It was a Saturday and my doctor, – we’ll call him Hippocrates in my blog’s standard of renaming names to protect the innocent – just happened to be doing his turn to work a Saturday at the clinic.
The nurse took me back to the exam room area and stood me on the weight scale, which mis-weighed me as it always does. “Oops”, she said at first, “I almost took 50 pounds off of your there for a moment you weigh 145 not a195.” Hell it doesn’t matter because I don’t weigh 195 either. Like I said, their scale is off. You’d think a med clinic would have more accurately calibrated equipment. I wasn’t mad at this, more amused than anything. Took my temperature and blood pressure too, as they always do by routine. All normal as usual.
As we entered the exam room proper, she said “go head and sit down in the chair please.” Now, there were two chairs, placed side by side against the wall between the sink and the examination table. I chose the chair on the left and sat down. “Oh not that one, she said, the other one.” OK, could you be a bit more specific, I thought. She meant the other chair. Apparently she couldn’t see that there were two of them and I guess I was supposed to just know that she meant the one on the right. How silly of me. No worries, though. It was somewhat amusing too.
The nurse was middle aged, like 40-ish, and a 3 on the HB scale [warning: NSFW]. It wasn’t her usual day to work either and it showed. She yawned. She couldn’t’ remember if she’d seen me before. Well, I didn’t remember her either; on the three occasions that I’d visited Dr Hippocrates, I’d been introduced to three different nurses. This one didn’t understand what I written on my patient visit sheet (where it asked what would you like to discuss with your physician today?) I had a momentary bit of anxiety, worried that I wasn’t supposed to written on that form. I wasn’t here to have my T checked but that I’d decided to get treated for it. Low T, that is. It’s all good, though – I knew that Dr H. would remember my last visit when he’d told me about Androgel.
Then I waited ten minutes for Dr Hippocrates to come in. In the meantime I read a magazine article about Phil Mickelson’s arthritis. For some reason the magazine had chosen as it’s lead photo of him a shot of him in a gay, bright purple golf shirt. Well, the magazine was mostly targeted at women. It wasn’t SI.
So Dr H. came in with my charts and paperwork from previous visits, etc. Actually, he scuffed into the room with suede moccasin slippers on his feet. He seems like a good doctor and is friendly and smart and knows his stuff, but them slippers weren’t professional-looking. Okey-dokey, must be a casual Saturday thing. Of course, my gatekeeper (the inner voice) stopped me from saying anything about it. In fact it would never occur to me to make any such remarks. I’m too sensitive about making others feel embarrassed Even though I am always feeling embarrassed in most situations, myself.
I said, “I’ve been in here before about my T-level which was ‘low-normal’. And you told me about AndroGel. I was going to think about it, and I’ve decided to give it a try.”
“OK, good.” He was starting to remember me, perhaps? He looked at my lab results, which showed the T levels. Then, I realized he didn’t remember me, because he spent fifteen minutes telling me everything he had already told me the last time I was there.
Men experience a natural, gradual decline in T as they age, declining about 10% each decade. Even though its called ‘male menopause’ it’s not like the menopause women experience, because it’s not sudden or precipitous. There was the analogy of a bull elephant stampeding through a village, full of testosterone, and of violent men in prison. I would’ve had high T when I was a teenager, of course, but now my level was quite low for someone my age, he remarked.
“How old are you, again?” he asked, flipping the pages of my chart.
“Forty-four”, I said.
He hesitated just a split second, then chuckled a little and said, “Oh, you look a lot younger than that.”
Oops. He’d thought my T level was extraordinarily low (for a young man, which I’m not), not just a little low. I get that a lot – people telling me I look younger than I am, that is, not people questioning my testosterone level. I suppose that virginity, having only a few gray hairs, and staying out of the sun will do that to a guy. Anyway, the level was still a bit low, and treatments are available.
The typical patient who comes in seeking treatment for low testosterone is doing so because his relationship with his wife or girlfriend is suffering due to his loss of sex drive. There are other reasons as well – or, symptoms, I should say. These include having low energy, moodiness and irritability, fatigue, low motivation, and so on. Those would be my reasons, but I didn’t tell him that, specifically. I just added those symptoms in with low sex drive, as if it were all part of the same package.
He thought I was married. I told him no.
Sexually active? – No, but I’d like to be (throwing him a bone, so he’d think I was normal).
Seeing someone? – No.
Homosexual relationships? – No.
Have you ever been in a Turkish prison? – No.
Do you like movies about gladiators? – No.
(OK, I made up those last two.)
So, Dr H. was confused as to why I was concerned about my T level. He questioned me some more, trying to find out what, if I wasn’t eager to increase my sex drive and improve my relationship with a “partner”, I was hoping to get out of AndroGel.
Inwardly I bristled, though I remained calm on the outside. No one must find out my ugly secrets, you see. For a moment I thought I should’ve just lied and said yes, it’s to help my sex life with my wife. Good thing I didn’t, since I’m not wearing a wedding ring. Or I could lie and say it was for sex with my girlfriend. I’m not comfortable with lying, despite the habit of trying to conceal all my secrets. In the end I told him the truth, how it was recommended as supplemental treatment for depression.
His demeanor changed subtly. Not in a negative way — more like he lost his state of confusion (confusion caused by me and my Gatekeeper, that is) and he now understood that he had a different tack to follow. He began describing how there are of course other reasons for supplementing one’s testosterone, that sex drive is simply the most common one, and that medical science is still somewhat new regarding men and testosterone and it’s effects and how levels can vary and so forth.
I sat there and listened calmly – which for me means self-consciously trying to look normal, making eye contact, nodding, trying to smile occasionally, etc. (You ought to understand how deeply, thoroughly, overwhelmingly sensitive we fucked-up neurotic people are to the reactions to us shown by others, even the imaginary reactions. And, most of the time we’re barely aware that that’s how we are!)
As I sat there listening, sadness came over me. My Gatekeeper told me this was a mistake, that I won’t actually get the Rx filled, I won’t take it and won’t return for a follow-up visit, that I should’ve seen a specialist who has experience treating patients with comorbid psych conditions, that I’ve embarrassed him and made him uncomfortable, that I’m once again the square peg who’s doing something for weird reasons. I caught myself doing this, ruminating in front of Dr H, and then self-consciously worried that I might have a sad or distressed expression on my face and ought to control it so as not to make him uncomfortable. A bit of warm moistness rippling behind my eyes – if any depressives are reading this, you know what I’m describing, that hot black despair that arises and threatens to overtake you at inopportune times. If you’ve never experienced it you don’t know how powerful it can be. Not a good sign, here and now, don’t want to cry in front of him, what’s the matter with me?
That said, Dr H was tactful and understanding and still willing to prescribe the Man-Gel for me. If this were a novel, I would’ve made his character more bizarre, or judgmental or something, or perhaps gay and would hit on me, right? Such is life.
Do you understand the power that the fear of embarrassment can have over a person? That’s why I didn’t tell him I was a virgin. That’s why I also hesitated initially in telling him that my real motivation was to improve all those non-sexual things. What? Don’t’ you want to have a sex drive? No, because I’ll just wind up frustrated all the time. I went through my teens and twenties full of raging T, and came out of it still a virgin, because my gatekeeper would not let me get over my love-shyness.
One of my major, lifelong personality traits is an habitual reluctance to reveal personal details about myself to others. It’s that whole fear-of-being-shamed thing that comes with an avoidant temperament. It’s an automatic reaction, not something I decided on or planned to become. Thus, personal questions – even from a physician seeking to properly diagnose and treat one’s medical condition – are to be evaded.
Dr h handed me a prescription for this controlled substance. It’s not like steroids, though, so you’re not going to go to the gym and bulk up by using it. Nevertheless, that’s how the deeply concerned
nannies regulators of our FDA has classified it.
We’ll see how it goes.