In Part 2 of medical tests you likely don't need, learn the controversy over testosterone levels, routine EKG screenings, allergy testing, and employer-requested vaccine titers.
In part one of our review of medical tests you may not actually need, I shared the reasons why there seems to be a cycle of over-testing in this country, starting with the media’s overpowering influence (referring mostly to TV and internet) on people to push for expensive tests and costly drugs when it comes to their health. This in turn pressures doctors into ordering unnecessary exams in order to please patients who rate them on Yelp and other non-quality measuring surveys. Patients are really “customers” in our current healthcare system, just like any other business. This shoots healthcare costs through the roof.
At the heart of this issue we should be asking: should healthcare be a business? Is it ethical for it to be so? As things stand, the lines are blurred and our state of healthcare continues to suffer for it. It's a slippery slope. Should financial decisions be influencing the practice of medicine? How can it not—if it affects patient decisions, then how can it not affect your care? Should your doctor be distracted by financial factors and their desire to please the patient, or should they practice medicine using their expertise and training without external influences? I’ll leave these questions for us to ponder for now.
But let’s pick up where we left off. In our first segment on medical tests you don't actually need, we dissected the reasons we typically don’t need some commonly ordered tests (but may think we do)—including Vitamin D levels, shoulder/knee MRIs, hormone levels, and blood typing. Today, let’s review the next set of four.
5. Testosterone Level
For those of you who listen to my podcast or read my articles, you knew this one was coming, right? I’ve dedicated an entire podcast to this one. The “low T” rage has taken up a storm in the last decade or so, thanks to the fortune-hungry pharmaceutical companies that have largely driven this fad. Men in their 20s seek “Dr.Google” for a cure for their depression and fatigue, while middle-aged men yearn for more robust stamina or some fountain of youth. “Low T” seems to be the answer to it all.
First of all, similar to the Vitamin D controversy, experts don’t agree on what is considered a “normal” level. That makes it tough for doctors to determine the appropriate target levels when treating the patient. Next, symptoms like depression, fatigue, and low libido are all complex medical issues that are often multifactorial—meaning that they are influenced and caused by multiple factors. Low testosterone alone is unlikely to be the sole cause, if at all. Also, studies on testosterone are mixed and inconclusive. That’s right, currently we don’t have a lot of evidence to back up the efficacy of testosterone treatment. A placebo, however, is a powerful drug that's well-established in the scientific community. Now I’m not saying it’s all a placebo effect, by no means. We simply need more solid answers before jumping on this “low T” bandwagon.
Testosterone treatment is also not risk-free. According to research studies, it can cause infertility, worsen sleep apnea, potentially feed a hidden prostate cancer or enlarge a prostate, cause blood clots, or possibly even increase the risks of cardiovascular disease (heart attack and stroke).
As with everything, we must weigh pros/cons before making decisions for each patient when it comes to controversial tests like testosterone levels.
6. Routine EKGs
Speaking of heart disease, it's the number one killer of men and women in the U.S. There was a time when routine electrocardiograms (EKGs) were run during physical exams (and I believe the military still performs them if I am not mistaken) in order to help identify those with potential risks of cardiovascular disease. And by “routine,” I mean performed as a preventative test for asymptomatic people, not for those with chest pain, heart palpitations, or symptoms of potential cardiac issues. That’s a whole different ball game.
But not any longer. The U.S. Preventive Services Task Force (USPSTF), one of the primary expert groups that set guidelines for practicing doctors, concludes that based on current evidence the harm of routine EKGs on asymptomatic low risk patients outweighs the benefits, and therefore recommends against it. The USPSTF also states that there is currently not enough evidence to recommend it in asymptomatic but intermediate risk people.