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Testosterone levels must be low at 8 a.m. to receive injections

Columns

DEAR DR. ROACH: My insurance company won’t let me receive my testosterone injection unless I have a low testosterone level at 8 a.m. Does this make any sense? — T.B. ANSWER: Although I am never fond of insurance companies making medical decisions, this does make sense from physiology. Cholesterol is made in the body, mostly in the liver and mostly at night between midnight and 8 a.m. (This is why people are often recommended to take statin drugs at night; although with long-acting statins like rosuvastatin, it isn’t as important.) Since cholesterol is used to synthesize many ...

Insurance company now requires preapprovals for medications

Columns

DEAR DR. ROACH: My insurance company has suddenly instituted all kinds of new rules that require me to get preapprovals for medications (including seizure medicines) that I have been taking for years. I didn’t find out until I tried to renew my medicine, and now I may run out. Why are they doing this? Isn’t it dangerous? — D.M. ANSWER: In my opinion, it is dangerous. Studies have shown that requiring a preapproval for a medication that a person is already on increases the odds of it being discontinued sevenfold. It also delays the prescription from being filled by an average of ...

Between deterrence and peace: What history demands we remember

Columns

These are no longer theoretical debates confined to policy forums. The conflict is widening. American servicemen have now been lost. Regional nations are absorbing casualties. Retaliation cycles are accelerating. What once appeared contained now carries the unmistakable risk of broader regional war. Here is the reality: Iran has long advanced its nuclear program, and the international community has repeatedly warned that enrichment capability could move beyond peaceful energy into weapons potential. International inspectors have acknowledged they cannot fully verify all aspects of ...

Cuba should accept Trump’s ‘friendly takeover’

Columns

President Donald Trump has shown Cuba’s communist rulers two ways their reign over the island can end: the Maduro way or the Khamenei way. The Cuban regime is a mix of gerontocracy, nepotism and socialism. Its official face is President Miguel Diaz-Canel, but supreme authority still emanates from the 94-year-old Raul Castro, brother of the state’s founding dictator, Fidel Castro. Though the long-lived Castro clan seems to prove only the good die young, no one beats the actuarial tables in the end, and Raul’s days are drawing short. Cuba is overdue for a profound change, and ...

Feeling stranded by so-called friends

Columns

Dear Annie: I am the friend everyone calls when they need something. I am the one who remembers birthdays, checks in after surgeries, brings soup when someone is sick and sends the “just thinking of you” text. If a friend is going through a divorce, I am there. If someone’s child is struggling, I listen for hours. If there is a crisis, I show up. But lately, I have started to notice something painful. When I am the one having a hard time, the room gets very quiet. A few months ago, I went through a health scare. It turned out to be OK, thank goodness, but while I was waiting ...

I can’t stop Trump’s war, but I can show up for my community

Columns

While President Donald Trump initiated war against Iran last weekend, my family was out volunteering at our local community garden. Another war weighs heavy on me, but I know I do not control military orders. I cannot make Trump adhere to the Constitution and get a proper declaration of war from Congress. Nor can I control how Congress responds, or in this case, chooses not to respond. But I can pick up a rake and help my community prepare a garden for spring and feed our neighbors. Trump, with the help of a GOP-dominated Congress, has stripped billions of dollars from healthcare ...