While I was going thru my morning email today, I stumbled upon a note from one of several pharmaceutical websites that continually keep health professionals apprised of new medications, different doses, side effects, warnings, etc. Of course, given
this morning's earlier post, I was drawn to a
hyperlink indicating that a new dose of Androderm was now available. However, you can only imagine my surprise when I found out that the manufacturer's was now promoting lower doses of Androderm at 2mg & 4mg, to be made available next month! Sacre bleu! This can't be! As (bad) luck would have it,
Androderm's website didn't have any information on this new dosing, just their previous 2.5mg & 5mg patches.
What was their rationale? Apparently 97% of subjects achieved "normal" testosterone levels within 28d of use w/94% achieving "normal" levels within 8d as a result of the 4mg patch. But when you search the manufacturer's website, they note that "in some laboratories, the lower limit of the normal range for total testosterone is 300mg/dL in healthy young men." In other words, we should be satisfied w/bumping our patients up to 300mg/dL and leaving it at that.
But isn't that like tutoring a failing student until they learn just enough to pass with the lowest D? Why not tutor someone until they fully understand & comprehend the topic? Likewise, shouldn't our goal for testosterone replacement/supplementation be a clinical goal, rather than just a numerical goal? In other words, shouldn't we aim to improve the patient's quality of life, energy, libido, mood, cognitive function, etc, whatever it was that brought him into our office in the first place? Rather than aiming for 300mg/dL.
Now don't get me wrong. I don't advocate shooting for the moon w/total testosterone levels above the upper limit of normal (whatever that may be for that given laboratory's equipment & methodology). And I certainly won't tolerate side effects or adverse risk profiles resulting from excess testosterone for any given individual. My point is this - work with your family physician to get optimally treated for hypogonadism. Don't just accept cookie cutter treatment.
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