Wednesday, March 05, 2014

Vitamin T

You could call me the hesitant endocrinologist.
After all, I might be a hormone specialist (and I use the term specialist very loosely. Maybe only my wife and mother think I'm special), but I really don't like to prescribe these things unless the needs exceed the risks.
In this case, I'm a sceptic, I'm old-fashioned, I'm cheap.
I ask for the evidence behind the treatment. Good old EBM.
And so, it is a challenge when in the recent years, I see so many men asking for testosterone treatment.
The mild: older men with mildly low free and total testosterone. Studies suggest mild hypogonadism do not need treatment. Most feel no improvement.
The wild: young men in their 20s, who despite having normal testosterone labs, believe their levels should be "higher". Because they work out. Or believe they should be more virile. Or because their personal trainer told them so (I kid you not).
Where do we draw the line? Our lab's normal range is 350-1000. I've had guys say their 450 isn't normal. They should be at 800. I saw a chap whose T was 1200 last week (on replacement), refusing to budge his doses down because he feels good.
The winner in my short career thus far, is probably the very muscular, athletic man I saw 3 years ago- with a total T of 8000. Refused to believe me when I advised him for safety reasons to reduce. Never came back to see this quack endocrinologist, because I obviously don't know what I'm talking about.
And just weeks ago I saw a man who is a professional athlete (apparently is involved even in the Olympics), who had normal levels but feels he should be higher. And when I told him I couldn't in good conscience suggest treatment, his last words to be as he left the exam room were: "Well, if you won't prescribe it, I can easily get it from the gym...".
Why is there a need to justify medically how we feel? Low energy, fatigue, low sex drive, ED, lack of stamina, inability to lift XX lbs of weights?
If I looked at the list of hypogonadism symptoms so artfully advertised by pharma, I personally have 6 of them (don't ask me which).
And so, why do we need a medical diagnosis for what could be life? More importantly, why are we so keen on taking hormonal treatment for a mild low, or even a normal? I imagine a large part has to be the misconception that all fatigue must be low T. And all low T must be treated. If you get treated, you'll feel like a new man. A devious, ingenious scheme of pharmaceutical advertising.
While the risks have been known all this while, the more recent cardiovascular studies remind us this is not to be toyed with. Not just amongst the elderly or those with a history of CAD, but even the younger male population.
And so, while I usually cringe when I see lawsuit ads on TV by greedy lawyers, when the testosterone lawsuit ads started appearing 2 weeks ago, a part of me was somewhat pleased.
Perhaps this will give some caution to pharma to back off on their aggressive direct-to-consumer advertising.

5 Comments:

Blogger mmjiaxin said...

coach outlet store
swarovski jewelry
michael kors outlet
christian louboutin shoes
michael kors uk outlet
ugg boots
nike running shoes
michael kors outlet sale
ray-ban sunglasses
cheap soccer jerseys
nike air max uk
prada sneakers
michael kors outlet online
nike roshe
swarovski crystal
oakley sunglasses
ralph lauren uk
nobis jacket
north face outlet
roshe run men
mm1127

8:29 PM  
Blogger ninest123 Ninest said...

ninest123 12.15
oakley sunglasses, louboutin shoes, michael kors outlet online, prada outlet, louis vuitton outlet online, oakley sunglasses, nike free, oakley sunglasses, replica watches, burberry outlet, christian louboutin, nike air max, tiffany jewelry, tiffany jewelry, ralph lauren outlet, ray ban sunglasses, burberry factory outlet, cheap jordans, longchamp outlet, michael kors, ralph lauren polo, michael kors outlet online, replica watches, gucci handbags, michael kors outlet, ray ban sunglasses, uggs on sale, michael kors handbags, nike outlet, nike air max, uggs on sale, uggs outlet, christian louboutin, prada handbags, uggs outlet, tory burch outlet, louis vuitton outlet, louboutin uk, longchamp bags, longchamp outlet, ray ban sunglasses, cheap oakley sunglasses, louis vuitton handbags, oakley sunglasses, louis vuitton, uggs on sale, michael kors outlet online, louis vuitton outlet

12:19 AM  
Blogger ninest123 Ninest said...

louboutin pas cher, timberland pas cher, nike trainers uk, true religion jeans, nike roshe run pas cher, nike air max pas cher, nike blazer pas cher, lunette ray ban pas cher, abercrombie and fitch, lululemon outlet, michael kors outlet online, michael kors, coach outlet store online, coach purses, new balance, nike air max, hollister uk, michael kors, lunette oakley pas cher, true religion outlet, nike tn pas cher, replica handbags, nike air max uk, longchamp soldes, nike free, longchamp pas cher, north face uk, ralph lauren pas cher, michael kors uk, north face pas cher, vanessa bruno pas cher, true religion outlet, polo ralph lauren uk, nike air force, converse, vans pas cher, nike roshe uk, burberry pas cher, sac guess pas cher, true religion outlet, nike air max uk, ray ban uk, hogan sito ufficiale, jordan pas cher, hermes pas cher, mulberry uk, polo lacoste pas cher, nike free pas cher, abercrombie and fitch UK

12:22 AM  
Blogger ninest123 Ninest said...

chi flat iron, iphone cases, wedding dresses, hollister clothing, reebok outlet, herve leger, converse, mac cosmetics, iphone 6 plus cases, vans outlet, jimmy choo outlet, giuseppe zanotti, timberland boots, ray ban, celine handbags, polo ralph lauren, vans scarpe, iphone 6 cases, ghd hair, beats by dre, oakley, mont blanc, p90x workout, iphone 6s cases, instyler ionic styler, valentino shoes, north face outlet, mcm handbags, abercrombie and fitch, insanity workout, iphone 5s cases, bottega veneta, gucci, nike air max, hollister, iphone 6s plus cases, nike air max, new balance shoes, lululemon outlet, babyliss pro, soccer shoes, north face outlet, ipad cases, asics running shoes, nfl jerseys, s6 cases, nike roshe run, softball bats, soccer jerseys, salvatore ferragamo, hermes handbags, louboutin

12:28 AM  
Blogger ninest123 Ninest said...

sac louis vuitton, ugg,uggs,uggs canada, supra shoes, coach outlet, canada goose outlet, doke & gabbana, hollister, montre pas cher, pandora jewelry, swarovski uk, ugg pas cher, canada goose, juicy couture outlet, links of london uk, moncler uk, moncler, louis vuitton, canada goose jackets, louis vuitton uk, thomas sabo uk, barbour, moncler, moncler jackets, lancel, canada goose outlet, ugg,ugg australia,ugg italia, barbour jackets uk, canada goose, replica watches, karen millen uk, moncler, pandora jewelry, juicy couture outlet, swarovski jewelry, canada goose jackets, toms shoes, louis vuitton, marc jacobs, pandora charms, ugg uk, canada goose uk, canada goose pas cher, moncler outlet, bottes ugg pas cher, pandora uk, wedding dresses uk, moncler, moncler pas cher, sac louis vuitton, converse shoes outlet
ninest123 12.15

12:30 AM  

Post a Comment

<< Home