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Is my 89 year old dad's urologist taking advantage? (re: testosterone therapy)
My dad 89 year old dad has been battling depression for several years. It's finally gotten so bad we had to hospitalize him. Only now, with a multi-doctor team, do we find out that he's been giving himself testosterone injections for well over 10 years, under the care of his urologist. His new doctors were shocked to find this out, incredulous that at his age he should have any need for testosterone therapy, especially when he'd never had any hormonal problems his entire life. My dad says that the testosterone is to improve his troubled mood, but mom and I suspect he's not being forthcoming, and that it's just insecurity about his virility--AND that the treatment could be doing far more harm than good.
All the years he's been dealing with depression, he's talked about this urologist as if he's a primary care doctor. I always wanted to ask, "why are you constantly seeing a urologist?" but I didn't ask because I guess I thought it would be too uncomfortable a topic. But all this time I've suspected that this urologist is just happily taking the money he gets from keeping my dad as a recurring patient--while not caring about the possible negative effects that the testosterone injections could be causing.
I know that you can't make a diagnosis based on my remarks above, but I'd like to hear opinions on whether someone in his late 80s should be on testosterone therapy, and opinions about the validity of my suspicions that this urologist is just being predatory. Thanks very much.
All the years he's been dealing with depression, he's talked about this urologist as if he's a primary care doctor. I always wanted to ask, "why are you constantly seeing a urologist?" but I didn't ask because I guess I thought it would be too uncomfortable a topic. But all this time I've suspected that this urologist is just happily taking the money he gets from keeping my dad as a recurring patient--while not caring about the possible negative effects that the testosterone injections could be causing.
I know that you can't make a diagnosis based on my remarks above, but I'd like to hear opinions on whether someone in his late 80s should be on testosterone therapy, and opinions about the validity of my suspicions that this urologist is just being predatory. Thanks very much.
Your dad's depression was not caused by the testosterone or by the urologist. Even if you feel the urologist did something improper by giving your dad the shots he was taking, being mad at the urologist is displaced anger at the situation, and is not going to improve the medical situation for your father, which is the primary issue. Your dad may have told himself he was doing it for his mood (even if you suspect otherwise) but obviously it hasn't solved this problem, and the issue now is to get him out of the hole he is in emotionally if he can get out of it. To move his care forward, he needs proper workups under a primary-care doc (which sounds like it is happening) and should go with what the primary-care guy recommends or prescribes. He should certainly be considering antidepressants or anti-anxiety meds, they will do much more for him than testosterone.
Once you get your dad out of the trough he is in, if you are still angry at the urologist you could file a board complaint, saying you feel the testosterone shots were excessive or unnecessary. But again, unless you can show they harmed your dad (you can't) and unless your dad was not in his right mind and you can prove the doctor knew it, the urologist's defense will be that the shots were at your dad's request. Unless what a patient requests is medically dangerous or simply blatantly unnecessary, usually it's OK to give a patient what he wants, especially if he is unhappy and feels it will make him happier. (And regarding everyone's judgement that these shots were blatantly or obviously a waste on such an old man, who is to say that a guy in his 70s or 80s does not have the right to request testosterone, on the chance he'll feel better? They might have indeed made him feel emotionally better.) Unless you can show that the doctor did something medically dangerous, such as not checking for prostate or heart issues, he (the doc) was probably within his rights to do what his patient requested.
Once you get your dad out of the trough he is in, if you are still angry at the urologist you could file a board complaint, saying you feel the testosterone shots were excessive or unnecessary. But again, unless you can show they harmed your dad (you can't) and unless your dad was not in his right mind and you can prove the doctor knew it, the urologist's defense will be that the shots were at your dad's request. Unless what a patient requests is medically dangerous or simply blatantly unnecessary, usually it's OK to give a patient what he wants, especially if he is unhappy and feels it will make him happier. (And regarding everyone's judgement that these shots were blatantly or obviously a waste on such an old man, who is to say that a guy in his 70s or 80s does not have the right to request testosterone, on the chance he'll feel better? They might have indeed made him feel emotionally better.) Unless you can show that the doctor did something medically dangerous, such as not checking for prostate or heart issues, he (the doc) was probably within his rights to do what his patient requested.
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Regarding the prostate and heart, while your dad is in the hospital, these should be checked (unless there are records of the urologist doing a scrupulous job of doing so). Testosterone is not known for big side effects (and, incidentally, is not known to either cause or increase depression), but there can be some slight elevations in things that affect the heart or prostate.
(For example, if your dad had been a heart patient or had a heart attack before seeing the urologist, he should not have been prescribed testosterone.)
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