Male hormone treatment and testosterone replacement concerns

One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala.

He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school.

One thing that stands out in my memory, to this day, from those two months is how Professor B refused to deal with anything but the esoteric diseases his patients came to his ward for. If anyone had a cough or an ache or a rash, he would scornfully say “I treat diseases, not ailments”.

It seems that nowadays many ailments have been given disease status. Restless legs, premenstrual syndrome, thinning hair and overactive bladder are bona fide diseases now.

Even aging is, in this country, largely viewed as a constellation of diseases. It strikes me as odd that in this age of high regard for Evidence Based Medicine, we so boldly define things that happen to all of us sooner or later as diseases and try out treatments for these symptoms when every shred of available evidence suggests these are actually natural occurrences.

When I was a resident, I got docked if I didn’t offer postmenopausal women estrogen replacement. It seemed like such an obvious thing to do – who wouldn’t want to keep women from aging as nature had so cruelly intended? Who wouldn’t want to save them from heart disease, dementia, osteoporosis, genito-urinary symptoms and decreased joie de vivre? Who wouldn’t want to preserve and prolong youth?

Now, of course, everyone agrees that estrogen replacement increases a woman’s breast cancer risk and also increases her risk for blood clots, stroke and heart disease.

The male aging process seems to be the current frontier for many of those who wish to medicalize the human experience. As if we never learn from our mistakes, we are now prompted to look for low testosterone levels in middle-aged and older men, who might not have their usual vitality, muscle mass or sex drive anymore.

Never mind that there are already concerns about what male hormone treatment might do to prostate cancer and maybe even heart disease risks.

I wonder when the drug companies will focus their attention on the other big transition we all go through.

Adolescence is a life-changing condition for both girls and boys with many undesirable, hormone-mediated “symptoms”. Every generation of parents and teenagers until now has had to go through it without help from the pharmaceutical industry. If we were to follow the menopause-and-aging-as-diseases logic, this is probably the next medical frontier after we conquer the male menopause. Just think of all the “patients”, who suffer their way through this “disease”.

It’s probably only a matter of time until we have diagnostic codes and blockbuster drugs for this, too.

A Country Doctor is a family physician who blogs at A Country Doctor Writes:.

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  • SarahW

    Eyeroll “Now, of course, everyone agrees that estrogen replacement increases a woman’s breast cancer risk and also increases her risk for blood clots, stroke and heart disease.”

    That’s a tad overbroad.

    These risks are associated with a particular kind of HRT, started rather late in some patients.

    Earlier therapy may provide more benefit to justify risk, and lower dose therapy may improve risk profile, and bioidenticals have a good safety profile in Europe, and if there is no extensive evidence of lower risk from bioidentical hormones on which physicians choose to rely, there is some rational basis for believing that chemical signaling may matter, that dose may matter, that steady release may matter, and that avoiding passes through the liver may matter.

    Aging is a pathologic process, and merely because it is natural does not make slowing it folly or irrelevant to health.

    Recent research showed aging mice given ovary transplants not only had very significantly etended lifespan, but began acting like younger mice, with new energy and zeal for mousey tasks. Menopause might be natural, good for the species or whatnot, or has been, but it isn’t necessarily “good health”.

  • Maija Haavisto

    Aging is a disease that should be, and will be, cured. Those who say that it is a “natural part of a life” should think about how “natural” anything about our lives is (very little). The goal should be on minimizing suffering, obviously as safely as possible. For some reason any doctors have a phobia of all kinds of hormones and even when a patient has a clear deficiency they will only repeat their mantras of how corticosteroid replacement causes Cushings, excess thyroid hormone thins your bones etc. Sure, hormones can have nasty side effects in excess, but their deficiencies are also very problematic and all too often go untreated or poorly treated.

    P.S. RLS, overactive bladder and PMS can be extremely debilitating conditions.

  • Jake

    If you want to talk about the really ridiculous case of giving disease status to a non-disease, consider the case where someone gets into trouble in their use of alcohol (eg. drunk driving), then by court order gets a medical diagnosis for their “disease” that caused them to abuse alcohol, and is then sentenced to be “treated” by an AA type facility where to successfully be treated, the patient must participate in (and claim acceptance of) a 12 step religious cult.

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