Talk before testosterone
In “Nothing More than Feelings?” (Current Psychiatry, July 2005), a psychiatrist is asked to decide whether a convicted child molester should receive testosterone treatment so that he can have sex with his girlfriend.
The article demonstrates a physician’s failure to do one of his or her most important functions: obtain as much information as possible before deciding on any course of treatment.
First, talk in person with the girlfriend with whom the patient says he wishes to have sexual intercourse. Does she really exist, or did the patient make up this story to obtain testosterone? What does she have to say about the patient and his sexual potency? Is she a reliable informant?
Second, talk to the patient’s parole agent. He or she is legally responsible for making sure that the patient stays out of trouble. The parole agent should have much information about the patient and be able to tell the psychiatrist whom else to contact. Also, talk to anyone else—such as a family member or roommate—who might have information about the patient.
Finally, the physicians should have tried one of the newer erectile dysfunction medications, such as sildenafil, before considering testosterone therapy.
Yehuda Sherman, MD
The authors respond
We agree with Dr. Sherman’s comments and thank him for his feedback. We are happy that this important article is grabbing readers’ interest.
David Krassner, MD
San Luis Obispo County Mental Health Services
San Luis Obispo, CA
Robert Hierholzer, MD
Matthew Battista, PhD
University of California, San Francisco