The Wild West of Wellness

I had been in endocrine practice for nearly 10 years when a 40-year-old woman came to see me for changes in her body that she couldn't explain. 

Over the previous few months, she had noticed missed menstrual periods, oilier skin, bulging veins, increased muscle definition despite not working out, hair loss from her scalp, acne reminiscent of her teenage years, and new hair growth in unwanted places. 

My initial concern was that she might have a testosterone-producing tumor. However, her lab results told a different story. Not only was her testosterone level very low, but the pituitary hormones that regulate reproduction were also markedly suppressed. She had an elevated red blood cell count, low HDL ("good") cholesterol, and high LDL ("bad") cholesterol—findings that were strikingly different from her previous lab results. 

At that point, I became less concerned about a tumor and more concerned about something else. Could something she was taking be causing these changes? 

As we reviewed her medications and supplements, she mentioned that she was seeing a chiropractor who had recommended a vitamin B-complex supplement to boost her energy. I advised her to stop taking the supplement and return for follow-up in a few months. 

When she came back, both her symptoms and her laboratory abnormalities had significantly improved. 

We later discovered that the chiropractor had been secretly adding anabolic steroids to the vitamins he was selling to patients. He believed it would help them feel better and had no understanding of the harm it could cause. Ironically, he even reported some of the adverse events his patients experienced to the Department of Health—without realizing that he himself was the source of the problem. 

I think about this patient every time someone comes to see me with a long list of supplements they are taking to improve their health, or when I hear about patients obtaining compounded medications—such as GLP-1 drugs—from wellness spas or online vendors without physician oversight. 

Not because all supplements or compounded medications are dangerous. Most are not. And when a supplement appears to be helping a patient and poses little risk, I simply encourage them to use caution and choose reputable sources. 

The challenge is that supplements and non-FDA-approved compounded medications exist in a space with far less oversight than prescription drugs. Patients often have no way of knowing exactly what they are getting, whether the ingredients are accurate, or whether contaminants or impurities are present. 

The recent popularity of compounded GLP-1 medications has brought these concerns into sharper focus. Beyond potential quality and purity issues, using these medications without appropriate medical supervision can lead to unintended health consequences. Excessive weight loss can result in fatigue, difficulty concentrating, hair loss, loss of muscle mass and strength, and even osteoporosis and fractures. 

Just as importantly, successful long-term treatment requires ongoing medical guidance. Patients need individualized plans to maximize health benefits, monitor for side effects, preserve muscle and bone health, and determine if and when it is appropriate to taper or discontinue therapy.  

In medicine, there are rarely shortcuts. When it comes to supplements and compounded medications, consumers should remember that "natural," "customized," or "available without a prescription" does not necessarily mean safe. This patient was incredibly grateful that we took the time to look beyond the obvious and uncover the true cause of her symptoms. Had she continued taking that "vitamin" supplement, the consequences could have been far more serious. 

As an endocrinologist, I encourage patients to ask questions and take an active role in their health. But I also encourage them to seek guidance from qualified medical professionals who can help them separate evidence-based treatments from marketing claims. In today's wellness marketplace, where products are often promoted more aggressively than they are studied, having an experienced physician on your side is more important than ever.