got labs back, starting new regimen monday!!!!

[JSayaMD]

YOUR arrogance is unmatched and unwarranted as evidenced by the COUNTLESS inconsistencies in your posts... When challenged, you attack...as is customary for anyone who cannot partake in a valid evidence-based debate.

I've sat down with so-and-so this, talked with yada yada, 1000 of this a 1000 of that, and yet you CANNOT produce the single collection of DATA (that YOU supposedly presented to Nicholls Institute) that would VALIDATE all of your claims...until you do it is only anecdotal and opinion.

Am I as old as you or have as many years experience as you, no, but your experience is relative as you've (rightly so) changed your methods/practices over the years.

I could point to your lack of knowledge in the concern that Subq injections would spike E levels more so than IM injections, which you admitted didn't show true in clinical practice, and I clearly described to you ( earlier in this thread) WHY that did not happen and why, if you were truly knowledgeable about the physiology involved - ie esters cleaved in bloodstream, etc) you should have NEVER even had that concern let alone be relieved when you noted it didn't happen.

I respect your years and path, and I do learn and take THE BEST from various experts (which I feel you may be in CERTAIN aspects, not in others) in the field so that I may one day, perhaps sooner rather than later, be even better. Such is evolution.

Your pokes, narcissism, and condescending remarks are, quite frankly, unprofessional and not fitting of a scientific discussion between an MD and DO.

Enjoy your journey and eventually, maybe in years when you retire to a tropical locale somewhere, look upon my career and what pieces of your clinical experience I may have adopted, perhaps even the topic of this discussion once DATA is available.

Have to get my work-out in now.

Dr Saya

 

[Dr. John Crisler]

There are no inconsistencies in my posts, to those who understand the art.

And "arrogance" is what those who fall short claim of those who excel them. It's a common weakness.

You missed the point, once again: I did not begin using SC injections until it was proven to me (and by a couple doctors whose word I trusted) that same would not cause tissue damage and estrogen spikes. The former is appreciation for the tissues involved, since we really had no data on oil-base injections into fat; the latter because of the proximity of the aromatase found directly in the skin and fat. That decision was logical, reasonable, and prudent (I wanted other doctor's patients to be the guinea pigs first LOL).

But, for sure, I did not attack Dr. Shippen because he got it before I did. That is a hint.

The way you act, I would not even recommend anyone for you to study under. You need a LOT of training.

And there definitely IS a difference in the level of care of those at the top of this field. The patients who have not found resolution to their issues until they finally got in front of one of them will be happy to attest. You have no idea. Really.

STILL refusing to simply look on a Quest Diagnostics printout? Or are you STILL claiming you know more than the top experts in laboratory science? The data is already right there, on your desk before you.

The simple fact is you are but a rank beginner. And you are no where near being qualified to judge anyone else's skills. You have to prove you understand more than basic concepts--which are still challenging for you at this point--before you can.

But, unlike you, when I got the chance to interact with those of international prominence (such as Dr. Eugene Shippen--who raises the hair on the back of my neck when I talk to him, his insights are so profound--Dr. Ronald Rothenberg, Dr. Sharon McQuillan, Dr. Mark Gordon, etc) I was all ears, to learn what it is they do that makes them SO much better.

THAT way of thinking is what landed me on the stage at The Royal College of Physicians in London, my third year of practice. Or to write the most highly read paper in the history of the field of Endocrinology. To be featured in an article in Playboy Magazine (for my work and my ethics). And to create numerous medical protocols which countless doctors all over the world successfully employ. Or why doctors pay me $2,500 a day, just to hang out with me.

I did not act as you have. Had I, they would have dismissed me; along the same lines, I would not accept you as a student.

I've had plenty of newbs try to attack me over the years. Not one of them have made it to the top.

As far as the future goes, IF you are able to honestly begin to learn about this stuff, one day you will realize how right I was about all I have posted here, why it is my patients do so much better...and, hopefully, the folly of your actions.

 

[Dr. John Crisler]

For the record, the top Thought Leaders in the field do things in different ways. Some times VERY different ways. So there is plenty of variation across the board.

But none of them would, for instance, NOT do a SHBG; on each and every patient. It's TRT 101.

When you really analyze the different protocols--as I have, in trying to reach the best conclusions, to best help my patients--you one day realize everyone uses little tricks that balance things out, and that is why we all get such good results, using different means.

Many of those conversations occur during cocktail hour, after a long day at a medical conference. THAT is where REAL medical advancement comes. LOL

I would also add that I believe these people are MUCH smarter than I. It's hard to compare brains with people who can speak five languages, fluently, for instance. LOL

So why am I there? Because they know I am a mechanic; the guy who rolls up his sleeves and gets the job done. Simply, my protocols work.

Anyone around long enough to remember when I first (and I do mean first) began advocating HCG at only 100iu per day? Lots of ridicule. Now what do we know?

The common "knowledge" that 100mcgs of GHRP-6 completely saturates the receptors was also popular. Now we know much better there, too. I had the labs to prove it.

My strategy of "backfilling" the pathways, behind the administration of testosterone--from what I hear from the doctors who try it--is really catching on. Because patients report it makes them feel so much better (it's also obvious enough to be innate, IMPO). That feels good.

The same with the need for sensitive estrogen assays in adult males.

Whatever I have been able to figure out has been only because I have studied the ways of those who came before me. That's also a hint.

 

[JSayaMD]

Anyone who reads the entire thread, and is intelligent, will easily see the holes.

You say "I don't know where you got the middle-range from...that's not even relevant"...umm, it was YOU that first mentioned it, that was also when you became hostile...when I pointed that out.

Throw around names, it may impress some, but DATA does the walking as I said, not hard just ONE PIECE of data that you supposedly presented and, thus, should easily be able to PRODUCE (the statement on the lab report is not data).

I am really done, from pattern you will likely post another condescending reply to my post but I will not partake in cheap jabbing and banter any further. Show me the DATA.

Dr Saya

 

[Dr. John Crisler]

No one is so blind as those who will not see.

Look on your desk. Pick up a Quest Diagnostics printout: the data is right there, below where you ordered the wrong Estradiol test.

Then, please call the Director of the Nichols Institute, and tell him their experts are wrong, too.

Please report back to us on what you hear.

Maybe hold off on your next criticism of not having any data until you do?

 

[JSayaMD]

Data.........

 

[JSayaMD]

And if Quest posted that on their lab report WITHOUT you presenting DATA to them, all the more reason I have less faith in their results.

If you did present DATA to them, produce it... it's THAT SIMPLE...EVERYONE would appreciate it.

Dr Saya

 

[Dr. John Crisler]

And if Quest posted that on their lab report WITHOUT you presenting DATA to them, all the more reason I have less faith in their results.

If you did present DATA to them, produce it... it's THAT SIMPLE...EVERYONE would appreciate it.

Dr Saya

You are like a broken record. That is easier than thinking, and learning.

I do not have all my patient records with me, obviously. I am not at the office. But I am getting the idea no matter how many individual laboratory printouts we produce, at whatever time expense, nothing would suffice for you.

So, let's apply a little common sense: Do you REALLY think Quest would have drastically changed that assay description, without expert analysis of the concept? Now you are just plain being silly.

And others do "appreciate it" already. This is pretty common knowledge. It's talked about all over the forums. Even lay people get it.

BTW, the answer is STILL right there, on your desk.....

 

[JSayaMD]

You can fix the broken record by presenting your supposed DATA that you supposedly presented to them...

That would fix that broken record once and for all, and something tells me IF you had that DATA you would eagerly produce it for just that purpose...

You're right, this has become futile and silly...

I will take the high road.

Good night Dr John.

Dr Saya

 

[Nelson Vergel]

Only those that spend the time, effort and money to do chart reviews and present them in conferences and publications can own claims. It is easy not to have to show evidence and data when you do not have to deal with insurance companies or when you have no association with academia. But only those physicians who take the time to gather evidence to substantiate their claims can help the men's health field move forward and have a comprehensive TRT program with side effect management therapies become mainstream.

Not every patient has cash to afford a comprehensive TRT program. Many people will have insurance in the next few months and only doctors who are equipped to show evidence for therapies like HCG, anastrozole, and special labs will remain in the TRT marketplace a few years from now. A few physicians are already collecting their evidence to be ready for what is coming.

It is no rocket science to get IRB review for pilot studies and HIPAA compliant chart reviews even if you are not linked to academia. In HIV many private clinics have been able to do this for the last 20 years and gotten a name for themselves by obtaining back up data for letters of medical necessity that got therapies reimbursed. We were even able to study taboo medications like nandrolone decanoate.

Fringe medical groups like A4M and others would benefit greatly by having their physicians generate data to validate protocols. Only this way they will be taken seriously by regulators and insurance companies. The first clinics that get some sort of insurance reimbursement with evidence based data will thrive in this field.

I predict that a clinic network will come up with evidence that will eventually be accepted by conservative groups that develop guidelines for male hypogonadism and sexual dysfunction ( Guidelines: Europe and United States )

Physicians with academic institution affiliations like Dr Larry Lipshultz are leading efforts on generating data on TRT+HCG + or minus AIs that will enable this field to move forward. There are others like Dr Shalender Bhasin who are also leading the field and pushing guideline groups to open their minds to side effect prevention and management adjunctive therapies in TRT protocols. It is a matter of time when men like them will make what seems like cutting-edge medicine now become mainstream. Only then all men who need TRT can be treated well without having to spend a lot of their cash.

We can argue back and forth as much as we want. There is huge value on medical practice experience even if it is unpublished even as a poster presentation in small conferences. But at the end of the day, those with data will win.

 

[Dr. John Crisler]

You can fix the broken record by presenting your supposed DATA that you supposedly presented to them...

That would fix that broken record once and for all, and something tells me IF you had that DATA you would eagerly produce it for just that purpose...

You're right, this has become futile and silly...

I will take the high road.

Good night Dr John.

Dr Saya

IF you are calling me a liar, sir, then you certainly have not taken the high road.

Expecting me to spend countless hours looking through old laboratory printouts, since I have not ordered the wrong test in many years, to prove what the Director of the lab will tell you, is idiocy.

By the way, you don't even need to consult with a laboratory science expert. Just look down, grab the first Quest Diagnostics printout you see. Tell us all what it says, right under where you ordered the wrong estradiol assay.

So: you are not willing to spend 15 seconds doing that, but I am supposed to spend hours digging through very old medical files, to prove something all experts already know?

You betcha.

 

[Nelson Vergel]

This thread will now be closed. Too much drama for my guys in this community. Amusing but serves no purpose for patients. Thanks for your lively back and forth.