Hans Amato@HansAmato
met an endocrinologist at a conference last year who told me something that changed how i think about men's health
he said "i see 15 patients a day. twelve of them are men under 40 with the hormonal profile of their grandfathers. and i'm not allowed to tell them that because the reference range says they're normal"
"not allowed?"
turns out if he diagnoses a 32 year old man with hypogonadism based on a total testosterone of 350 (which would have been flagged as clinically low 20 years ago) his hospital system pushes back. the reference range got updated. 350 is "within range." insurance won't cover treatment. his department head tells him to move on. the patient goes home with "you're fine" ringing in his ears and a body that's falling apart
this man has been practicing endocrinology for 22 years. he told me the average testosterone level in his male patients under 40 has dropped measurably in every single year of his practice. not stabilized. not fluctuated. dropped. consistently. every year.
for over two decades.
and every few years, some committee adjusts the laboratory reference ranges downward to accommodate the new population average. so the decline becomes invisible. you can't be diagnosed with something when the definition of "abnormal" keeps moving to include you
he said the most frustrating moment in his career was watching a 28 year old with testosterone at 280, estradiol at 48, zero morning erections, brain fog so severe he couldn't work, and depression that landed him in the ER twice -- get denied treatment coverage because the lab flagged him as "low-normal"
"low-normal." 280 ng/dL at 28 years old.
that would have triggered an immediate workup and probable treatment in 2005. in 2025 it gets you a follow-up appointment in 90 days
what does he tell patients who fall in this gap?
"i tell them to order their own labs, find a practitioner who reads the numbers in context instead of comparing them to a reference range built on a sick population, and never accept 'normal' as an answer when their body is clearly telling them something is wrong"
"btw i go to my next patient and do it all over again because the system i work inside wasn't designed to optimize health. it was designed to manage disease. and if you're not diseased enough to meet the threshold, you don't exist to the system"
this is the guy who went to medical school for 12 years, completed a fellowship in endocrinology, and his professional opinion gets overruled by a lab reference range updated by a committee he's never met
your doctor might agree with everything i post. he might know your testosterone is too low for your age. he might know your thyroid isn't functioning optimally. he might know that your "anxiety" is probably metabolic.
and he might not be able to do a single thing about it inside the system he works in
you are not his only patient. you are his 13-minute slot between two other patients who also got told they're fine
stop outsourcing your health to a system that gets paid whether you feel better or not
order your own labs. learn to read them. find someone who treats the person, not the reference range
