Quote from: highlight on December 21, 2015, 08:47:27 PM
Hay HughE you said that doctors don't like treating or diagnosing Hypogonadism..why is that?
A variety of reasons I think.
Ignorance probably plays a big part. Hormones can't get much coverage in medical schools, since most doctors don't seem to have the first clue about them (for instance my GP doesn't know the difference between primary and secondary hypogonadism). Rather than admit that they don't know anything about hormones, it's easier for a doctor to pretend that there isn't a problem in the first place. This isn't helped by the fact that most of the symptoms of hypogonadism (depression, fatigue, muscle wasting, osteoporosis etc) aren't immediately visible, so as far as the doctor is concerned, most men with hypogonadism probably don't look like there's anything wrong with them.
Another important consideration is that the standard treatment for hypogonadism is testosterone, which (due to abuse by bodybuilders) is a controlled substance. Doctors have to jump through extra hoops in order to prescribe testosterone, which they don't have to for most other prescription medicines. It also places them at heightened risk of being sued or struck off if anything goes wrong.
Also, here in the UK, the official guidelines for when to treat hypogonadism are based entirely on blood total testosterone measurements, not symptoms, and if your total T is above a very low level (12 nmol/l I think), it's considered "normal", and you're not eligible for treatment. This is despite the fact that 12 nmol/l is less than half the average total T level in normal, healthy adult men. In other words, it's just some arbitrary criteria that the NHS have come up with that means they avoid having to treat people.
It's possible that past HRT disasters have something to do with it too. Until quite recently, nearly all hormone treatment has tended to involve synthetic rather than bioidentical hormones (mainly because that's what the pharmaceutical industry have been pushing). Synthetic hormones all appear to become toxic when used continuously over a long period of time, which is what happens with HRT! There have been a number of quite serious HRT disasters in the past, during which large numbers of people suffered serious adverse health consequences (including death). The ones I know about are DES, ethinylestradiol, premarin and provera for women's HRT, and methyltestosterone for men's HRT. Despite the fact that those hormones are all synthetics, it's probably led to HRT with bioidentical hormones being tarred with the same brush in the minds of a lot of doctors.