or it can join with other substances (protein) in the blood. When it is by itself, it is known as free PSA. With benign prostate conditions (such as BPH), there is more free PSA, while cancer produces more of the attached form and therefore, the free PSA is less then 25%. If a man’s attached PSA level is high but his free PSA level is less then 25% the presence of cancer is more likely. It is easiest to just remember that the free PSA should be above 25%.

Since this can be a confusing concept let me write it in another way. PSA, a protein produced by prostate gland cells, circulates through the body in two ways: either bound to other proteins or on its own. PSA traveling alone is called free PSA. The free-PSA test measures the percentage of unbound PSA; the PSA test measures the total of both free and bound PSA. About 75% of men with an elevated PSA do not have prostate cancer. a free PSA greater than 25% is more likely to have a benign condition than to have cancer, making a biopsy unnecessary. Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer ( Harvard Medical SchoolOriginally published April 2009; last reviewed March 21, 2011. )

So the tests that I do in the case of a rising PSA are:

  1. free PSA

  2. ultrasound

  3. repeat the PSA in 3-4 months making sure that events that could give a false positive have not happened.

  4. DRE-digital rectal exam or have the urologist do this since. I so often refer to them if there is a chance of serious pathology.

  5. IF the man is on testosterone the laboratory chemistry I order are:

    • testosterone free and total

    • estradiol

    • sex hormone binding globulin (SHBG)

    • another PSA and free PSA if the last one was more then 3-4 months

    • dihydrotestosterone (DHT)

    • if there is a suspicion because of signs or/& symptoms it warrants caution. I believe the best way to handle any doubt is to get another opinion from a urologist.

 Many men were diagnosed with, and treated for cancers that would not have been detected in their lifetime if they had not had screening and, as a consequence, were exposed to the potential harms of unnecessary treatments, such as surgery and radiation therapy . Here I am just stating results and not giving advice as to what each individual should do if there is a possibility of prostate cancer. This is up to the individual with guidance from their own physician. Just investigate all options before making a decision.

Scientists are also researching ways to improve the PSA test, hopefully to allow distinction between cancerous and benign conditions, as well as slow-growing cancers and fast-growing, the latter being potentially lethal cancers. These new tests that they are researching and developing are too numerous for this blog and they are still in investigative states. But the reader can investigate all these potential diagnostics via the Internet and should do so if they believe they have a problem since research and progress come about so fast. Too often physicians do not know all the research being done outside their expertise and area and it is up to the concerned client just to Google further information and bring it up to their physician.

I hope this short excursion into PSA helps those men that have anxiety about not understanding the PSA test.

Author: Alan J. Sault MD. ABHM-Diplomat Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your-well being and what you can do about it .