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James Ray and testosterone replacement therapy (TRT)

For the last four years I have served in a volunteer capacity among a panel of pharmacotherapy experts queried regularly by the ABC News Medical Unit about breaking or upcoming news involving the efficacy and safety of drugs and supplements. Where appropriate, I provide background information that informs the story.

My incentive is largely to put my time where my mouth is when I say that scientists need to take a more active role in making sure medical stories are reported accurately. An additional dividend is paid to my students who then benefit from my presentation of the science behind timely medical developments.

On occasion, perhaps once or twice a year, I’ll be asked for an on-camera interview. Even when this occurs, the resulting story will contain no more than 15 seconds of the interview and some summary by the reporter of other issues we discussed. I take this responsibility very seriously and prepare as much as I can given the deadlines of the press and my daily education and research schedule.

But given airtime constraints, much of what I prepare would normally end up in the abyss of my files and come out in the classroom when I lecture about that particular topic. Blogging, however, now allows us to expand further on stories where we are consulted, giving us an opportunity to air, albeit to a smaller audience, the information we found important from our perspective. Authoring a blog, therefore, takes away the excuse some scientists and physicians have in not wanting to talk to the press: “There’s never enough airtime to tell the whole story the way I would tell it.”

This post was informed by one of those brief appearances, this time on ABC World News Sunday with Dan Harris. The interview was solicited last weekend following the release of information obtained during the execution of a search warrant in lodging occupied by the self-help guru, James Arthur Ray, who led an Arizona sweat lodge ceremony last October where three people ultimately died and almost two dozen were hospitalized. The segment was not archived to the World News website but some ABC affiliates subsequently aired truncated versions of the story.
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On October 8, 2009, paramedics responded to a 911 call at a mystical retreat being held at Angel Valley Spiritual Retreat Center in West Sedona, Arizona, a stunningly beautiful area known widely as a mecca for New Age enthusiasts. Eyewitness accounts compiled in this October 21 New York Times article describes what medics encountered upon arriving at a 415-square-foot “sweat lodge” on the center’s grounds:

Midway through a two-hour sweat lodge ceremony intended to be a rebirthing experience, participants say, some people began to fall desperately ill from the heat, even as their leader, James Arthur Ray, a nationally known New Age guru, urged them to press on.

“There were people throwing up everywhere,” said Dr. Beverley Bunn, 43, an orthodontist from Texas, who said she struggled to remain conscious in the sweat lodge, a makeshift structure covered with blankets and plastic and heated with fiery rocks.

Dr. Bunn said Mr. Ray told the more than 50 people jammed into the small structure — people who had just completed a 36-hour “vision quest” in which they fasted alone in the desert — that vomiting “was good for you, that you are purging what your body doesn’t want, what it doesn’t need.” But by the end of the ordeal on Oct. 8, emergency crews had taken 21 people to hospitals. Three have since died.

Participants paid $9,695 each to attend a “Spiritual Warrior” retreat led by Mr. Ray, an event whose next offering continues to be advertised on the website for James Ray International, Inc.

Yes, the 2010 event is still scheduled for September 18-23, 2010 and registration remains open.

But I wouldn’t put up my ten grand just yet because an investigation of Mr. Ray is ongoing and the Yavapati County Sheriff’s Office has recently released the affidavit from a search warrant executed shortly after this tragedy.

This December 30 New York Times article displays the 33-page search affidavit and this January 3 Prescott News article has several photographs and an excellent distillation of the affidavit.

Many other news sources will provide you with details on the circumstances of the tragedy with eyewitness reports and you can read elsewhere of Mr. Ray’s appearances on The Oprah Winfrey Show associated with the book, The Secret by Rhonda Byrne.

But here we would like to discuss some of the pharmacology associated with the Sedona tragedy. Lynne LaMaster in the Prescott News notes that according to the search warrant documents, investigators were originally looking for:

“A saleable/useable quantity of unlawful drugs including but not limited to marijuana, methamphetamine and peyote, paraphernalia for packaging, manicuring, weighing, distributing, including but not limited to scales, baggies, grinders, bindles, envelopes, seals paraphernalia used to administer the drug, i.e., syringes, cotton swabs, alcohol swabs, spoons, razor blades, tubes.”

While investigators did not appear to find any overtly psychoactive substances, they did find a veritable cornucopia of prescription drugs, dietary supplements, and syringes, with prescriptions in the name of Mr. Ray. But it wasn’t the supplements that caught my eye. It was this letter from a Michigan doctor of osteopathy:

James Ray Crisler Rx letter from Prescott News.jpg

Dr. Crisler operates the website, allthingsmale.com, and offers in-clinic and online consultations. The frontpage of his site argues strongly that he is in the business of anti-aging therapies as shown lecturing to the American Academy of Anti-Aging Medicine and offering subscriptions to Life Extension Magazine. Further exploration of his website reveals that he specializes further in assessment of low testosterone levels, or hypogonadism.

Testosterone cypionate, hGH, hCG, Arimidex (anastrozole) and finasteride (sold previously as Propecia or Proscar, but now available generically). OK, that’s starting to make sense. Testosterone and human growth hormone (hGH) are anabolic agents. That is, they enhance the development of lean, skeletal muscle mass. But you might have some questions at first glance.

(For pharmacology students and professors, dissecting the endocrine pharmacology of this combination would make a great comprehensive qualifying examination question for graduate candidacy.)

Arimidex/anastrozole? Isn’t that used to treat estrogen-dependent breast cancer?

Finasteride? Isn’t that used to treat prostate cancer?

Let’s take a closer look at some of these drugs.

Testosterone cypionate is known as a “depot” form of testosterone that has a half-life of 5-8 days, sold as DEPO®-Testosterone in the US. Testosterone, the steroid hormone primarily responsible for secondary sex characteristics in men, is not active when taken orally because it is rapidly metabolized by the liver. Therefore, if one wishes to boost testosterone, it is commonly formulated into a gel or patch that slowly releases the hormone across the skin. But it is more effectively delivered by injection, usually into muscle. When combined with a fat-soluble compound like cypionic acid, the testosterone is slowly released from the injection site. According to a PowerPoint presentation available at Dr. Crisler’s website (here, 4.5MB), his regimen employs weekly injections of 100 mg testosterone cypionate, about double the manufacturer’s recommendation for treating clinical hypogonadism.

When I was interviewed by Dan Harris for ABC World News Sunday last weekend, we discussed in footage that did not appear whether testosterone qualified as an “anabolic steroid.” The public normally thinks of ultrapotent, clandestine compounds as being the anabolic steroids used by athletes. But in purely pharmacological terms, testosterone is a steroid based on its chemical structure and it has anabolic, or tissue-building, activity. However, testosterone is an anabolic steroid that we make naturally, men and women.

Hence, testosterone is an endogenous anabolic steroid. When injected as testosterone cypionate, this would be called the exogenous supplementation of an endogenous steroid. But true bodybuilders wouldn’t bother with something like testosterone when more potent and effective synthetic anabolic steroids are available on the clandestine market.

Arimidex (anastrozole) is classified as an “aromatase inhibitor.” You may not know that testosterone is the starting material for estradiol, the steroid hormone primarily responsible for secondary sex characteristics in women. Testosterone, which we all make from cholesterol as the starting material, is converted to estrogen by aromatase or CYP19, an enzyme that is highly abundant in the ovaries. When a woman is diagnosed with a form of breast cancer that required estrogen to grow, aromatase inhibitors are given to prevent the ovaries from making more estrogen from testosterone (Older drugs such as tamoxifen can also be given as they directly block the effects of estrogen on breast cancer cells themselves.)

We do not know if Mr. Ray was among the approximately 1% of breast cancers that occur in men. Former drummer of the rock band KISS, Peter Criss, is the most recently public of male breast cancer patients in the US.

However, it does not appear that Dr. Crisler is a board-certified oncologist, so there must be some other reason that he prescribed Arimidex to Mr. Ray. Men have some testosterone that gets converted to estrogen but usually it’s not enough to cause estrogenic side effects such as gynecomastia and testicular shrinkage. But when taking supplemental, supraphysiological doses of testosterone, the small amount of aromatase that men have will convert enough of it to estradiol such that they may experience some feminizing effects.

Interestingly, Dr. Crisler notes on slide #66 of his aforementioned PowerPoint presentation that anastrozole’s #1 use worldwide is in testosterone replacement therapy regimens. Unfortunately, a citation is not available to support that statement.

Finasteride prevents conversion by 5-alpha-reductase of testosterone to dihydrotestosterone or DHT, a form of the hormone that can cause benign prostatic hypertrophy, can promote prostate cancer, and is also partly responsible for hair loss. Hence, finasteride combats several side effects of testosterone supplementation. So, these testosterone injections can be combined with anastrozole and finasteride to maximize testosterone’s anabolic effect while minimizing “unsightly” side effects.

Human growth hormone (hGH) is a peptide normally produced in the pituitary gland that is also anabolic on its own and augments the muscle-building effects of testosterone.

Human chorionic gonadotropin or hCG is normally the hormone produced by the placenta during pregnancy and is the hormone detected in the urine by home and clinical pregnancy tests. Yes, men taking this hormone would give a positive pregnancy test.

Understanding why hCG might be given in this cocktail requires that we revisit the hypothalamic-pituitary-gonadal axis (HPGA). Gonadotropin-releasing hormone, or GnRH, is produced in the hypothalamus of the brain and signals that pituitary gland to synthesize and release several peptide hormones that each share a common subunit: LH, FSH, TSH, and hCG. LH, or luteinizing hormone, when released from the pituitary gland and causes the testes to create mature spermatozoa and release testosterone. However, when too much testosterone is produced, or too much is available from external injection, a negative feedback loop suppresses LH secretion. Suppression of LH over time will cause testicular atrophy. It is thought that providing hCG will provide more of the subunit shared with LH, restoring LH levels. I am not convinced that this actually occurs. Restoring LH also is purported to increase the conversion of cholesterol to pregnenolone, a precursor or building block of testosterone. Believe it or not, this is an oversimplification of the pathway but I hope that gives you an idea of the rationale behind hCG use.

There were also some other drugs found in Ray’s room at the lodge prescribed by other physicians that included Diovan (valsartan), an antihypertensive of that competitively binds receptors for an endogenous vasocontrictor, angiotensin II, and an injectable relative of vitamin B12 called methylcobalamin. Although we don’t know for certain if Ray was taking the drugs prescribed by Dr. Crisler, investigators did at least find anastrozole and Genotropin brand of hGH, Propecia brand of finasteride, together with pregnenolone, the testosterone precursor. Also found were bags, suitcases, and pill boxes of energy supplements and amino acids. The complete litany of objects confiscated from his possession are detailed at the Prescott News website.

As mentioned at the outset, one of the biggest reasons investigators were interested in any drugs that might have been in Ray’s possession was that there may have been psychoactive substances that could have impaired his judgment or that of followers/clients in the sweat lodge at the retreat. Ray was reported by several eyewitnesses as being aggressive and aloof, and even unhelpful when medics arrived at the sweat lodge. Dan Harris at ABC News asked me if I thought that Ray’s pharmacopeia might have contributed to his state of mind.

This is very difficult to do for a plethora of reasons, not the least of which because I am not a physician nor am I privy to what drugs he was actually taking or his basal personality characteristics. However, I am a pharmacologist and did train in endocrinology during my postdoctoral fellowship and can make some general comments.

A person taking an anabolic steroid regimen (recall that testosterone is a natural anabolic steroid) is prone to mood swings, anxiety, and aggressive behavior. In “TRT: A Recipe For Success,” a Word document available at All Things Male, Dr. Crisler apparently makes note that the intent is not to create an anabolic steroid cycle but rather testosterone replacement therapy, where testosterone levels are targeted to the upper-level of a normal range. Unfortunately, we cannot be sure if Mr. Ray was taking the drugs as directed or at doses greater than those recommended.

A physician colleague also reminded me that some of the drugs on the search warrant could alone cause electrolyte disturbances that could be exacerbated by being in an enclosed area with hot stones where other people were vomiting and begging to get out after fasting for 36 hours. Specifically, testosterone can cause sodium retention and Diovan/valsartan can cause potassium retention. These ionic imbalances can certainly influence one’s state of mind and one can speculate that these imbalances would be made worse by fasting and dehydration.

Off-label drug prescribing
This case also raises some questions as to how these drugs were prescribed in the first place. Sources close to Ray told ABC News that the “practical mystic” was being treated for a hormonal imbalance.

It is peculiar why a man of Ray’s means living in Carlsbad, CA, would be prescribed drugs by a physician in Michigan rather than seeing a board-certified endocrinologist or urologist at one of the outstanding medical centers in southern California.

Nevertheless, there are no laws that would have prevented Dr. Crisler from prescribing this regimen to Mr. Ray. To the contrary, physicians in the United States, whether they are MDs or DOs, are granted the latitude to prescribe any FDA-approved medicine for any indication they see fit. While it is illegal for drug companies themselves to promote “off-label” uses of drugs (i.e., indications for which the company has not received explicit FDA approval), a physician can legally prescribe a breast cancer drug to a man wishing to build lean muscle mass. I will leave it to my physician colleagues to comment on whether this falls under the standards of medical practice. In fact, the ethics of off-label prescribing would be an excellent separate issue to discuss in another post.

But let us not forget that this is a very sad case where three people lost their lives and nearly two dozen people were hospitalized. Press accounts of the sweat lodge incident and subsequent investigation suggest that blame and potential criminal penalties will fall where they may. The Camp Verde Journal noted in its 2009 roundup that:

Lawsuits have been filed by survivors, victims’ families and the Black Hills Sioux Nation, alleging Ray “committed fraud by impersonating an Indian,” thus violating the 1868 Treaty of Fort Laramie.

What we have offered here is a perspective on the pharmacology and toxicology of prescription hormone products and considerations of issues raised in publicly available documents and questions posed of us by the press. It is likely that several factors conspired to end up with this loss of life. As always, tragic events are what drive changes in laws and regulations.

Posted in: Pharmaceuticals, Science and the Media

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18 thoughts on “James Ray and testosterone replacement therapy (TRT)

  1. windriven says:

    If one of the SBM bloggers is a psychiatrist it would be interesting to explore the psychology of those who, after 36 hours of fasting, vomiting and struggling to maintain consciousness didn’t simply decide ‘enough is enough’ and leave. Mr. Ray seems to be a messianic sort and there may well have been considerable pressure from him and from peers to persevere. We all like to test ourselves but, in the immortal words of Harry Callahan, “a man’s got to know his limitations.”

    More to the point, is there a common thread of character that those susceptible to woo exhibit that involves an unusual willingness to replace judgment with credulity? If so, is this related to other mass frenzy phenomena? Is this different in kind or only in degree from the Jim Jones disaster several decades ago?

  2. I realized I have become a regular reader of your blog when I read your post here and realized I’d already read it on your blog a couple days ago. You can thank Gorski for the new reader.

  3. …that is I read the first few paragraphs of this post and realized I’d already read it.

  4. daedalus2u says:

    I think there is very little understanding of the psychology of extreme physiological states such as these people were experiencing. These states are far too dangerous to put people into, there is real risk of serious injury and even death (there may always be actual permanent injury even if death does not occur). People can push themselves to the point of physical injury and even death. I have used the example before, but the ability to run yourself to death while running from a bear is a feature that can save your life if the bear gets tired before you drop dead from exhaustion. These states are highly non-linear, so slightly different degrees of different kinds of stress may cause completely different outcomes.

    Under these conditions, your body hides your physical state from you by inducing the delusion that everything is ok, that you feel no pain, and that you can run forever. You can’t run forever, just until you drop dead from exhaustion, but when a bear is chasing you, those are equivalent.

    My own hypothesis is that extreme physiological states induce a number of characteristic psychological states, depending on the source of the extreme physiological state. I have written about what I think happens in the postpartum period when women don’t have enough liver metabolic capacity to support lactation, I think it causes postpartum psychosis. I think the “runner’s high” is another example. During hand-to-hand combat I think it causes the state of “going berserk”. Stockholm Syndrome might be another. I think the dissociation of trauma, the “life passing before you”, “out of body” experiences, “seeing the light” might be different aspects of this too, with completely physiological explanations.

    I completely agree with the sentiments of Harry Callahan, “a man’s got to know his limitations.” The only way you find out what those limitations are is by coming close to them, and in some cases finding out you have exceeded them by failing.

    I suspect that the traditional Native American sweat lodge practices may have been a mechanism for people to learn what their limits are, so as to have some experience with the near death physiological state under (somewhat) controlled conditions so as to be better able to survive it if it happened under other circumstances, i.e. if a real bear really did chase you. These states are all very complex and like all complex things get easier to do if one has experienced them before. I think the care with which the traditional practices were done reflects how dangerous they actually are. I think what James Ray did reflects his ignorance of the actual practices of Native Americans and his ignorance of physiology, and his recklessness in proceeding anyway without proper safeguards.

    I think the traditional Native American practices were somewhat safer because the participants (most likely) had their normal ammonia oxidizing bacteria biofilm. With copious sweating, that biofilm would have produced a high NO/NOx level which drives the ATP level in cells high. I suspect that provides greater protection from protein denaturing because the heat shock proteins have higher ATP levels to work with. The NO/NOx also shuts down mitochondria and blocks heme enzymes from making superoxide. This protects from free radical injury, but only if there is sufficient blood glucose for the body to maintain ATP production by glycolysis. If there isn’t, then the mitochondria will turn on and generate superoxide. Depleting liver and muscle glycogen stores before such an episode would make it even more dangerous. The liver might not have time to go into ketosis. If this is what happened, you might see ectopic fat in the liver.

    That James Ray might have been in an altered mental state (to me) doesn’t absolve him of any responsibility. When he set up this exercise, presumably he wasn’t in an altered state and at that time he did not institute the proper safeguards, having medical supervision and medical support available, etc.

  5. qetzal says:

    Here’s an interesting and possibly relevant side note. Dr Kroll wrote in his post:

    Nevertheless, there are no laws that would have prevented Dr. Crisler from prescribing this regimen to Mr. Ray. To the contrary, physicians in the United States, whether they are MDs or DOs, are granted the latitude to prescribe any FDA-approved medicine for any indication they see fit.

    In the case of human growth hormone, that might not be true. US Code, Title 21, Section 333(3)(1) states:

    Except as provided in paragraph (2), whoever knowingly distributes, or possesses with intent to distribute, human growth hormone for any use in humans other than the treatment of a disease or other recognized medical condition, where such use has been authorized by the Secretary of Health and Human Services under section 355 of this title and pursuant to the order of a physician, is guilty of an offense punishable by not more than 5 years in prison, such fines as are authorized by title 18, or both.

    (Paragraph 2 doesn’t provide any exceptions, it merely increases the penalites if the offense involves someone under 18.)

    Depending on how this is interpreted, it could outlaw prescribing of hGH by a physician for any use other than the approved label indications. In adults, I think that’s limited to growth hormone deficiency. In other words, it may well be illegal for an MD to prescribe hGH for something other than growth hormone deficiency.

    In fact, I recall seeing a position statement somewhere (involving some endocrinology group, I think) that interpreted things exactly that way. But IANAL, so maybe I’m off base here.

  6. Eric Jackson says:

    Hm. I seem to recall that there are a few other uses for hGH injectables from the AHFS-DI. While not FDA approval, it’s about the next best thing.

    The dearth of labwork and grad school opportunities out there has found me employed doing prior authorizations for a pharmacy benefits management company. I’ll probably be dodging thrown bricks shortly after this post because of that.

    Anyway, one of the most common requests to come past me is for Androgel, a topically applied gel containing testosterone used to treat male hypogonadism. It’s actually one of the easiest drugs to get approval for, as the near universal Prior-Auth requirement slapped on it by insurance companies is designed to prevent the company from getting stuck footing off label and frequently crazy uses.

    I think I’ve yet to see a request come in for someone under the age of 40, yet to see one denied, and have yet to see one come in where the lab results for testosterone blood concentrations weren’t immediately available.

    Now it strikes me as somewhat outside the realm of ethical practice to prescribe drugs such as Depo-Testosterone without evaluating this sort of information. A readily available and probably not too expensive laboratory test that measures a key feature of hypognadism seems like it should be well within the generally accepted standard of practice to perform this test before prescribing these drugs.

    On the pharmacology of the above, it seems like it falls into the realm of working it out on paper rather than based on any sort of established clinical evidence. Table-top pharmacology if you will. The same of sort vague reasoning by which some alternative practitioners justify having people eat GABA supplements with the claim it will treat anxiety – factoid based assembling of a treatment with little grasp of what is actually going on.

    I can see some justification for this, in an area where there’s a relatively solid understanding of pharmacology and a failure of existing or flat out nonexistance of established treatments – say what comes up often in the treatment refractory of mental illness. Given that there’s an accepted treatment for hypogonadism, why go out and muck about in uncontrolled and possibly unethical experiments in pharmacology?

    Oh, and I think we can safely shove most of what hGH and hCG are advocated for out into the rain. Totally personal opinion, but if you’re going to go wandering around the endocrine system banging on different parts, have a good reason, and know what you’re doing.

  7. DLC says:

    With any luck, Ray will be locked up for depraved indifference homicide. Oh, and some nice fraud convictions would be good to see also.

  8. windriven, you make excellent points and I wish I understood the psychology more. Several people who caught up with me after the interview were bewildered that intelligent people with lots of money would fall prey to such things.

    Thanks, Karl – I’m happy for you to read me anywhere.

    daedalus2u, always nice to have your insights.

    Very interesting, qetzal – I had not known about those additional restrictions on hGH prescribing. Thank you for the detailed insights and supporting references.

    Eric, it does seem that this physician does do diagnostic and follow-up testosterone monitoring but I don’t think that Ray would be bother by his co-pay or footing the entire bill.

    DLC, the investigation remains ongoing but the release of the search affidavit makes me think something action is on the near horizon.

  9. Fifi says:

    There actually has been research done that applies to these kinds of dynamics, which aren’t just limited to new age cults. Bankers/traders and their followers/investors are pretty much the same. Scorn for the victims/followers tends to be exactly what the leaders of these movements express, so those who feel superior and scornful may want to check in with themselves. It’s the actions of the leaders that are antisocial and they’re the ones deserving of scorn (however our culture has an unfortunate romance going on with narcissism and elevates narcissists to positions of power in all kinds of arenas).

    The vast majority of these kinds of leaders seem to be displaying a Narcissistic Personality Disorder (aka they’re have an antisocial personality disorder or are sociopaths). Grandiose thinking (I’m a god!), viewing people as objects to be used for ones own ego or monetary needs, complete lack of empathy or guilt/shame/responsibility for their actions, different rules for them and their followers, doing one thing and saying another, etc. There is the tendency to blame the victim (and to take the view that people who show emotion or vulnerability are weak and deserve to be exploited). Narcissists exploit people’s vulnerabilities and start off with a charm offensive, they tend to be very charming people because they NEED you to think they’re special and to give them their fix. The perfect forum for them is to present themselves as healers to attract people who are emotionally or psychologically troubled, going through a difficult or transitional time, have addiction problems. Childhood abuse seems to make some people particularly susceptible to the authoritarian and love/abuse dynamic most cults use (along with various means to disorient people to make them weak, confused and easier to manipulate – such as sleep deprivation, drugs, “vision quests”, nutritionally deprived diets, etc). As does some peoples’ own narcissistic disturbances. Reading up on how sociopaths/people with NPD operate can give some insight into how they operate. A lot of the victims/followers deserve compassion, they’re needy people who are being exploited and abused. What they really need is proper therapy – of course most people prefer some fairytale explanation and magical cure over a psychiatric diagnosis. Also, a lot of these culty new age things have at least some small component that works to at least temporarily make the victim feel better or (falsely) empowered. These kinds of personalities do make it into medicine as well, for obvious reasons it’s attractive to them (godlike power over others). These would be doctors who sexually abuse their patients or promote themselves as godlike figures.

    Normal, healthy people don’t want to be gurus. Telling people what to do all the time is a lot of work and normally socially functioning, empathetic people have a distaste/horror for exploiting others so sadistically (and don’t lie to themselves about how great they are as effectively as narcissists). Normal, prosocial people just don’t feel okay being that shitty to other people. Compassion and empathy get in the way of exploiting others, it’s why us humans tend to dehumanize those we do cruel things to.

    Narcissists can charm normal people simply because there’s a human tendency to think/assume others are like us (and narcissists work very hard to be charming as a means to an end). Narcissists do things that most of us find unconceivable….like kill other people through premeditated negligence and then go about business as usual, even going so far as to claim that they’re the real victims of the tragedy they’re responsible for creating. You’ll notice that Ray talks about how hard this experience is for him but hasn’t really extended even fake empathy/remorse towards the victims’ families. The fact that he was using drugs to make himself appear younger and more vibrant (it’s The Secret! ;-) – and more masculine – isn’t very surprising at all. Drug use by gurus – even those who preach against it – is very common. Scientology’s L.Ron Hubbard was an addict, Bagwan/Osho was an addict and so on.

  10. Fifi says:

    “Several people who caught up with me after the interview were bewildered that intelligent people with lots of money would fall prey to such things.”

    People aren’t more intelligent or less likely to buy into rubbish because they’re rich. Stupid people get rich or inherit money all the time. In fact, money creates a cocoon and is often used to remove oneself from reality. I’m not sure why one would assume that these people were intelligent just because they could afford his rubbish, in fact it’s a bit of an indication they don’t know how to think critically and aren’t that intelligent! Ultimately there’s usually an appeal to narcissism (you’re a god and will be a superior enlightened being) or a manipulation of neurosis going on. Throw in the aging Boomers’ terror of aging and death and there’s lots for a conman or narcissist to use to suck people in.

  11. TsuDhoNimh says:

    Windriven said, it would be interesting to explore the psychology of those who, after 36 hours of fasting, vomiting and struggling to maintain consciousness didn’t simply decide ‘enough is enough’ and leave.

    By then they were not capable of rational thought. the first thing that goes when you are dehydrated, sleep deprived, and hyper or hypothermic is your mental acuity. To repost and augment a comment I made on Terra Sig:

    They had all the ingredients for a physiological disaster:

    1 – Spent several days in long hours of strenuous activity in a very warm, dry climate and got low-level dehydration started. Sedona is deceptive. It’s lovely at that time of year, but bone dry. Reportedly the “homework” for the sessions ensured they would not get much sleep.

    2 – Spent the previous 36 hours fasting and water-free in a very dry climate, getting them more dehydrated.

    3 – Broke their fast immediately before the sweatlodge, which didn’t give them enough time to get rehydrated.

    At this point we have 50+ dehydrated, exhausted people.

    4 – The $@#%!# idiot who built the sweatlodge (to whose specs?) covered the entire structure with waterproof tarps, ensuring minimal O2 exchange. (real sweatlodges are covered by wool blankets or a cotton canvas, not plastic sheeting)

    Limiting the O2 supply and increasing the CO2 induces a mild euphoria – it’s a cheap guru’s trick for making people think they are experiencing something special (spiritual auto-erotic asphyxiation).

    5 – The lodge was far larger than the usual, with 4x the usual number of people jammed into it. Real ceremonies might have a dozen people, but that’s an unusually large number.

    This made it impossible to monitor the condition of the participants … the usual arrangement is one row of people, sitting around the edge, with one person designated to making sure everyone is OK. Leaving if it gets too hot is not disparaged. Also, discreetly lifting the blankets to let in a small cool draft is allowed.

    6 – The *)&%^ idiot who was running the ceremony didn’t understand the role of water and the water pourer, and instead of scattering a small amount of water on the rocks (small increase in apparent heat) he reportedly dumped a bucket or so on them at a time, releasing huge clouds of steam.

    Now we have 50+ already-dehydrated people in an intensely hot, humid environment with limited O2 supply … and one greedy SOB telling them to push beyond their limitations and stay in the killing fields.

  12. johnathanelopez says:

    I suspect that as I age and face the inevitable decline of testosterone levels, I may become a candidate for such therapy. My fear is that sensationalism will embolden the witch-hunters who will then make obtaining treatment and medication difficult to obtain for those of use who have a legitimate medical need. 3d tutorials

  13. Fifi says:

    This whole thing is much more likely to get sweat lodges banned in the US, which is silly because they aren’t dangerous when properly managed, they’re just like saunas really. There was intention and gross negligence in this case. You don’t have to worry about medically prescribed testosterone getting banned, the general cultural narcissism and elevation of narcissists as the social ideal (be they bankers, CEOs or new age gurus) won’t allow for that. The issue and dangerous element here wasn’t the sweat lodge, it was the cultural elevation of someone with a NPD to a position of authority (which people with NPDs seek out). Because our culture idolizes narcissists, narcissistic behavior and grandiose fantasies – and equates narcissistic behavior with being strong and masculine, even though it’s actually weak, needy, antisocial and out of touch with reality – we continue to blame the victims instead of confronting, containing and preventing this kind of behavior. Or even calling out the people who do it for being pathologically antisocial.

    So, don’t worry, advertising will continue to promote youth and narcissism as the ideal and you’ll have access to the means to try to pretend you’re younger than you are and to try to buy immortality. The big shame in this is that many people actually get much more interesting as they age and mature, and natural biological aging is part of this change in temperament. (I’m all for staying fit and healthy as one ages – these being the basis for being attractive no matter one’s age – it’s the selling of magic anti-aging potions that I question. Science is still out on HRT for men and we’ve only started to understand the true consequences of HRT for women recently. Both have their place obviously, and what someone does with their body is their own choice, but HRT for men isn’t exactly medically necessary most of the time and is often about narcissism (as it so obviously was in the case of Ray). It’s ironic that “spiritual” people prove themselves to be obsessed with the superficial over and over again.

  14. J_ says:

    Entertaining article, but it should be filed under psychiatry and medical ethics. The pharmacology is certainly science based medicine to the extreme, and it’s clear the doctors prescribing this cocktail knew exactly how the endocrine system works: they passed the graduate exam with flying colors.

  15. Andreas says:

    “A person taking an anabolic steroid regimen (recall that testosterone is a natural anabolic steroid) is prone to mood swings, anxiety, and aggressive behavior.”

    Could you please cite somehow this statement ?

    It does not seem to make any sense, if that’ s the case all men (ncluding you) that produce testosterone are prone to mood swings and an agressive behavior.

  16. Fifi says:

    Andreas – “It does not seem to make any sense, if that’ s the case all men (ncluding you) that produce testosterone are prone to mood swings and an agressive behavior.”

    How hormones drive behavior has to do with how they’re balanced out with other hormones. High testosterone levels seem to make both men and women more likely to exhibit outgoing and status conscious behavior (and it’s a key player in both men and women’s sex drives). Recent studies seem to show that it drives fairness in women. (We all share the same hormones, just in different combinations, so testosterone isn’t just a guy thing.)

    http://www.cbc.ca/technology/story/2009/12/08/tech-biology-testosterone-behaviour.html

    http://neuroskeptic.blogspot.com/2009/12/testosterone-aggression-confusion.html

    Mood swings are more about fluctuating hormonal levels (hence the swinging part). I’d say that in Ray’s case his behavior is entirely due to being a malignant narcissist and his rather obvious antisocial personality disorder. My bet is that he’ll try to blame the hormones (and maybe even try to paint himself as a victim of Big Pharma/medicine as a means to appeal to his flaky followers and dodge personal responsibility), which would be a very predictable move for a narcissist.

  17. edterry says:

    Arimidex is sometimes prescribed to men receiving TRT. As men age, they produce more aromatase and this causes an ever increasing conversion of testosterone to estradiol. Given sufficient estradiol in the blood, men receiving TRT can experience erectile dysfunction.

    It is not uncommon to prescribe a drug outside of it’s normal use. It’s called off-label prescribing. The most famous case is the drug minoxidil. It’s original labelled used was for hypertension. It took years to gain approval for a common side effect – hair growth.

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