Wednesday, April 25, 2012

Admittedly I've often wondered if I shouldn't have been something else other than an endocrinologist. Because, the shameful truth is, I might be a hormone specialist (now, the term specialist is being used looselysmiley icons) but really I don't like prescribing them.
No, really.
My philosophy is, as smart as we damned doctors think we are, we're not. We often can't medically explain why you may be losing hair, or feel like, or have problems with your erections. Why your penis is short/droopy. Why your bench press limit is maxing out at 200 lbs. Why you can't sleep. (all are real consults I've been asked to see).
And so, I tend to be really conservative- I prescribe a medication when I am confident that a patient is truly having a problem, that the medication will help, and that it will do my patient no harm.
The old adage of Primum Non Nocere has been my cornerstone of practice.
But of late, I've been seen more and more issues to which I cannot ethically allow myself to address. The case in mind was an exhaustive visit with a patient who started off with his personal trainer suggesting that he takes Testosterone to help with his muscle stamina. However because this may be aromatized to estradiol, he also wished to be on an aromatase inhibitor. And to preserve testicular function, requested a 3rd medication in the form of HCG shots.
He called it a cocktail.
Oh man. Is it me, or is it kinda messed up? Maybe I'm just a wimp and isn't ready to do something totally off-label like that. Sure, the physiology of that combo seems reasonable. But has it been studied for use in that context in large scale efficacy and safety studies? Who's gonna speak for the patient who suffers from a stroke or MI from Anastrozole? Who's gonna protect me from litiginous consequences when something untoward happens because I chose to do something that is not standard of care of the medical community?
Also, what's with these TV ads these days promoting supplements that will boost a man's testosterone? These seem to be replacing the weight loss supplement ads these days.
Sigh; life used to be simple, a mentor once said. We used to be doctors. We treat the diabetes and reduce their risks. Diagnosed the thyroid cancers. Correct their hyperthyroidism. Replace their hypopituitarism.
But these days, the practice of endocrinology seems to be going into a very dark, grey area.


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