Ask Dr Rand McClain

[Nelson Vergel]

Please help me welcome my good friend Dr Rand McClain from Santa Monica, CA. He will be answering questions for us.

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Dr. McClain earned his medical doctorate at Western University and completed his internship at the University of Southern California's Keck School of Medicine Residency Program (U.S.C. California Hospital) and has worked with some of the best and original innovators in Sports, Anti-Aging, Cosmetic and Family Medicine. Dr. McClain strives to provide those interested in optimizing health, life quality, function and performance with the very best science has to offer to these ends using the latest published research as well as knowledge gathered from the world's elite professional and amateur athletes and other men and women whose lives and professions depend on functioning and looking their very best. His philosophy is based on a commitment to producing results using concepts founded in science and proven in clinical practice. By sorting through and eliminating unsupported methods, techniques and fads, our mission is best achieved.

RESEARCH EXPERIENCE
Research Assistant, California State University, Northridge, June 2001 – August 2003 Culled literature, collected and maintained data related to synthesis of dl-hexestrol and possible ligand creation for the treatment of osteoporosis in women with estrogen-sensitive cancers.

ABSTRACTS AND PRESENTATIONS
McClain, Randolph S., Traditional Chinese Medicine in the treatment of Epilepsy. Presented at the Epilepsy Foundation Conference in November 2002. McClain, Randolph S., Exercise and nutrition in the treatment of Epilepsy. Presented at the Epilepsy Foundation Conference in November 2002.

PROFESSIONAL AFFILIATIONS

American Medical Association
American Osteopathic Association
American Society for Bariatric Physicians
American Society for Apheresis
Endocrine Society
American Academy of Family Physicians
California State Oriental Medicine Association
American Academy for the Advancement of Science
National Academy of Sports Medicine
National Sports Acupuncture Association
USA Weightlifting


To make an appointment to see Dr McClain, please visit:

http://psrmed.com/

 

[Rand McClain DO]

Please help me welcome my good friend Dr Rand McClain from Santa Monica, CA. He will be answering questions for us.

NOTE: To ensure best use of our expert's time, make sure you search the answer to your question on ExcelMale first. Failure to do so may get your question deleted by moderators. Thanks

Rules for New Folder: Ask Doctors and Experts


View attachment 4200


Dr. McClain earned his medical doctorate at Western University and completed his internship at the University of Southern California's Keck School of Medicine Residency Program (U.S.C. California Hospital) and has worked with some of the best and original innovators in Sports, Anti-Aging, Cosmetic and Family Medicine. Dr. McClain strives to provide those interested in optimizing health, life quality, function and performance with the very best science has to offer to these ends using the latest published research as well as knowledge gathered from the world's elite professional and amateur athletes and other men and women whose lives and professions depend on functioning and looking their very best. His philosophy is based on a commitment to producing results using concepts founded in science and proven in clinical practice. By sorting through and eliminating unsupported methods, techniques and fads, our mission is best achieved.

RESEARCH EXPERIENCE
Research Assistant, California State University, Northridge, June 2001 – August 2003 Culled literature, collected and maintained data related to synthesis of dl-hexestrol and possible ligand creation for the treatment of osteoporosis in women with estrogen-sensitive cancers.

ABSTRACTS AND PRESENTATIONS
McClain, Randolph S., Traditional Chinese Medicine in the treatment of Epilepsy. Presented at the Epilepsy Foundation Conference in November 2002. McClain, Randolph S., Exercise and nutrition in the treatment of Epilepsy. Presented at the Epilepsy Foundation Conference in November 2002.

PROFESSIONAL AFFILIATIONS

American Medical Association
American Osteopathic Association
American Society for Bariatric Physicians
American Society for Apheresis
Endocrine Society
American Academy of Family Physicians
California State Oriental Medicine Association
American Academy for the Advancement of Science
National Academy of Sports Medicine
National Sports Acupuncture Association
USA Weightlifting


To make an appointment to see Dr McClain, please visit:

http://psrmed.com/

Hi All,
Just want to jump in and say welcome and get started. Please shoot any questions you may have by me via the thread and I will touch base a couple times a week to do my best to answer.
Best,
Rand

 

[Nelson Vergel]

Does anyone have any questions for the guru?

 

[CoastWatcher]

Realizing you're not a urologist, but I'd be interested in how you manage the patient who, following prostate cancer treatment, wishes to resume TRT. What factors do you and his urologist consider, are there any absolute contraindications that make it a no-go for you as the prescribing doctor, and what changes in monitoring the patient do you (and the urologist) institute? Three patients in my doctor's practice, I am told, are in this situation and somewhere in the back of the minds of many of us the question lurks.

 

[stephanfresco]

hi dr rand
i am on trt 160 TESTOTERONE ENANTHATE TWICE A WEEK...
i have tried many kind of arimidex protocol and when i do 0.5 ADEX TWICE A WEEK my e2 crash and feel bad...even at 0.25 TWICE A WEEK MY E2 CRASH ...if i dont use arimidex ,my e2 is around 45 ,i feel lethargic;libido down sometime high but ed...i m good at around 20 E2....
can you help me on this situation?
on this protocol my total testoterone is around 900 ...free test high...bioavailable test high aswell...
shbg around 20.
MAYBE i should take testoterone once a week with one a week ai???
its very hard to manage it,when its low i feel really weak....and high weak aswelll....

thank you dr rand, wish i ll come to your office in the future....
thank you very much

 

[HanginOn]

In your videos a year or two ago, you have supplements in your office behind you and your desk that I presume are your daily essentials. What are your daily essentials as far as Vitamins go for health and longevity for the TRT male. Truly doesn't matter if there's 5 or 25 essentials...I'd like to hear all of yours.

I've also heard you talk about the importance of Magnesium Glycinate and how you try to consume 2grams of it with a meal. I am thinking this must be in liquid form since most tablets are 100mg and that would take you swallowing 20. What is the product you use to get your 2 grams daily?

E2 is said to be best at 15-21 in many of your videos...what is the highest you are OK with seeing it in patients?

Is there a way to get into the life extension/anti aging field without going to medical school?

What do you think about things like stem cells and gene editing tools like Crispr?

 

[Rand McClain DO]

We, the medical community, are gaining more information regarding prostate cancer and testosterone use geometrically rapidly since Dr. Morgenthaler pointed out the flaws in the study that was the basis for which 70 years of dogma re testosterone causing prostate cancer was made.
We now have evidence that low testosterone is correlated with prostate cancer and that some estrogens activate the genes (which all men carry) for prostate cancer.
Recently, a small study (n=15) showed that cyclic use of testosterone can reverse or cure prostate cancer.
I’ll share that I was diagnosed with prostate cancer over two years ago and have been cancer free for two years after treatment using green tea extract with capsaicin (“Capsol-T”), Metformin, dutasteride and testosterone along with other forms of nutritional, supplemental and lifestyle support.
Standard of care still uses chemical castration, estrogen, radiation and prostatectomy as first line treatments with variable results and many side effects - many permanent. And, standard of care still uses PSA to screen for prostate cancer despite the proven lack of efficacy and the inventor of the test asking it no longer be used for screening because of the consistent false positives and negatives and frequent unwarranted biopsies that have plenty of unwanted consequences as well.
A PSA can be used, however, to screen for possible undetected metastases of prostate cancer in cases where the prostate and all prostate cancer has been presumed to be removed.
I have patients with successfully treated prostate cancer using TRT and none have had recurrence of prostate cancer. I suggest to any patient concerned about cancer to submit to an ONCOblot assay which evaluates for the presence of ENOX-2 proteins (found only in cancer or fetal tissue) and by weight and pH can determine tissue type for at least 26 cancers. Early detection is key and if used properly (ie frequently enough) the ONCOblot test should be used with available treatments to treat successfully most cancers.
So, if concern exists about extant prostate cancer present after treatment, PSA, ONCOblot, and/or MRI (can detect lesions as small as 3mm) can be used to rule it in or out. DHT has definitely been shown to fuel prostate cancer so I recommend use of a 5-alpha reductase inhibitor if prostate tissue is still present. As previously stated, certain estrogens also activate the genes for prostate cancer which is why I recommend using an aromatase inhibitor to keep estrogens as low as possible while still keeping enough requisite for heart, brain and joint health. The use of DIM or consumption of ample cruciferous vegetables can help prevent conversion of necessary/beneficial estrogens to harmful estrogens.
I hope this allays any concerns you and others may have about resuming TRT after successful treatment (or as yet unsuccessful treatment) of prostate cancer.

 

[Rand McClain DO]

I believe the issue is simply a matter of dosing your T versus your anastrozole appropriately so that your E2 stays in the range that works for you.
Most of my patients inject weekly with satisfactory results (and 100% fewer injections). I would consider trying this simply because you have already pared your anastrozole dose down to 0.25 mg so practically it may be too difficult to precisely dose 0.125 mg.
To be clear though, if you are using 160 mg twice per week (as opposed to 80 mg twice per week as I would assume given standard dosing and your T assays) then I would continue to do so (as opposed to 320 mg once per week). In the case of 160 mg twice per week, I would consider compounding the smaller doses of anastrozole that you appear to require.

 

[Rand McClain DO]

In addition, the timing of your dose of anastrozole is important. You might want to try varying the timing of dosing, eg: instead of taking your anastrozole when you inject your T, wait 12 or 24 hours before taking your anastrozole.

 

[Rand McClain DO]

My supplements change depending upon my goals, time of year, activities, stress levels and other variables. I can say that in my experience, everyone needs supplemental B vitamins and vitamin D3. Remember the Kreb (Citric Acid) Cycle? Need B vitamins, magnesium, zinc and coenzyme Q10 to convert food into usable energy. No one gets enough vitamin (actually steroid hormone) D3 anymore even if they work mostly outdoors. Vitamin D3 is manufactured by the body via liver and kidneys and exposure of skin to sun. No one should get all their vitamin D3 from the sun these days anyway since malignant melanoma is a very real threat now that life expectancy is no longer 28 years as it was just 300 years ago.
Regarding magnesium intake, I see magnesium, RBC assays that are frequently on the very low side of “normal” (“normal” typically being nowhere near optimum). Magnesium helps relax the smooth muscles of the vasculature and tends to help patients relax in general while improving blood flow to muscles. Again, magnesium is also needed for the Kreb Cycle.
Magnesium glycinate is well absorbed and I use Designs For Health brand which come in 300 mg capsules. I recommend taking as much as you can tolerate without suffering from any excessive laxative effects (remember that poorly absorbed magnesium like magnesium oxide, hydroxide or sulfite is used for laxative effects).
Regarding E2 levels, some men do better with higher E2, especially if sensitive to E2. Over suppressed E2 can lead to genital insensitivity, joint pain, low libido and erectile dysfunction and excess E2 can lead to water and fat retention, moodiness and irascibility, erectile dysfunction and libido issues.
Some of my strength athletes do better with E2 closer to 30-35 pg/mL stating they feel stronger and have fewer joint and tendon issues.
These days, so much information is available that if you aren’t lazy, you can learn anything. The trick is discerning between good information and bad. That typically takes some formal education and/or experience but I suppose is not necessarily required.
Stem cells and CRISPR technology are two of the most exciting edges of medicine today. Between the two, we should be able to eventually cure many diseases, reverse most degeneration, and heal much traumatic injury. Quality of life improvement as well as life extension will both be one day as ubiquitous as antibiotics are for bacterial infections. I have seen incredible results with stem cells with finger tips being regrown, symptoms of MS reversed and bucket handle meniscus tears completely healed. Beware the “centers” that offer a few million cells for ridiculous prices. Know the type of cell and source being offered and find doctors who haven’t just jumped on the stem cell bandwagon is my advice.

 

[stephanfresco]

HI DR RAND ...
thank you very much for your answer, i m using 160 MG/WEEK so 80 mg twice a week.....
stephan

 

[CoastWatcher]

We, the medical community, are gaining more information regarding prostate cancer and testosterone use geometrically rapidly since Dr. Morgenthaler pointed out the flaws in the study that was the basis for which 70 years of dogma re testosterone causing prostate cancer was made.
We now have evidence that low testosterone is correlated with prostate cancer and that some estrogens activate the genes (which all men carry) for prostate cancer.
Recently, a small study (n=15) showed that cyclic use of testosterone can reverse or cure prostate cancer.
I'll share that I was diagnosed with prostate cancer over two years ago and have been cancer free for two years after treatment using green tea extract with capsaicin (“Capsol-T”), Metformin, dutasteride and testosterone along with other forms of nutritional, supplemental and lifestyle support.
Standard of care still uses chemical castration, estrogen, radiation and prostatectomy as first line treatments with variable results and many side effects - many permanent. And, standard of care still uses PSA to screen for prostate cancer despite the proven lack of efficacy and the inventor of the test asking it no longer be used for screening because of the consistent false positives and negatives and frequent unwarranted biopsies that have plenty of unwanted consequences as well.
A PSA can be used, however, to screen for possible undetected metastases of prostate cancer in cases where the prostate and all prostate cancer has been presumed to be removed.
I have patients with successfully treated prostate cancer using TRT and none have had recurrence of prostate cancer. I suggest to any patient concerned about cancer to submit to an ONCOblot assay which evaluates for the presence of ENOX-2 proteins (found only in cancer or fetal tissue) and by weight and pH can determine tissue type for at least 26 cancers. Early detection is key and if used properly (ie frequently enough) the ONCOblot test should be used with available treatments to treat successfully most cancers.
So, if concern exists about extant prostate cancer present after treatment, PSA, ONCOblot, and/or MRI (can detect lesions as small as 3mm) can be used to rule it in or out. DHT has definitely been shown to fuel prostate cancer so I recommend use of a 5-alpha reductase inhibitor if prostate tissue is still present. As previously stated, certain estrogens also activate the genes for prostate cancer which is why I recommend using an aromatase inhibitor to keep estrogens as low as possible while still keeping enough requisite for heart, brain and joint health. The use of DIM or consumption of ample cruciferous vegetables can help prevent conversion of necessary/beneficial estrogens to harmful estrogens.
I hope this allays any concerns you and others may have about resuming TRT after successful treatment (or as yet unsuccessful treatment) of prostate cancer.

Many thanks for your thoughtful and detailed answer.

 

[HanginOn]

My supplements change depending upon my goals, time of year, activities, stress levels and other variables. I can say that in my experience, everyone needs supplemental B vitamins and vitamin D3. Remember the Kreb (Citric Acid) Cycle? Need B vitamins, magnesium, zinc and coenzyme Q10 to convert food into usable energy. No one gets enough vitamin (actually steroid hormone) D3 anymore even if they work mostly outdoors. Vitamin D3 is manufactured by the body via liver and kidneys and exposure of skin to sun. No one should get all their vitamin D3 from the sun these days anyway since malignant melanoma is a very real threat now that life expectancy is no longer 28 years as it was just 300 years ago.
Regarding magnesium intake, I see magnesium, RBC assays that are frequently on the very low side of “normal” (“normal” typically being nowhere near optimum). Magnesium helps relax the smooth muscles of the vasculature and tends to help patients relax in general while improving blood flow to muscles. Again, magnesium is also needed for the Kreb Cycle.
Magnesium glycinate is well absorbed and I use Designs For Health brand which come in 300 mg capsules. I recommend taking as much as you can tolerate without suffering from any excessive laxative effects (remember that poorly absorbed magnesium like magnesium oxide, hydroxide or sulfite is used for laxative effects).
Regarding E2 levels, some men do better with higher E2, especially if sensitive to E2. Over suppressed E2 can lead to genital insensitivity, joint pain, low libido and erectile dysfunction and excess E2 can lead to water and fat retention, moodiness and irascibility, erectile dysfunction and libido issues.
Some of my strength athletes do better with E2 closer to 30-35 pg/mL stating they feel stronger and have fewer joint and tendon issues.
These days, so much information is available that if you aren't lazy, you can learn anything. The trick is discerning between good information and bad. That typically takes some formal education and/or experience but I suppose is not necessarily required.
Stem cells and CRISPR technology are two of the most exciting edges of medicine today. Between the two, we should be able to eventually cure many diseases, reverse most degeneration, and heal much traumatic injury. Quality of life improvement as well as life extension will both be one day as ubiquitous as antibiotics are for bacterial infections. I have seen incredible results with stem cells with finger tips being regrown, symptoms of MS reversed and bucket handle meniscus tears completely healed. Beware the “centers” that offer a few million cells for ridiculous prices. Know the type of cell and source being offered and find doctors who haven't just jumped on the stem cell bandwagon is my advice.

Great answer Dr. McClain! I was wondering if you were going to mention some things like Curcumin, Vitamin K, Citrus Bergamot, ALA, DIM....or even baby aspirin. Your basics are fantastic though and provide some real insight. That being said, what do you find are some others that you consistently cycle throughout the year without fail?
Im currently trying to get my Vitamind D levels to somewhere between 70-80 and it might take 15,000iu..we'll see.

Designs for health brand no longer makes a Magnesium Glycinate....figures. I'm not sure if I will go with the glycinate chelate(150mg capsules) or look elsewhere. The important thing is to find it as high dosed as possible and in capsule form as I do not trust tablets as a general rule.

I have considered visiting and consulting with you 3 or 4 times in the last two years. I am an east coast guy that comes to LA semi-often. I need to make sure to do so.


Are there any sure fire ways you have found in boosting free testosterone in your TRT clients?

Thanks and hope you had a Happy Thanksgiving Doc!

 

[HanginOn]

Happy Birthday Rand!

 

[Vince Carter]

Dr McClain, have you any thoughts in the area for low SHBG guys and Free Estrogens, perhaps the Free Estrogen test being more important or at least used in conjunction with the Estradiol (ultra) Sensitive LC/MS/MS tests? Also the need perhaps for low SHBG guys to be closer to 20 on the LC/MS/MS test for the higher amount of Free Estrogen we may be carrying?

 

[Nelson Vergel]

Happy Birthday, Dr McClain !

 

[Brian7624]

I'm really glad you got the Doc to come on here. I feel very fortunate to have him as my doctor, he is a wealth of knowledge and speaks very highly of you as well Nelson. Welcome Dr. Rand!

 

[Bullt15]

Hello Doctor, I live in Canada so not able to drop in and see you. Do you or are you able to recommend a clinic or doctor that works in the TRT field in Canada, preferably in Edmonton, Alberta?

 

[Marco N Cognito]

3 questions for Dr. McClain:

1) Have you seen any thyroid suppression with the use of carnitine supplementation for those who are hypothyroid and on thyroid replacement (L-carnitine has been shown in many studies to suppress both T3 and T4 at the cellular level)? If so, do you think taking the thyroid meds hours apart from the carnitine would be an adequate workaround to allow the benefits of carnitine without the thyroid suppression?

2) There is much anecdotal use of the research peptides BPC-157 and TB500 for musculoskeletal issues. Although these compounds are outside the scope of what a physician can prescribe, what's your opinion, if any, on these compounds and what has been your observation with patients using them?

3) I am 57, not on TRT, and produce a total T between the mid 400s-mid 600s, while free T is on the low end of normal, depending on time of draw. Libido seems ok. Have increased joint pain and inflammation lately, but don't know if that's related to T levels. If I did wish to further optimize my levels, would you recommend I try a SERM like clomiphene before 'throwing in the towel' and going with TRT as I would prefer to preserve what endogenous T I have left?

 

[Rand McClain DO]

Hi "Built15", I do not know of any docs in Canada, but, you could certainly make use of docs here in the US via telemedicine. We have some doctors here in the US that have alot of experience with TRT: Dr. Saya, Dr. Lawson, Dr. Crisler and others, all of whom, to my knowledge, welcome consultations via telephone or Skype. Of course, I am happy to help as well.