A Letter from Michael Scally: Michael C. Scally, M.D. vs. Texas State Board of Medical Examiners
I am a physician in private practice with a patient base that draws from states far and away from my Houston, Texas office. As an amateur athlete I have competed only once, at the insistence of my trainer, in 1994 at the age of 44. I placed 2nd in the Mr. Texas Competition which was held at San Antonio that year. I have developed a practice which is primarily devoted to the medical care of the individual utilizing anabolic-androgenic steroids (AAS). The spectrum of the patients is as complete as one could imagine – multiple sclerosis, cancer, elderly, AIDS, hypogonadal (primary and secondary) – and the focus has remained the same – ensure the health of each individual pre-, intra-, and post- AAS use. I am confident when I say that I probably have equal to or greater experience than anyone I have read, met, or by any other means imaginable. The particular area of interest that holds my attention is the clinical tools to return an individual to normal physiology after AAS use. This has led me to an in-depth knowledge of androgens both in regards to their positive potential whilst being aware and disciplined to their negative aftermath. The most significant being the total and complete shutdown of the hypothalamic-pituitary-testicular-axis (HPTA). In over 100 cases of initial presentation where the patient’s diagnosis was hypogonadism or hypogonadotrophic hypogonadism I have been successful in returning the individual to normal physiology. Subsequently, the patient may be monitored and supervised in a program aimed at optimizing their health attaining while avoiding and minimizing side effects. I am neither a loose cannon nor a pill mill. Any patient of mine will attest to the tight controls and monitoring that accompany my programs.
Hypogonadism After Androgen Cessation
Peer-reviewed published articles describing significant body composition changes with the use of androgens are numerous and have formed a basis for their use most predominately amongst HIV+ males. A rudimentary knowledge of endocrine physiology teaches that exogenous androgens cause a shutdown of the normal feedback system. The reproductive system, HPTA, does not immediately return to normal after androgen cessation. Indeed, in those studies, very few, where this has been studied it is in the use of testosterone for birth control measures and not with supraphysiologic doses use to effect body composition changes. Of even greater importance is that absolute lack, none, of HPTA normalization studies after androgen analogues. It has been incredulous that scientific literature that imposes a change upon a steady state A to an UNsteady-state B is not taken to task for its failure to account for the return to the original steady-state A. The period of hypogonadism after androgen cessation, unknown, may bring about more harm than good. This is precisely and exactly what brought about my entry into this field.
During the last 5 years, the treatment of andropause, sarcopenia and hypogonadism has grown significantly. The amount of attention paid to this problem by the media, pharmaceutical industry, and healthcare sector is a marker for the importance and relevance in one’s life.
However, what is little told or not reported is that the very treatment, androgen, advocated and recommended may be the cause for this problem in countless individuals. For this reason and this reason, alone it would seem to be imperative upon the medical establishment to investigate the role of androgens in producing hypogonadism. Additionally, whether there are medical protocols that would correct the hypogonadism rather than androgens which potentially may exacerbate or possible worsen the condition.
I am a proponent of androgen treatment when the considerations are given to the above points. During the last 5+ years, I have set about treating individuals with hypogonadism from androgen use with a medical protocol that has proven highly successful. This has been true whether the individual has used androgens from illicit or prescription, i.e., physician, source. This has been of an increasingly greater importance in HIV+ males treated with androgens to effect body composition changes. One can easily see the vicious cycle initiated once androgen treatment has begun. I have recently treated individuals with problematic secondary polycythemia and lipid changes due to continued uninterrupted androgen use. The treating physician was unable to stop androgen administration due to the severity of hypogonadism signs and symptoms upon androgen cessation.
Medical Treatment of Hypogonadism After Androgen Cessation
As a natural corollary to the above, this office set out to put in place programs that would effect body composition changes and improve upon one’s health without the sequelae of hypogonadism after androgen cessation. This, also, has been successfully done. I have presented my work at various conferences over the past years as well as submitted the work for publication. Copies are available upon request.
- Scally, MC et al. Uncontrolled Case Study of Medical Treatment for Elimination of Hypogonadism After Androgen Cessation in an HIV+ Male with Secondary Polycythemia treated 2 years Continuously with Testosterone. American Association of Clinical Endocrinologists (AACE) – 12th Annual Meeting & Clinical Congress, May 2003.
- Vergel N, Hodge A, Scally MC. HPGA Normalization Protocol After Androgen Treatment 4th (2002) International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, Abstract 81
- Scally MC, Street C, Hodge A. Androgen Induced Hypogonadotropic Hypogonadism: Treatment Protocol Involving Combined Drug Therapy. The Endocrine Society 2001 Abstract.
- Street C, Scally MC. Pharmaceutical Intervention of Anabolic Steroid Induced Hypogonadism – Our Success at Restoration of the HPG Axis. Medicine and Science in Sports and Exercise 2000 Suppl; 32(5).
This work and effort on my part has recently gained support by the following publication:
- Fertil Steril 2003 Jan;79(1):203-5. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Tan RS, Vasudevan D.
Failure of the Medical Community
The medical treatment of hypogonadism, particularly after androgens, is far from being accepted and this is very unfortunate. If one just considers the AIDS patient the potential and real harm to this group is great. It is beyond comprehension that the medical establishment will recognize the adverse effects of hypogonadism but does not take an investigation into how to eliminate, shorten, or minimize this period seriously. If I am shot down or shut down the one and only person in the country who is investigating this will be gone. And no doubt others will be scared from further investigations.
Medical Travesty and the Texas State Board of Medical Examiners
I knew that at sometime in the future after I began my practice that I would be challenged for my viewpoints and medical judgment. The time is fast approaching as I have come under fire from the Texas State Board of Medical Examiners over the past few years.
The TSBME has scheduled a hearing for September or October to revoke my medical license. Unfortunately although not surprisingly, my concern for the problem of hypogonadism has been at the greatest professional risk. I will need to justify my prescribing practice or I soon will be without my professional medical license. Headstrong and stubborn I wish to either vindicate myself or be proven wrong.
Mauro DiPasquale, M.D. has signed on as my medical expert. As I prepare my treatise on this subject for both the defense of myself, my patients, I need further assistance in the form of personal experience and testimony. It is important to make contact with individuals to be lay witnesses to testify to the problem of hypogonadism after androgen cessation. This would include being treated with androgen for hypogonadism after androgen cessation by a physician. Emails, letters, etc., from affected or possibly affected individuals to either myself or my attorney would be greatly appreciated. I will compensate for one’s time and effort.
If I can defeat this action it will be a momentous step for everyone involved in the use of androgens!
Assistance is appreciated and needed, ASAP.
Michael C. Scally, M.D.