Mark E. Richards M.D.

Bio-Identical Pellet Therapy
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After over 20 years of plastic surgery practice, the last ten of which have been devoted to aesthetic surgery of the face and body, I have become aware of a significant unmet need present in most all of my patients. I have been surgically rejuvenating clients’ appearance to better reflect externally how they desire to feel internally. Still, the aging process causes the inevitable evolutionarily programmed decay of body structure and function. Like many of us, I have read with interest articles of varying quality that have been published on “anti-aging” treatments. Aging and death are inevitable (fortunately). However, the unpleasant decreases in quality of life that occur as a result of “aging” has as its causes: decreased bone density, increased fat, decreased muscle mass, increased fasting blood sugars, increased cholesterol, decreased libido, decreased energy, anxiety and depressive symptoms, sleep disturbances, poor erectile function, etc. Stress seems to accelerate this process. The percent of the population in our high stress metropolitan area taking anti-depressants for many of these symptoms staggering. Yet, many of the diseases and symptoms listed above can be reversed or even cured with no health risk.

Many believe (as I have now come to believe) that a significant part of the decline in quality of life as we age has to do with decreasing levels of hormones, in particular testosterone in both men and women. Interestingly, testosterone is a major source of intracellular estrogen in men and women via the aromatase enzyme. Several well done studies have shown not only a shocking decrease in average testosterone levels in the US population over the last 20 years (about 200ng/dl in males), but also a high correlation between low testosterone and mortality from all causes! The wide spread use of statins (which effectively blocks cholesterol synthesis) further aggravates the prevalence of testosterone deficiency as it leads to a marked decline in its production. (Cholesterol serves as the initial building block for all hormone synthesis.)

It is abundantly clear that men and women are very unhappy with the state of their “sex” hormones for more than just sexual reasons. The multibillion dollar sales of antidepressants, erectile dysfunction drugs and OTC “herbal remedies” of varying quality for men and women speaks loudly to the prevalence of their symptoms. Oprah aired two different shows devoted to bio-identical hormones in January of 2009 as another sign of the current public interest and unmet need in treating quality of life and health issues.

I am not starting an Internal Medicine, Endocrinology, or OB-Gyn practice! However, I am offering a service to your patients (and mine) of inserting bio-identical testosterone time release pellets into those that might benefit. (I almost never add bio-identical estrogen pellets, as women usually synthesize all the intracellular estrogen they need from testosterone, relieving their menopausal symptoms.) The testosterone in the pellets is molecularly identical to our endogenous human hormone, and is synthesized from an oil derived from yams. In my research into this topic, this manner of supplementation is far superior to injections, gels and patches as regards maintaining physiologic levels, symptom relief, patient compliance, cost, and convenience. Please read the enclosed Dear Patient letter that describes this process from a patient point of view.

While there are hundreds of scientific articles that report on bio-identical hormones, there is little doctor education on this topic due to the lack of pharmaceutical company funding. Testosterone pellets have been available in the US since 1938. Drug companies cannot significantly profit from non-patentable bio-identical hormones. There have never been any findings of health risks when using relatively physiologic doses of bio-identical testosterone, nor logically should there be any. In fact, over one hundred recent scientific studies show a lack of side effects and the measurable benefits of bio-identical testosterone in symtpomatic individuals. The Women’s Health Initiative Study points to the obvious: that pregnant mare urine derived hormones which are not molecularly nor physiologically identical to human hormones cause severe health issues attributable to differences in their mechanism of action. Most all of the dangerous “side effects” of non-bio-identical hormone treatment are absent when treating with bio-identical hormones. (Upon request, I am happy to provide you with scientific literature on this topic.)

When I was training at one of the largest pellet insertion clinics in the U.S., the self reported patient satisfaction with quality of life improvements was astounding. Osteoporosis responded very favorably to testosterone pellets, with most osteopenic patients having a normal bone density within a year. Contrary to my initial thoughts, symptoms in their male BPH were reported improved with testosterone supplementation. Academic studies on the cancer prevention aspects of bio-identical hormone therapy are underway. There is already sufficient literature showing that men with low testosterone are much more at risk for aggressive prostate cancer than men in the highest quartile of testosterone. There are studies reporting that most breast cancer cell lines are inhibited by testosterone, and a report that women on testosterone pellets have a greatly reduced incidence of breast cancer. More research is being done worldwide. As my medical school dean told me on graduation, “Half of what we taught you is wrong. Your job over the next 40 years is to figure out which half.” I believe the weight of science is now clearly on the side of bio-identical testosterone therapy for both sexes.

I look forward to providing this wonderful service that has helped so many elsewhere regain better health and, equally important, regain a better quality of life both personally and within their marriage and family. I am always willing to discuss this therapy in general or as it concerns a specific patient. The pellet insertions I perform should have nothing but beneficial effects on your patient’s health, and make your job of attending to their medical needs easier. I expect you to take on no additional work or precautions except to note that type II diabetics will often experience a lowering of their blood sugar, and the need for anti-depressants, anti-hypertensives, and statins may be lessened.

Respectfully yours,
Mark E. Richards, M.D.