A major dermatology journal has confirmed what we already knew. It takes more Botox to get the same results in men. This isn’t new information but having a peer reviewed article like this one might help men understand better why it costs so much more for their Botox than it does for women. Botox is a commodity product that prices out by the unit. Often when a provider charges “per area” they are figuring towards 15-20 units per area of the face. That’s enough to be sure that most women will get a good result. Obviously, with men needing often twice that much it’s much more difficult to price “per area.” Per unit pricing makes more sense for everyone.

Don’t get confused or ripped off with “per area” pricing. Make sure that you’re getting what you are paying for. Here in Las Vegas, the going rate for Botox Cosmetic seems to be about $12/unit. That means that a $240 “area” should be 20 units. Make sure you’re getting what you pay for.

So much of anti-aging and regenerative medicine thinking hinges on the idea of reducing inflammation. Lacking the right hormones or being overweight can lead to inflammatory states that increase the risk of “age related” disease like heart disease, diabetes, atherosclerosis, and even diseases like Alzheimer’s. Because of this, there’s lots of scientific work being put into looking at inflammatory markers and how to control them. The thinking has been since fish oil (specifically the EPA+DHA fatty acids) reduce inflammation to the point they are effective supplements to reduce this inflammatory cascade. This fish oil fraction has been shown to impact things like serum triglycerides in a positive way so the thinking is that they are valuable to supplement.

This month, the Journal of Nutrition has a couple of studies that relate directly to fish oil. Some Japanese researchers demonstrated that fat metabolism is upregulated when the diet of mice is supplemented with fish oil. The same issue also contains a study that demonstrates that weight loss of about 10kg is more effective at reducing inflammatory markers than fish oil supplementation for obese men. A goldmine of fish oil data, the journal also has a piece on human monocytes (cells involved in the inflammatory process) that are inhibited by use of fish oil. The study is a little soft but the effect is definitely there.

The world of supplements is full of plenty of bunkum but the value of fish oil supplementation is clear and getting clearer. The more we understand about fish oil fatty acids and how they impact human metabolism the more refined the recommendations will get to be. For now, some supplementation is probably better than none. Check the contents of your fish oil supplements to make sure they have as much of the EPA+DHA fatty acids as possible since that seems to be where the metabolic action is.

An actual clinical trial of hGH (human growth hormone) was conducted and published here. The trial shows that patients with low IGF-I (the blood factor that we follow for growth hormone) and fibromyalgia saw improvement in their fibromyalgia pain with regular dosing of hGH. This shouldn’t come as a surprise since hGH and IGF-I both are involved in various enzyme cascades including those associated with inflammation. Also, for someone with low levels of hGH to do better when supplemented isn’t a surprise either.

Since I posted this morning, Dr. James Forsythe (whose original DOJ release on his indictment you can read here*) spoke at the conference that I am attending. He elaborated on his experience from the initial sham patient used to entrap him through his jury trial acquittal. It’s clear from his experience and presentation that several things are happening:

• There is now judicial precedent for “off label” use of hGH being legal and acceptable.
• Dr. Forsythe is working with the A4M to develop a national protocol for age related use of hGH.
• Dr. Forsythe is of the opinion that “anti-aging” gets the attention of the FDA where as “age management” does not. Whether this is true, I can’t say but it does seem likely.

This story is over from a criminal standpoint. Dr. Forsythe is a free man and back in his practice. There are civil proceedings pending from wrongful arrest to prosecutorial prejudice that will take time to shake out. The fallout for practice of “age management” will continue for some time.

This affair, while an awful experience for Dr. Forsythe, can only improve the quality of “age management” medical care by bringing it closer to the mainstream.

* It’s funny that I couldn’t find the DoJ release about the acquittal…

It seems like the controversies over human growth hormone never to end.

A couple of weeks ago, a Nevada physician was acquitted of illegally prescribing growth hormone to his patients. The Olympic Committee is worried about growth hormone. Sylvester Stallone was busted with human growth hormone. ABC news claims it’s the secret to eternal youth.

Professional baseball is embroiled in a growth hormone scandal over a banned substance that doesn’t work if taken orally and doesn’t “juice” the way testosterone and pure anabolic steroids do. The Mitchell report came out yesterday. I’m still chewing through it since it’s over 400 pages. All it seems to be is one tedious tale of how players obtained steroids and hormones after another. The list of players involved is extensive, but the report does little to demonstrate that it mattered. To Major League Baseball the simple question is whether players used hGH because it was against the rules.

It’s definitely against the rules for pro-athletes, but because of odd twists of law even medical professionals who understand growth hormone deficiency have trouble figuring out whether it’s legal or not. It turns out that it is legal to use to replace growth hormone for people truly deficient, but the exact means needed to satisfy the legal requirement is fuzzy. It may be that an examination and history by a physician is enough to meet the requirement. Diagnosis might require labs though there is some question as to which blood levels are the right levels to follow.

So what are patients and physicians to do? How can doctors tell whether their patients are truly deficient of growth hormone or suffering some other complication?

Well, the American Academy of Anti-Aging Medicine holds regular physician training. The problem is, this organization has some controversies and by some is considered outside the mainstream.

The more widely accepted group, The Endocrine Society has a policy statement on growth hormone, including extensive clinical guidelines. Sticking to these guidelines will no doubt keep physicians in the clear legally.

There are other sets of guidelines to be sure. There are also more aggressive approaches based on published medical articles. Depending on how much legal risk the physician is willing to take on, they might be more aggressive than just the Endocrine Society guidelines.

Regardless, the evidence and clinical opinions are clearly adding up. Replacement of human growth hormone for patients with real, documented deficiency is absolutely an accepted practice by physicians trained enough to understand the deficiency syndrome.

I’ll talk more about growth hormone deficiency later. Despite what the media might portray over the coming days because of the Major League Baseball scandal, use of human growth hormone in medicine is legitimate, real and in no way “juicing.”