Saturday, May 29, 2010

Nurse Practitioner To Treat or Not To Treat Menopause or Andropause In Patients?

Over at A Country Doc Writes, he poses the question about whether we should treat naturally occurring problems as we age such as menopause or andropause.

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.

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.

Here's what I replied..

"I do tend to treat patients with low testosterone if they are young. I do a baseline PSA and use the least amount of hormone to do the trick. I stumbled onto low testosterone long before the commercials on television were touting it as the new thing to do. My male patients were coming in on all sorts of depression medications and feeling terrible. Once I found the true reason for their fatigue and loss of interest in activities, they are able to stop taking mood altering medications that were unnecessary. I also ask women about their hormone replacement needs and base it on how it affects their lives and how important sex is their relationships. I also require that both people in the relationship be involved because one may find it more important than the other and I don't want to be the one to wreck a relationship or cause an affair. I go over the risks and benefits and family history thoroughly before we make the decision together."

What say you?

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