How many times have patients complained to you that they just don’t feel like themselves?
In my experience, this often happens despite a clear medical diagnosis and strict compliance with doctor’s orders. This is the patient who was diagnosed with diabetes or high cholesterol and is taking the right medications, perhaps even exercising, but still feels blah.
As a pharmacist, it can be hard to see patients like this and not have any words of comfort. It’s also challenging to have an idea about the root cause of the problem, but not know how to bring up the subject of hormone imbalance. This topic can be touchy, especially for male patients, because it conjures up scary thoughts of impotence and getting fat and bald when, in fact, the gamut of symptoms runs well beyond these.
Low testosterone (T) is a much overlooked ailment because its symptoms are mirrored by other conditions like depression, thyroid disorders, or aging. Symptoms include low libido, weight gain, loss of lean muscle mass, fatigue, loss of body hair, and general malaise.
These symptoms present for so long in some patients that they become accustomed to feeling poorly. They are often dismissed as being considered “natural” or “part of getting older” when, in fact, they are not. Men in particular seem to forget that feeling well, or even fantastic, is a reasonable expectation.
I have found that low T is consistently misdiagnosed among patients. Education is the key to helping men with low T because it is an insidious condition that often times presents itself as another medical condition.
The typical scenario is like this: the patient goes to the doctor complaining about fatigue, feeling “dull,” weak, or depressed. The physician will draw blood, but often doesn’t check T levels. At the follow-up appointment, the doctor will prescribe a biguanide, an antidepressant, or, perhaps even worse, a statin. The symptoms do not abate, and then the patient comes to me when refilling his scripts. The patient wonders why he is paying for refills when he feels the same or worse than before the diagnosis.
I am very empathetic to this type of interaction, and I want to help the patient. It is human nature to want to help people, and that’s why many of us became pharmacists. Sometimes, however, it is hard to provide empty reassurances.
Starting a dialogue can help. I often refer to my own low T story to put the patient at ease. I then recommend that he not only brings up the subject to his doctor, but requests the necessary blood work to determine whether low T is to blame.
If the patient seems open to my suggestions, I provide him with information to share with his clinician. In some cases, the patient does indeed have the originally diagnosed medical condition, but also low T. Treating the low T might alleviate or eradicate not only the symptoms, but also the medical condition.
I challenge you to educate yourself on low T symptoms and solutions, so you can help identify this condition and start the conversation with patients. Here are a few facts that might help you in your role as a trusted pharmacist and adviser:
- The Academy of Anti-Aging Regenerative and Functional Medicine recommends that men be tested for free and total T levels at least once a year, unless they are undergoing T replacement therapy, which requires closer monitoring.
- Advise patients to keep a written log or notes on their phone calendar to indicate good and bad days. This will help determine whether there is a pattern of symptoms.
- Learn who in your area is experienced in treating low T. Often, endocrinologists, urologists, and integrative medicine clinicians are trained in men’s health issues.
Gopesh Patel, RPh
Gopesh Patel, RPh, is co-owner of New Drug Loft in Manhattan, and VLS and Lane Drugs in Brooklyn. He focuses on providing high-quality prescriptions and compounded medications, as well as personalized care for the 3 stores' many customers. Patel is a member of the International Academy of Compounding Pharmacists, Professional Compounding Centers of America, A4M, and he is a Wiley Protocol Premiere Pharmacist. He is a Preceptor for pharmacy students from the Long Island University College of Pharmacy and the Massachusetts College of Pharmacy and Health Sciences University in Boston.