Hi, Welcome to our first and it may be our last edition of "Off the Cuff." "Off the Cuff."
I have absolutely no notes and I just spontaneously bring in a world-renown expert to ask questions,
and then this person, off-the-cuff, answers them, and then we edit as freely as we want
to to make each of us look really good.
So, if I watch TV enough, I'm thinking that everybody in the world has low testosterone—that
I have to have it—so that's if I'm watching TV. Obviously, that's not correct, but when
do you—because men with prostate cancer are told not to get testosterone—so what's
your opinion of testosterone? How do you use it? How do you implement it into your patient
program? So take me through that kind of thinking—testosterone and when and how you use it.
So, testosterone, you know, we never used it before with prostate cancer because part
of the prostate cancer treatment is blocking testosterone (Moyad: That's right.) to starve
the cancer cells from treatment. Well, there's a lot of data to show that men who have low
testosterone actually have more problems with dying from prostate cancer than men with regular
testosterone levels.
So it's not unusual that you give a man testosterone who needs testosterone after they've been
treated for prostate cancer?
Now.
Moyad: Now.
You know, five years ago we'd say no. (Moyad: Right.) So that was heresy to start that up.
There are a million ways to get testosterone it seems now as a prescription. Can you take
us through some of these and which ones you like versus the others?
Right. So there's, you know, gels that people use. They can be bought by, you know, substances
such as AndroGel, you know, you buy them and it's covered by insurance and you rub them
on your shoulder. And there's one that goes under your arm called Axiron.(Moyad: Right)It's
a little bit watery and sometimes it can go down your side and that can be a problem.
(Moyad: That's not fun) You know there are different types. There's one that's a buckle
one that goes under your, you know [points to mouth]. Baseball players like that.
Yeah, the one that goes in your mouth. That's actually true. I mean these are all options.
Auerbach: And there's one that can go in your nose.
(Moyad: Yeah, no. That's attractive.)
So, you know... There's intramuscular. There's a new one called Aveed that's a three-month
testosterone supplement.
Is that A-V-E-E-D?
Correct. And so, you know that's covered by insurance if you fail two other ones. There's
one that's compounded that you can put underneath the skin. And there's one that's, you know,
it's covered by insurance it also can go underneath the skin sub-q . There's regular depo testosterone.
That's been tested by a buddy of mine that's in New York and he's gonna be writing a paper
on that, and it's actually given sub-q, under the skin.
Moyad: So you just inject it there?
Yeah, so you do a half CC of that, once a week. Which is depo testosterone that means
it's being given into the muscle, but now they've done studies and it gives good levels.
So I'm injecting here once a week?
Auerbach: Yeah.
Are you injecting? Are they coming in every week?
(Auerbach: No, you teach the patient how to do it.)
So the patient goes home and they get the syringes and then they inject themselves?
Auerbach: Yeah, and they do the injection and they get pretty good levels of testosterone
that way.
And do guys have in problems injecting themselves in the stomach?
It's been pretty... Most of the guys have done it. Some guys don't want to do it. They
get freaked out.
But men are more freaked out by injecting themselves in the penis than in the stomach?
Yeah, they can do the stomach a little easier
Moyad: Just want to make that official.
Yes.
So, okay, so which ones are your favorites out of all of those?
So, the patient doing the one in themselves in the stomach is becoming the more favored.
(Moyad: Really? Is that cheaper or more expensive? Do we know?)
I think it's cheaper for the patient
(Moyad: So if they go home and do once a week...)
Yeah, and also the pellets that I do for them
Moyad: So you actually put in a pellet around their waist?
Underneath. It's good for six months. That's probably the cheapest because it's about—I
think it's 250 dollars for the pellets for six months.
Moyad: So you like the pellets and the injections?
Yeah, so that's probably the cheapest, but that's a bigger needle so... But it's not...
[indiscernible]
But it's not bad for the patient. So whichever one they choose is the best one. Whatever they like.
And do you find that, in general, people notice the difference when they get testosterone?
Or is it more of a placebo thing because they're injecting themselves?
It can both. You know when they see the numbers are good they're feeling better.
Moyad: Yeah, so when the numbers get better, they feel better.
And the problems that they have, sometimes they can get higher hemoglobin, you know,
so their red blood cell counts get higher, and that can be a difficulty because they
can end up, you know, possibly, you know, getting a traffic jam in their blood vessels.
Moyad: Yeah, too many red blood cells.
So we have to have to have them phlebotomize (they have to give blood off) and they take
aspirin because they got too many blood cells and you don't want to flip a stroke.
Moyad: I mean, that's scary.
That's scary.
(Moyad: Tell me that doesn't that often)
I haven't had anybody get a stroke, thank the lord.
(Moyad: Or even these large increases in blood cell count. That's not that common, right?)
No, and they have to be... You know you have to pay attention to them.
(Moyad: Right.)
They have to be very compliant to get their blood cell count, to get their PSA looked
at, and come in for prostate checks. Some of these guys, if they're not compliant, you
know, I don't work with them anymore. They get fired because they have to be good at
that.
Well you know, we're in California; we're in Los Angeles, where perception is everything.
Right? I mean people have all these wild ideas. I love L.A. because people have all these
wonderful ideas about health. Some are perfectly reasonable, some are absolutely bonkers. They're
crazy. So, but that's true of a lot of places, but especially here where people are health
conscious, right? What I see a large number of out here, which I don't see in other places
in the country, are compounding pharmacies where we'll just make you testosterone. Do
you feel comfortable sending people to these make-your-own-testosterone outfits? These,
call-them, compounding pharmacies? What's your experience with that?
Well, for the pellets we work with this one and they've done a good job. I mean, I've
had an issue, you know, one time and especially when we saw that scare back east or where ever that place was.
Yeah, that guy was just indicted for a compounding pharmacy gone wrong, so that's why people
are concerned about some of them.
It's scary, it's scary
(Moyad: But your experience has been pretty good?)
Yeah, and you know, I'd rather use, you know, real drugs than compounding, you know, patients,
it gets kind of tough because they end up having to pay 750 dollars versus, you know,
1500 dollars versus, you know 200 dollars, 300 dollars.
Moyad: It's expensive
Yeah, it's a very expensive, that drug.
So testosterone, the benefits of it are a possible increase in bone strength, muscle
strength, you feel better, men think better, they think more like men. We're crazy, we're
more alert. We have our energy. We're on it. We're ready to go
Moyad: Top of our game.
You know, we're not listening to our wives, you know, we're caught in what we're thinking
we're going to do three days from now, or next hour, or when the ball game is on.
Moyad: Yeah absolutely, this is all testosterone.
Yeah honey, I'll be right on it. Okay. No.
Moyad: So you've been happy with the results?
Yeah, so as long as people are being monitored, I think that's a good thing.
This has been another episode of "Off the Cuff" with Dr. Moyad. See you next time!