We have been discussing how health care providers arrive at diagnoses through the process of differential diagnosis and how providing men with diagnostic information may influence this process.
Of course, determining a diagnosis would be much simpler if each disorder contained a set of unique symptoms. Unfortunately, life is never that simple, and there is often considerable overlap among symptoms and possible diagnoses.
When a symptom occurs across many possible diagnoses, that symptom is called non-specific. By definition, the presence of non-specific symptoms does not tell us very much.
The marketing push behind testosterone replacement, and its diagnostic path, focuses initially on non-specific symptoms such as reduced sexual desire, fatigue, and low energy. It is argued that if a man displays enough of these symptoms then that man’s level of serum testosterone should be assessed. If that man’s level of testosterone is deemed low, then testosterone replacement may be warranted.
This type of diagnostic approach is a form of inductive reasoning. It makes intuitive sense and is consistent with how we solve most problems in our daily lives. You start with a hypothesis or a hunch about something and you look for evidence that supports that hunch. When the cost of being wrong is low, it can be an efficient strategy.
However, it is not perfect. When using this method we are prone to confirmatory bias. That is, we may tend to focus too much on information that supports our hunch or perspective and we may ignore or disregard information that does not support our perspective. And when the cost of being wrong is high, this bias can be potentially harmful.
Due to the non-specific nature of the initial symptoms of possible testosterone deficiency, arriving at a definitive diagnosis or excluding all other reasonable alternatives represents a challenge. As well, given the possible negative side effects of testosterone replacement and its unclear benefit, one would assume that a cautious approach to diagnosis would be emphasized. That is, we would expect that existing methods of diagnosing testosterone deficiency would err on the side of under-diagnosis as opposed to over-diagnosis.
A reasonable assumption. But as we will demonstrate in the following posts, that assumption is wrong.
- Pantalone, K. M., & Faiman, C. (2012). Male hypogonadism: More than just a low testosterone. Cleveland Clinic Journal of Medicine, 79, 717-725.