Medical Opinion Highlights Hypogonadism as Overlooked Root Cause for Multiple Prescriptions

A recent social media post by Dr. Abud Bakri, a medical doctor, has ignited discussion around diagnostic practices in primary care, suggesting that low testosterone levels in men may be an unaddressed underlying cause for symptoms commonly treated with multiple medications. Dr. Bakri's tweet, which quickly gained traction, pointed to a scenario where a patient received prescriptions for ADHD, anxiety, blood pressure, and GLP-1 medications, when, in his view, a testosterone deficiency (hypogonadism) was the core issue.

"A guy gets put on an ADHD med, anxiety med, BP med, GLP-1 when all he really needed was a vial or tube of testosterone," Dr. Bakri stated, adding, "He was hypogonadal (T <200ng/dl) but his PCP wouldn’t check it. Make it make sense."

Hypogonadism, characterized by total testosterone levels often below 230-350 ng/dL, presents with a range of non-specific symptoms including fatigue, depressed mood, and difficulty concentrating. These symptoms frequently overlap with those of anxiety and Attention-Deficit/Hyperactivity Disorder (ADHD), leading to potential misdiagnoses. Studies show a significant co-occurrence of ADHD and anxiety, with symptoms like inattention, restlessness, and irritability appearing in both conditions, making differentiation challenging.

Primary care physicians (PCPs) face several barriers in diagnosing testosterone deficiency. These include a general lack of awareness regarding the high prevalence and broad impact of hypogonadism, the non-specific nature of its symptoms that mimic other common ailments, and time constraints during patient visits. Furthermore, some PCPs may be hesitant to order testosterone tests or prescribe therapy due to concerns about potential adverse effects or a perceived lack of clear, consistent clinical guidelines.

Untreated hypogonadism is strongly linked to broader health complications, particularly metabolic syndrome, which encompasses risk factors for cardiovascular disease and type 2 diabetes. Men with low testosterone often exhibit increased abdominal obesity, dyslipidemia, hypertension, and impaired glucose tolerance. The use of blood pressure medications and GLP-1 agonists (often prescribed for diabetes or weight management) in the scenario described by Dr. Bakri underscores the systemic health issues that can arise when testosterone deficiency is overlooked.

The medical community emphasizes the importance of thorough clinical evaluation to identify underlying causes of complex symptom presentations. While testosterone therapy is indicated for symptomatic men with confirmed hypogonadism, its long-term effects on cardiovascular outcomes remain an area of ongoing research. Dr. Bakri's tweet serves as a poignant reminder for a comprehensive diagnostic approach that considers hormonal imbalances in patients presenting with a constellation of seemingly disparate symptoms.