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The Blurry line between "need" and "Want" in Healthcare

Some octogenarian rocker once said something like “You can’t always get what you want, but if you try sometimes you might find that you get what you need.” But in reality, the line between “need” and “want” can be blurry. 

Take medicine, for instance. Most of how we define need is based upon what is used to treat sick people and prevent death and increase lifespan. In contrast, very little intervention aimed to improve quality of life AKA health span falls under the category of need.  

For example, if you just had a coronary stent put in, conventional medical wisdom would certainly say you need to be on blood thinners because otherwise your stent could occlude and you could die of a heart attack. Definitely hard to argue with that. It is quite clear cut. But need vs want and everything in between is not always that clear. If your LDL-cholesterol is high, your doctor may tell you need to be on a cholesterol medication to prevent a future heart attack or stroke. And yes, statistically speaking you probably should be. But it is a little more of a gray area than the blood thinner example, as a cholesterol medicine may or may not have any impact on the health of a particular individual.

What about Viagra? Do you need it? Of course not. Viagra has little to no effect on your physical health. But it sure as hell improves quality of life. You want Viagra. But given our focus on lifespan over quality of life, it is certainly not a need.

How does this apply to testosterone? This is where our dogmatic concepts of need begin to really breakdown, particularly in the context of our strict, tunnel vision adherence to reference ranges. I am not going to spend much time explaining the pitfalls of reference ranges as I wrote an entire blog on it

It is certainly on brand with the healthcare definition of “need” to tell a man at the 5th percentile (340 on reference range 280-1100) who has fatigue, depressed mood, decreased libido & sexual function, impaired concentration & motivation, and muscle wasting that he doesn’t “need” testosterone because he is within the reference range. But it really makes no sense if the goal is to help him live a happier, more productive life. 

This is exactly where even the American Urological Association is myopic when discussing need when it comes to testosterone supplementation. As those of you who have read my blogs have probably concluded, it drives me crazy when symptomatic men with low “normal” testosterone levels are reflexively denied even a discussion of the potential benefits and risks of supplemental testosterone because they don’t “need” it. This is in part due to shortsightedness and insufficient knowledge about the current data regarding risks & benefits of testosterone supplementation, but also due the pervasive influence of insurance companies on how we practice conventional corporate medicine. 

I am 100% not saying testosterone is for everyone because it most definitely is not, but every man at least deserves a more thoughtful evaluation of their individual case before being told they have to live with symptoms that can profoundly affect enjoyment of life.

Medicine has been and should always be an art. We need to get away from making homogenous recommendations for a heterogenous population. We need to look less at the lab results in front of us and more at the man sitting across from us, and really listen. A man’s emotional health, relationships, personal beliefs and priorities do not show up on a lab sheet. We can do better.

And that’s exactly what we’re doing at The Men’s Center.

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