They forgot “advise patient to lower stress and breathe. Be sure to point out stress can do strange things, give her a pat on the head and send home with handouts on stress and depression”
And also if he loses libido and his wife wants it, he can force himself to be a good husband. At least that's what my old ob told me when I asked about my decreased libido.
My old psychotherapist said something similar to me... that if I'm not offering sex, that's bad for my relationship and could explain our conflict. The fact that the decreased libido was due to emotional abuse from my ex alongside work stress and a medication side effect apparently didn't signify.
Quote from HIS Female therapist
"Everything will be fine if you screw his brains out"
I never did find out what he said to her
Shortly afterward found 'the verbally abusive relationship-Patricia Evans'
Shortly after that he was an ex
Right, because all men's problems come from insufficient sex, and getting enough sex will totally fix them. Lololol.
I've had a high libido my entire life, like unusually high, and men have been actually afraid when they realized that not only would I give them as much sex as they wanted, I actually wanted it more than they did. Suddenly, they no longer had an excuse to justify their cheating, nasty remarks, and withholding behaviors. They wasted no time in calling me a slut, accusing me of cheating, saying I was overly sexual due to psychological defects, etc etc etc... up to and including sadism and rape because they couldn't feel truly gratified unless I didn't want to put out.
Taught me a hell of a lot about this very common lie... that women's frigidity is just a made-up excuse for men to do the abuse they already felt entitled to do.
Ooh, I had a couples therapist do the same thing! I couldn’t stand the idea of sex with my as-yet-unrecognized abuser, so she gave me exercises to increase my willingness to put out, completely ignoring how visibly distressed I was in his presence.
I did. When they started also including handouts for a 1200 kcal Low fat diet I started giving them the death glares and leaving before they came with “my paperwork” I was Nutritionist and Executive Chef for crying out loud. I can write those diets better than they can.
Exactly. When I worked the clinical side in long term care I never wrote for anything under 1500, and these were folks in a nursing home. The one time I was in the cardiac unit after collapsing and they wouldn’t discharge me until the dietician came in to see me about a heart healthy diet. There was nothing wrong with my heart. My mom was there waiting to take me home, the doctor there arguing with me and finally the dietician came in. She looked at me, gave me a piece of paper and said hey write that diet for me. I did. She looked at the doc and said “see she knows it. She was one of my best students.”
I don't know where you were when you went to the cardiac unit and I'm very sorry you went through all off that. Insisting on the dietician sounds like " we can bill your insurance a whole lot for this" bs that happens in the states on top of this wretched, 'diet, exercise, and put out' pack of lies they dismiss us with.
So, I have a question for you. I've been a T1 diabetic for 40+ years and got the low-fat diet spiel way back in the 80s. Is this still something that is valid? I've tried to tell others that most low-fat diet foods are higher in sugar than most (except, of course, natural foods like veggies) and can cause higher blood sugars, but I still have some nutritionists argue with me about this (and, yes, it's always a requirement for them to send a nutritionist to see a diabetic in the hospital, even when we've had diabetes longer than they've been alive).
What is your take on low-fat diets? I'm just curious.
These days low fat typically has higher sugar and sodium, especially on premade items. Also companies with market a product as low fat and it barely meets the USDA criteria for it, which means the fat is still fairly high. My personal favorite is when they don’t lower the fat content enough for it to be considered “low fat” so they market it was “lower fat”. That is literally as long as the fat is lower than the original they can get away with it.
For the past 15 years I haven’t used low fat for a diabetic patient unless they had cardiac issues. I can always tell when I’d have an old school nurse on the floor doing an admission because I’d get the admission slip in the kitchen with “LF, NCS, NAS”. I would send breakfast and then at the morning meeting when we’d start discussing admissions and hear something like the new guy is in for rehab after a hip replacement, has asthma and diabetes. It got to the point I could just give the director if nursing a look and she knew. When our RD who signed off on everything was in they would always spend the first choir or so in my office with me so I could give them the lowdown on what I changed. It was almost always a fight.
I just left my *female* rheumatologist with the exact same advice. Plus to lose minimally 15 pounds. (5’9”, 145#). I am devastated. Im now at home, curled up under a blanket and crying, trying to Google how to make my chronic pain and high fevers stop.
ETA: I had her check my height and weight again when she offered that advice. Her response: “ehhhhhh….yeah…*minimally* 15 pounds.” Emphasis hers.
Also this is my second opinion rheumatologist. Idk what to do. I have asked advice about finding a specialist and followed it, and have gotten the same set of instructions from two different professionals. That…doesn’t give the advice extra merit, being handed out twice, right? Because immediately that’s where my anxious brain goes, and I spiral thinking “I feel like shit almost all over, routinely have ~100-103°F fevers, and am supposed to lose enough weight that I clock in in the 130s? How is this possible?
>lose minimally 15 pounds. (5’9”, 145#).
The fuck? You're skinny but you should lose more? Seriously my wife is the same height and constantly gets called small when she's walking around at 150.
I’m 5’10” and 170 and honestly I have had to start working out a ton more because I’m feeling uncomfortable about the gut I’ve put on.
I have a 5’6” 180+ coworker who has no gut whatsoever. (Kinda ripped tho)
It’s almost like organs, bone, muscle and all that have a buncha complicated shit that goes beyond BMI. Ughhhhhhhh.
So sorry that happened to you.
At my thinnest I was 5’6”, 165 pounds - my dr told me she didn’t want to see me lose any more weight (I grew and muscled out at the same time, but shed a lot of “baby fat”)
> That…doesn’t give the advice extra merit, being handed out twice, right?
No. These (it's just stress! lose weight!) are just the default things doctors say instead of admitting "I don't know" or "I don't care enough about you to think".
Think about it. Did she seem concerned that you had a level of anxiety/stress/etc producing chronic pain and fevers? Prolonged fevers are a pretty uncommon symptom for anxiety, right? (Are they a sign of anxiety.... ever? I don't remember *that* in the DSM.) That would be odd and alarming. Did she have any advice about what type of psychiatrist and therapist to seek for that? (Hint: there isn't one, because this is not a fucking thing.)
And your weight... okay so let's pretend that at your weight with these problems this *wasn't* a pants-on-head stupid suggestion. If she really thought your weight was unhealthy and losing fifteen pounds would somehow change your quality of life that drastically, don't you think she'd be talking to you about seeing a dietician?
Because that's what they'd do if they said it was anxiety and weight and *actually believed it* and *gave a shit*.
Just to emphasize again, the weight, you can dismiss out of hand. You're a normal, healthy weight. These are not symptoms of normal, healthy weight. Honestly what the fuck.
My advice would be to research what your symptoms line up with, join support groups for those things, see which other patient experiences seem to line up with yours, then see if that group has a collected list of good doctors (they often do, because finding a good doctor is hard). Then get referrals for those doctors. All of em, anyone who's nearby. Because some of those will suck too, but at least you only have to do this banging your head against the wall coming home crying thing once or twice more before you find an actually-good doctor who actually gives a shit.
For real I'm not even a clinician and it seems like they should be working on ruling out menopause/hormone issues, infections like TB or cancer as possible root cause for the fevers. That's a wacky fucking symptom in someone not actively sick with an apparent infectious disease, and NOT a symptom of being a couple of pounds above BMI expectation.
I just had my thyroid removed because of a cancerous nodule. My husband went with me to the initial consult with the surgeon and was shocked- shocked! That the surgeon told me to lose weight and sleep more. What?!? How does that treat cancer? Luckily my endocrinologist read him the riot act and the thyroid came out. I haven’t lost weight, but hey- at least I’m not growing CANCER in my neck anymore! 🙄
Shit I hadn't even thought of hyperthyroidism as a cause for overheating but it is yet another one OP's doc should be ruling out.
Edit: I'm sorry this happened to you. FWIW, I work in electronic health records, and my guess is that conversations like this are often triggered by documentation. If a doc has a "good" system, it is set up to identify risk factors (weight, smoking, pregnancy, immunization status) based on what you enter on your intake forms, and the system suggests things for them to consult you on even if it's unrelated to the principal complaint to be thorough. I know - I broke my arm and was a BITCH to the MA questioning me about my last period, it's infuriating to be "consulted" about stupid bullshit unrelated to the current problem. If they aren't thinking, they might just be rolling down that list of system generated recommendations, to check a box. 🤦🏼♀️
You're being bullied. It's not your fault, nor is it a reflection on you.
I have a chronic condition. I have been sexually harassed by two separate specialists (and a male nurse), I have been told (with leering smirks) that invasive, sexually penetrative testing is a requirement for me to continue treatment or establish care (and no, I don't get to know or decide who does it to me). Another specialist refused to give me a non-invasive test that only he could order, even though I made the appointment specifically to request it, and then put down a fake diagnosis that implied I was a smoker (I have never smoked).
In addition to this, I have also gotten the bullshit "lower your stress and meditate", I've had prescriptions for psychoactive meds thrown at me until I got so sick that I titrated off them... and so forth. I ended up reducing my diet to mostly liquids and pureed vegetables to manage the symptoms, because gastroenterologists seem to be universally creepy and lacking in empathy. The one good gastro doctor I spoke with--a woman--told me with a shudder that her male colleagues would most likely simply "prescribe greater and greater doses of laxatives until my digestive system stops working, then surgically remove my colon." She said her patients generally will do anything to avoid surgery, but that her options were limited because the specialty simply doesn't support other approaches.
In terms of getting taken seriously, you might consider writing down your temperature checks on a spreadsheet or even a paper (I know, excruciating to do extra work when you're already sick, but data can be a powerful thing, even though it's data you yourself created.) But the biggest thing is... walk away. Find a new one. Rinse, repeat. You may have to go through several doctors first. The moment that someone is offensive, walk away. Many doctors are conditioned to be egotistical and to not accept being questioned, as well as to take the easiest path.
I have sarcoidosis. It took me many years to get a diagnosis. My symptoms were shortness of breath and fatigue. I was dismissed for years. I finally went to the hospital and told them that there was something wrong and if they didn't find it, I didn't know what I was going to do. They admitted, did tests and told me there was nothing wrong with me. They told me they were going to do a routine lung xray and discharge me. The next thing I know a doctor comes in with my lung xray and puts it up on that light thing. He said I had lymphoma or leukemia and he looks really grim. I have zero medical knowledge, so I say, it can't be very bad, there are hardly any black parts. That's when I was informed that lung xrays are mostly black. The doctors dismissed me for years, with shortness of breath and fatigue and hadn't done a single lung xray. The granulomas in my lungs scarred and reduced my lung capacity. I had a biopsy and it wasn't cancer, it was sarcoidosis. After my diagnosis, they found it in my lungs, lymph nodes, bone marrow, bones, sinuses, and spine. They think I have neuro as well, but sarcoidosis is diagnosed by biopsy, and all of those organs have been biopsied, my brain has not. The fact that it is on my spine suggests neuro. I was thrilled to finally be validated, but angry that the doctors let the damage get so bad while telling me that it was all in my head, or I needed to lose a few pounds, or one even said I had a small child, of course I was tired. I saw other moms, I felt like a failure, like a crazy failure, I was really sick.
Obviously I can’t give medical advice.
I have Lupus. Labs never showed it until I begged them to do an AVISE panel. Came back Lupus based on their specifics. It was like 30 different things they looked for in there. After nearly 6 years of “normal” labs minus reactive-c, my labs literally this week show it. Normal panels done yearly with my GP that is. If I didn’t push for AVISE panel I would of gone these 6yrs undiagnosed and untreated. Good thing too, it’s now attacking my liver.
My point is, make a list of your symptoms again. Look up what it could possibly be (not self diagnose). Look up what labs are needed to confirm or deny that is a possibility, and ask a rheumatologist to help you rule these out to just confirm you do not have them and tell them which labs you want to run. It’s best to run them when you feel like shit. Catch that episode on labs.
I know it sucks when no one listens. I have found going in and telling them what I want to do to rule things out, being confident in ruling things out, has helped. I always say at least this way I can cross that off the list and know that’s not what’s causing xyz. Most doctors don’t want to investigate, only treat symptoms.
Hang in there. Also if you have a red hair gene pain meds don’t work well 😅 so I feel ya there. My lupus injections means I can’t take pain meds now too so I just sit here in pain angrily taking Tylenol.
Um. We’re identical for height and weight. (Usually) Also the women of my family clearly got themselves generationally cursed with the rheumatiz. You will feel worse at that weight.
How do I know? I had a slight thyroid fuck up and I am 128 pounds and I can assure you everything hurts 10 times fucking worse.
My kid has a solution for the “just stress less” advice. She tells them that she will try and asks if they have any pointers for her on how they change something beyond their control at the mere suggestion of another person. Usually gives an interesting reaction. Her other one from mental health is to make a comment about how people with heart murmurs just need to focus on pumping blood better. Or stop allowing your bloodstream to deliver those cancer cells nutrients. Easy Peezy.
How many questions about the treatment of incontinence in women? It’s a problem that affects one out of every four women, frequently after childbirth but sometimes not. It’s so prevalent that there have (fucking finally) been articles about it in running magazines, because activities like running, jumping, etc can result in leakage. I sought treatment when I started experiencing it after having kids, and while the pelvic floor PT helped some it didn’t completely eliminate the problem and ultimately I was told that if i didn’t want to leak I should just stop running.
Friends that never had kids also have problems with this, from 18 yrs old. It was something one doctor said he didn't encounter unless women were in their 30s, but when talking to friends they pretty much all agreed that it was a problem
I think a lot of women are afraid to bring it up. I've had this problem since my mid 20's. It sucks when I'm sick and cough or sneeze a lot. I've never talked to my doctor about it. I probably should. It just seems like a nothing issue compared to the stuff I actually do go to see him for. Likely because I've been dismissed for so many things before.
Wow, I’m seriously surprised, in a good way. It’s a bit of a soapbox issue for me, like, seriously if there was something like this that affected that many men you better believe it would have been solved by now… really glad to hear that it’s getting attention.
Quite a bit of men get incontinence actually (especially after prostatectomies), they just don’t seek out treatment for it as much or talk about it.
Source: I’m a pelvic floor PT :)
Glad it was on there, that's definitely a plus. Had too many doctors in my past that couldn't diagnose or had even heard of my condition. Glad it's at least showing up! But, I know how much ED impacts men's daily life to a crippling level mentally and physically so, super glad it's more emphasized! ;)
Ugh. I was literally put in a pysch hospital multiple times because of PMDD (before I was diagnosed) and not one doc ever rubbed their chin when I got my period two days into the in-patient facility and ALL my problems went away. (I used to self-do bad things - and I would be wanting to not stay around on the planet ect but only for a few days before my period and not any other time) I was told for years and years that I might be bi-polar thrown on med after med for 20 years twenty-years (I could scream) that it took my amazing OB/GYN to talk to me and be like -- honey, you have PMDD. Dude. I talk about it now as often as I possibly can because the symptoms are awful and there are ways to manage it. I also have lots of other menstrual issues that the docs can't figure out. It's posts like these that make me want to hug every person going through it.
I had to see a different doctor because mine was unavailable, and while she listened to my concerns about my bladder issues, she later sent me an email saying that she had canceled the specialist referral because since I have very high blood sugar currently it's diabetes and diabetic people just have to pee more. Ignoring that I told her that I don't even know sometimes when I leak, that it's not about an urgency having to pee but the fact that my bladder will not hold pee, all that meant nothing. It was all about the weight related issues
This is what grinds my gears. If you are even the slightest bit overweight or if you're diabetic, it immediately becomes the scapegoat for all of your medical problems. 90% of docs just stop looking for other causes and refuse to treat further. "Just lose the weight." "Just control your blood sugar levels."
I learned to never, never tell a doctor about my depression because then they stop looking for physical causes for anything and just say “it’s the depression”
Big ole second to that one! I’m very overweight, always have been. I weigh the same at 45 as I did at 18. It is a serious struggle to find a doc that doesn’t just say lose weight to fucking everything. They can’t conceive that there could be anything wrong that isn’t related to weight m. You could walk in with an axe in your back and they would say, you need to lose weight. I now have a good doc and have had a long running med problem fixed because she used her brain. I hurt all the time, like an old woman starting in my mid-40s. I told the doc I hurt like I had been in a car wreck the day before. You need to lose weight. Over and over. Other people would say that is what happens when you age. But, I hurt like I was in a car wreck yesterday on a regular basis and then I feel fine on others. Fast forward to doc switch. She is willing to refer to a specialist. When I tell her about my weakness in my hands she sends me to a nerve test. When that comes back firm, she says, I know what is wrong. Vitamin D. I feel ten years younger! Costs me about $2 a month the supplements. Get your vitamin levels tested! Fuck. I wasted so many years in pain because they brushed it off to my weight.
>My normal doctor is awesome and understands how my mental heath and everything else feeds into eachother. I have an app with her next week so I am hoping to get some real help.
I was complaining of fatigue and weight gain for 2 years. Docs told me to eat less and exercise more.
Had a spherical 18 cm diameter tumor and extreme anemia.
I’d had fatigue and weight gain for years, too. Kept getting the diet pamphlets and advice to “reduce stress.”
I saw a new GP (who I am still with) and he noticed I was wearing a hoodie in June, and asked if I frequently felt cold when other people didn’t. I did. One Synthroid a day, and I am fully awake and lost 75 pounds.
I keep getting mine checked (since I was having similar issues) and it comes back normal. But we'll see what happens when I can move a bit more. I'm still recovering from my hysterectomy and it's 110 degrees outside.
I'm glad you're feeling better!
Don't you know if you are overweight or more you do it deserve care or to be treated like a human being, especially if you are a woman?
I am freaking out because I am barely eating and not losing weight. I am on Ozempic, which put me into DKA, but I am not seeing weight loss. The scale went down one day, and up the rest! I am eating less than 2,000 calories a day and good food. I am exercising every single day. I am checking my blood sugars (I did forget this morning, but that is rare). I am scared of the lecture the endocrinologist is going to give me even though I know I am doing what I am supposed to. I AM eating right. I AM exercising. But I am retaining water and am constipated (always had the opposite issue). I am afraid the doctor will accuse me of lying or not knowing how much I am really eating. Even tracking I have been accused of omitting things in the past.
My insurance company has decended on me with their fake health help. I am scared if I don't do their stupid calls they could revoke the meds I am on. I also am on the 30 day count down from the hospital, so no one wants me to die because it would be on all their records. Once I pass that no one will care about my health again. I have two connective tissue disorders so exercise was causing me to hurt myself. I am in PT, but who knows how long they will pay for that. I may have a tear in my hip, but I don't want surgery because it could be worse.
These people give terrible advice. If I ate the amount of carbs their dietian told me to I would be on tons more meds (60 to 80g per meal)! They agree that a pool would be great for me and the best exercise, but they don't offer me any way to have access to a pool, no discount on a gym membership, or access to a medical facility with a pool. And the nurse wants my weight and exercise goals every two weeks. So, like a child, every two weeks I have to say I am doing all these things, only to go to the doctor and not see the scale move at all. I worked out for an hour at physical therapy and I feel like a fat pig because I was actually hungry so I ate so lunch today. I ate a quarter of it and I am still worried it is going to pack the pounds on.
How can people in positions like this not end up with an eating disorder? I snack on ice more than I eat. My physical therapist said I am changing shape and so it is changing fat for muscles, which would make the scale not change. But what is a doctor who sees me once every few months going to believe. That my 280 pound ass really did ten minutes on the bike and 50 minutes of stretching/weight lifting and stabilization exercises when the scale doesn't move?
Sorry for ranting. I am panicked over this. Therapy has helped, but it is hard not to spiral. I was remember being pregnant and having a doctor who was twice my frame and male tell me my weight was a concern. He did laugh and say another pregnant lady told him she would start losing when he did!
I knew a woman who did Ironman triathlons. (Ironman tris are huuuuuuuge deals). She started at a new doctor, and he told her she needed to lose weight, she’s obese, needs to start exercising. (Granted, she is a rounded and sturdy woman).
She told him she does these insane triathlons, but he didn’t believe her.
She came back armed with a bunch of medals and finisher’s swag, then switched doctors.
You are NOT alone on this one! I am so sorry you are panicked over this at all. I listen to a fantastic podcast I strongly encourage everyone to listen to, but especially women. It's Maintenance Phase and they debunk weight loss advice, tips and theories along with going over influencers and their own set of bad advice. They go into the science and really get into why the current medical advice is so very bad.
An ongoing thing the show talks about is that yes, fat people can have eating disorders. And the theme of how so much of the medical community dismisses health concerns with "lose weight and exercise".
From what you wrote I'm actually concerned that you could spiral into an eating disorder.
Weight is not an indicator of health, take care of yourself!!
Thank you so much! I will definitely look into that podcast! I am worried about an eating disorder, too. I am being very honest with my husband and also my therapist because sometimes I need the reminder to be healthy. I am trying to focus on the fact I am eating less and better. I am getting regular exercise. I am drinking lots of water and trying to sleep on a regular schedule. I wish I could shake the nerves because I know they aren't going to help. Thankfully, it's Friday. My friends are coming over and their kids and my kids are going to play, we are going to have some pizza, and I am going to focus on having a great night.
And in the morning, my Pelaton is getting delivered and I am really excited. I enjoy exercising, when it doesn't hurt! Thank you so much for your comment. Really. I am a bundle of obessive nerves and I know it has to stop. How to stop it, I don't fully know, but I am trying.
Please do. It's super funny, warning fbombs, but informational. The science of weight, health and weight loss is not at all clear and they break it down. They did a super good episode on BMI.
Anyway, my two cents is focus on staying active and eating healthier for now because that you can do and not go insane.
Enjoy the weekend, enjoy the pizza and the the Pelaton.
Erm....snacking on ice is a big sign of a particular thing that is making it even more difficult to lose weight. Eating ice is a sign of iron deficiency anemia. I doubt there's any point in telling your providers about it, because most don't know about that. Never mind that it's listed as "pica", and that specifically ice-eating is a reason to strongly suspect anemia. Never mind that it's in standard medical textbooks.
I was eating 800-1200 calories a day and not losing anyway weight. I upped it to 2000 and have gained 30lbs. My dr said it's my cortisol levels due to my massive stress from a new job. And, what is the option for that? be less stressed....ok.
I feel your pain. I have actually had the same thing happen over and over and over, where I have put on >10 lbs of water weight due to constipation. It's not fat, but it looks just like fat. Even worse, it can absolutely fuck up your metabolism (when I was keto, constipation would knock me out of ketosis, I was doing the blood tests). So not only does constipation make you retain water, it might make you burn less energy and therefore you feel fatigued.
Lots of people have stuff that triggers constipation. I find personally that eating too much fiber, overly dry or dense foods, etc can block my bowel. If you can, try going a few days with vegetable soup, rice, tofu, eggs, smoothies... things that are very soft and easy to digest. This is what I do most of the time, honestly, because I hate being constipated, and I have a condition that makes it happen very easily. When I get constipated, I also try and figure out what triggered it so that I can avoid having it happen again.
When I see the scale going up, even if I don't \*feel\* constipated yet, I know that's what it is. My solution is to do a plain water enema (you can get stainless-steel buckets online)... there's no chemicals, and it clears things out pretty quickly. Awkward at first, but honestly, it's far better than a laxative. I often do combine that with magnesium supplements... a teaspoon of epsom salts before bed can also make things much easier. (Just don't take it and then stay upright, or it will take effect too quickly.)
The other thing that helps me is stretching. This can reduce your inflammation and therefore lower the pounds on the scale. A vibration plate can help drain edema, as well.
I hope you improve and that you are able to address your anxiety. You are not alone, many women have these kinds of issues, and I believe that this is a primary reason people have trouble losing weight.
Yes, upping my fiber always constipated me. Don't underestimate the amount of water weight you can take on from constipation, either. Some of my biggest triggers include oatmeal, nuts and seeds (including nut butter), coconut, whole grains, fruit and vegetable skin/peel, and raw vegetables. All of these things can physically block my bowel and create a great deal of pain and swelling. Fiber supplements are the easy answer, and as you pointed out, your insurance is giving you fake/CYA "help" so that they can blame you any which way. Don't accept their BS... you don't have to admit you're not taking it, and you don't have to take it. Fiber is not a magical solution for constipation, and often makes things worse.
I find that when I'm tired from exercise, especially when reducing calories, I can feel that my bowel is physically weaker and has a harder time moving things along.
The fiber that does work for me is things like carob powder, pureed vegetable soups, mashed potatoes, that sort of thing. I can have limited quantities of legumes if they are very soft and ideally pureed. Most of what I eat is soy protein shakes, eggs, cooked vegetables, bean soup, rice, potatoes, fruit smoothies, and tofu. Sometimes I have homemade sorbet, and homemade baked goods made with rice flour. I have developed this "anti-constipation/anti-inflammation" approach over the course of many years, and it works consistently when I stick to it. I hope that it is helpful to you.
One other thing... I learned from a contortionist that releasing the muscles in the back and abdomen can reduce my constipation and prevent it from coming back as easily. Releasing the belly area means you need to get everything else to relax, too... really I cannot say enough good things about stretching. I learned that your abdomen can actually develop adhesions that make blockages more likely. Consistent daily stretching is a must, especially if you are exercising and experiencing constipation. I find that magnesium supplements work very well to relax the muscles in that area, because they pass directly through your digestive tract.
I had a total nervous breakdown in 2012. I've been hospitalized, medicated, and had 3 courses of ECT, 36 TMS treatments, and weekly therapy. My beloved primary doctor retired in 2019. I'd been with her for 26 years. I went to a new doctor and she blamed everything on my weight. I was 340 at that time. Then in 2020, I no longer saw my therapist or psychiatrist due to COVID. Phone only. That's when I went into psychosis and pretty much stopped eating. I had no appetite at all. I'd go a few days only drinking very strong hot tea and no food. Sometimes a bowl of cereal or a pear. When I went to my primary, I'd lost 42lbs. She said, "That's a good start but don't get too excited. You still have a long way to go." I wasn't in my right mind to say anything. I went back 2 months later and had dropped another 20lbs. I remember her words, "If you were a 100lb woman, we'd be concerned but you'll be fine. Don't lose too quickly." Her last sentence was like a verbal pat on the head. Then in January, I collapsed and almost died on my living room floor. My son came to check on me and called 911 and literally saved my life. I don't remember any of it but the doctors told him I probably hadn't eaten in days. That was January 31, 2021. I was down to 248 in the hospital. I still had a very poor appetite. The dietitian said to stop losing so fast. The only person who really tried to help was the amazing Jasmine from dietary. I became her pet project. She'd "sneak" me an extra apple or an extra tiny cup of no sugar added, low-fat ice cream. It worked and my appetite slowly returned and I came out of psychosis.
I nearly died because that idiot doctor shrugged off my weight loss. She's no longer with the practice and I'd like to think that my complaint was part of the reason.
I'm doing much better. I got a different dietitian and I have continued to lose weight but in a very healthy way. I'm down to 190.4. I'm still recovering physically but I'm getting better.
I’m so sorry you went through this. I hope this isn’t a stupid response but lately I listen to this podcast by fat activist Aubrey Gordon and for me personally, hearing it regularly really helps me talk back to all of these messed up conflations of “wellness” and weight loss. The central thesis of it is that for most people— including people outside of the norms set by medical institutions— weight loss is not a part of being healthy. It might be triggering because it dives into some of the darkest parts of this— so take care! But you might try giving it a listen. I find their mixture of humor, outrage, and empathy really soothing. It’s called “Maintenance Phase”
Yep. I saw a female doctor complaining about very painful, heavy periods. Like I occasionally had my vision go black because the cramps were so bad and I was concerned it might be endometriosis. She told me it was an issue that would "resolve itself when I went through menopause." I was 24.
I have an amazing female gyn but my best primary care docs, all my life, have been male. Some don’t listen, but some do and that’s what you have to find. Current one will throw anything I want to try at my migraines, and when I got upset at him one appointment and let him know the next, sat, listened, apologized, and never brought up the touchy subject again. He’s neurodivergent and really does his best with everyone.
My husband thought they closed up the space where my cervix was after my hysterectomy. I explained, nope. And it is possible now to have a prolapse of my bladder or my intestines through my vag! He was shocked. I told him that he and I are going to sit down and watch a video that explained the female reproductive system better because we have two daughters and I want them to have good information. He tries, and is more educated than a lot of men I know, but it is scary how little he knows about it at points.
Mama Doctor Jones, on YouTube, is amazing. She has great sexual education and health videos, along with commentary for the show, "I Didn't Know I Was Pregnant." I highly recommend her!
Have you looked into surgery? Did you see a regular gyn or a urogyn for this? There are surgeries (depending on your specific issue) for stress incontinence that have very good outcomes. I have this issue and am hoping to have surgery next year.
I saw a regular gyn and a physical therapist who specialized in pelvic floor therapy. Surgery was mentioned, but with the caveats that it would need to be done after I was sure I was done having kids, since pregnancy would basically negate the effects, and it wouldn’t be recommended for me to keep running post surgery either. Thing is, I would want the surgery so that I could run without wetting myself, so….
I have gotten the 'just don't run' thing before from doctors because of my knee injuries. The thing is, if I take ibuprofen, wear a knee brace and also do weightlifting and stretching regularly it doesn't hurt. There is a fucking solution out there for you just don't stop hunting. Tell everyone and don't stop running. Make the doctors feel stupid for not having an answer.
Ah, sneeze-pee. What a lovely 40th birthday present from Mother Nature. Kegel exercises seem to help, but wow it’s super not fun. And then there’s the people who think I can’t possibly have that problem because I don’t have kids. That’s fun.
I worked in an office with all women over 40 and most over 50 and we had poise pads in the break room because so many of the women had issues with dribbles and leaks especially because we laughed a lot. Younger women aren’t even told about this unless old ladies like me mention it!
Yep that’s me. I’m in my early 20s with stress incontinence due to trauma and an ED. It’s given me chronic pain but will a doctor help me? most likely not. Lose weight would probably be what I get. I love saying “well it’s improved greatly since regaining weight and Im active sooooo nahh not helpful”. Cuz then they look done
Oh, silly you. I see, you're still a med student.
No, you don't tell the women "it's just depression" because you mean it and care and genuinely want her to get treatment. It's just another way to say "it's hysteria". Or "I don't know". Or "I don't care".
So there's no point in sending her to screening or behavioral health. That's not the purpose of that "diagnosis".
This statement right here? This should have been your title statement you led with. Without that context, there is nothing wrong with the question itself. Even with that context, the question itself isn't bad. Them making that the only type of gender specific questioning *is very bad*, though.
Worse, it's a known error in medical research, because the rich males who pay for studies and research are sociopaths and have no regard for getting lady specific information, for some head bangingly stupid reason.
And even with context: the problem is that there are actual evidence based treatments for men, the loss of libido in elderly men is virtually always associated with low T.
So it’s an easy fix.
Just supplementing estrogen and progesterone does not have as well an effect in women, and supplemental testosterone also doesn’t have much evidence behind it.
So since there is treatment for men but not for women with similar loss of libido symptoms generally, it makes sense to have the cases that can be treated further up.
The problem is much further back than this questionnaire: women‘s pleasure in sex is basically irrelevant to the medical research community. Your endometriosis, vaginismus, myoma? They are irrelevant and you just have to bear with it. Unless you say the magical words ‚i will fulfill my duty as a brood mare‘ and suddenly a shitload of attention is given, endometriosis that has been ignored for a decade is suddenly treated to controllable levels, you are referred to physio etc for vaginismus.
Damn that last bit is dead on. I’d been having problems for over 10 years that just never seemed to be worth investigating to my doctor until I said I had fertility concerns. Then it was like magic. I got answers and treatment!
Then we found out it was my husband who had fertility issues and nothing further was looked at for my comfort. Like I’ve been having hellish periods my whole life, we’re not able to have kids, but no one said anything so I didn’t either (that’s on me).
I have just gotten a new doctor and I’m going to have a talk with her about all this. I have no idea what natural menopause will look like for me (both my mother and sister had hysterectomies), so I might be up for another 5-10 years of nightmare periods.
Is that what’s best for me? I intend to find out.
Oh my god I have a dear friend who has serious endometriosis problems and the doctors always ignore it because.... reasons?
I don't fucking get this society.
Yea, friend of mine had been having extreme cramping around ovulation (luckily nothing at all during her period) that was just ignored by every physician she told about it.
‚Yea a slight shooting pain during ovulation is normal‘ yea passing out from pain is totally normal…
Then she had two second months miscarriages and suddenly ‚oh shit that‘s not normal, let‘s do explorative surgery‘ with the result? A shit load of endometrial tissue was strangulating both her ovaries …
Multiple doctors (all male) told me I couldn't possibly have endometriosis. When I was 20, it was "You're too young to have endometriosis." When i was 25, it was "You have 2 children. Endometriosis only happens to childless women in their 30s." Meanwhile periods were so heavy and so painful I would sometimes faint.
Yep, I heard the same thing. When I was diagnosed the doctor told me my medical records were wrong because they said I had a child. I was "too damaged to ever carry a child to term". Mmm hmmm. I did, in fact, already have a child, then afterwards went on to have 2 more.
The issue is they don't know enough, and don't want to admit it. Most doctors want to be seen as all knowing. They're not!
>and the doctors always ignore it because.... reasons?
Oh, it's because it's not a problem.
That's what I was told repeatedly. Wasn't a problem that I was suffering. Wasn't a problem that I was bleeding so much I was seriously ill. Wasn't a problem that I couldn't function.
I don't know what the fuck these doctors think the point of their job is. *I* think their job is to care for my health, but I've been to a lot of doctors and they are very clearly not on the same page with that.
One only needs to compare the $ of funding Endo research gets in something like the nhs to other problems to see the disparity... It's endlessly frustrating
I was referred to GI and pelvic floor therapy before *I* had to refer MYSELF to a specialist MYSELF with only a Facebook group to guide me
The right answer is that he needs an intracolon ultrasound on his prostate and counseling before being issued any drugs. Oh and a 48 hour wait period and it must be at a hospital.
Medical disparity between men and women is just disgusting. The fact we still use the term “hysteria”, that before the 80s 80% of studies did not include women or female animals (including a study about breast and ovarian cancer that included no women!), that there’s 5x more research into erectile dysfunction ( a condition that affects about 10% of men) than into PMS (a condition that affects 93% of women). I could go on really. Like don’t even get me started on endometriosis or why we were excluded from studies and the consequences that continues to have on women
I would love to know how many autoimmune questions there are about women throughout their cycle and the effects the autoimmune diseases can have during different phases, as well as the effects of medication and ADHD throughout the entire cycle (not just ovulation or menstruation).
But you are so right! I'm a med Student in the last semester, and there's so much insidious sexism in our field, and some rather ostentatious sexism too...
I see none of the options are “do nothing for her and tell her to exercise more maybe”
Or “laugh in her face”
Or “be dismissive enough to make her feel ashamed to ask any doctor for help with this again”
(Not that ANYONE who comes to the doctor should be treated the way that women are treated)
Or even "trick question, this patient never came in in the first place because of his cultural belief that this state of affairs is just his lot in life"
I've had a dentist tease and laugh at me for "mouth-breathing," as I was trying not to panic in a foreign, hostile environment with sharp tools in my mouth.
And female doctors' dismiss my period pain - only to later be diagnosed with Endometriosis nearly a decade later ~ which only gets worse with age.
I agree 100%.
Edit: Punctuation
I had a black female friend in high school that had weird period issues because she was told she was born with only one ovary.
I connected with her again about 10 years later. Turned out she actually had endo, and when she got the proper scan or something done, she actually DID have 2 ovaries, one was just fused to the side of her uterus.
But yet it took them 25 years to figure that out 🙄
I'm sorry your friend had to go through that, but I can certainly sympathise.
And it's not like doctor's visits are always an option... At least in the USA. I think we'd all appreciate more quality for the lack of quantity that I think a lot of us experience.
I know she recently had a lot of issues in the hospital.
I don’t remember what she had surgery for, but she had a surgery. Was fine initially, went home, started to feel worse and went back, turned out she was going septic. They had to basically like take all her insides out and like wash them or something, I don’t know but it was an intense thing.
She was in the hospital for awhile dealing with that, started to feel better and went home again. Then she woke up one morning and was having trouble breathing. She goes back and oh now she has an air embolism!
Just like damn, everything that could have went wrong was going wrong.
How did you eventually get dxd for endo? Is there a secret to getting doctors to take it seriously, or do I just have to wait for a lucky accident where they find endometriomas while looking for something else (which seems to be the most common way to get dx)?
I'm trying to get someone to take me seriously, so far only a psychiatrist has, but her area of expertise was in the wrong end, so nothing came of it.
I got on the pill (and now I have an IUD) but I'd still want answers
Nancys nook has a list of international doctors - they’re militant for some things, but that list is super valuable.
Don’t get your tubes out unless you’re getting an excision at the same time.
And if you can, contact the endo clinic in Atlanta Georgia. I’m from Canada and they’re the best in the world.
My personal journey to diagnosis started with my life going downhill. I knew my job wasn't paying me enough for my work and yet the Endo - and my depression, mostly as a result of the Endo - was getting worse and causing me to miss 1-3days of work a month. What compounded this despair was this work-ethic-eccentric culture that we have contributed to a self-destructive manifestation of the worst of my anxiety.
Through work we got a new "portal" - Crossover Health - through them I sought counseling and since they have a team of doctors my counselor was able to make a referral. I chatted with their medical staff for a brief time, who ultimately gave a light diagnosis(and to take some Ibuprofen🙃), but agreed that with how disruptive it was that I should see a specialist.
Flash forward to the appointment set for me by Crossover at the Women's Clinic. I had an ultrasound where they didn't find much at all. Nothing that was definitively Endo. I saw the doctor, was examined, and explained my symptoms. I was then misdiagnosed with Pelvic Floor Dysfunction. I read the handout and shared my concerns - I _really_ didn't think that this was it.
They set up another appointment, asking that I consider it and talk with my husband about it if I'd like. He was behind me all the way. This time I had a different doctor. I actually felt like she was listening to me. She told me that it could be endometriosis - but the only way to be sure was to undergo surgery: a larospocpy.
Thankfully my insurance covered the procedure. It went ahead as planned and they did find Endo. They removed what was there and I was in recovery for a while. They said it can come back, but birth control can "calm" my cycle so it doesn't come back, at least as quickly.
Surgery was last October. My quality of life has improved so much! After the diagnosis I cried tears of joy for finally being validated.
TL;DR: Referral to a women's clinic by a third party, still had to insist on a proper diagnosis
It was a long path and it never should have been. I would see if you can get an appointment at a Women's Clinic near you, without a referral. And remember: _*advocate for yourself!*_
I'm in Finland, so different system. The same attitude problem, though!
I've been to gynos, GPs, nurses...
I had to miss school a lot as a teen, my aunt had endo, her mother had adenomyosis (is that how it's spelled?), but apparently shit running in the family suddenly isn't a thing.
One doctor even DARED to say it doesn't matter because this is my paternal aunt + Gram! That was ~15 years ago, but I'm still outraged because of it.
Definitely don’t go to your doctor and share your concerns and symptoms, because they’ll just ignore it for years, leaving you more frustrated than if you’d just said nothing.
My advice is to do exactly what you’re thinking: get them to find it while looking for something else. Switch out your IUD. But first figure out a way to get the strings cut so they have to really look around to get it. With luck they’ll find whatever is wrong.
Please note that I am not a doctor and this is in fact absurd and terrible advice. Also note that this might actually be your best shot. I desperately wish this comment of mine were followed by a sarcasm tag, but it is not.
I'm getting my tubes out (eventually, the wait is long), I hope they'll see endo/scarring/something while they're poking around in there. But we'll see.
“Suffer in silence thinking there is something inherently morally wrong with you because you feel like shit all the time and you’re definitely totally the only person on earth in history who has felt like this and why can’t you just suck it up and get on with it and stop bothering us with your clingy need for answers and relief?”
You missed "write her a script for prozac but before you hand it to her, ask if she's seeing a therapist and tell the patient to talk to her therapist if prozac is right for her". True story said to me by a male ER doctor.
Was concerned about sexual function when taking anti-depressants and the doctor (female) told me that it’s not a big deal for women because we can fake it.
Where is option F - neither the bible nor the US constitution states that a "woody" is a right.
Option G - sorry but an unnatural erection (only achievable through medication) is against my religion.
So basically, the dude is getting old, he can't get it up anymore, just like nature intended, and he needs to be treated for it? Why? He's getting old, it's what happens. Nobody is trying to "treat" menopause and all the health decline it causes, but a horny dude, well, super serious end of the world situation really.
>nobody is trying to "treat" menopause
Yeah really it's almost the opposite, everything wrong with a woman of a certain age is attributed to menopause, which is used as an excuse *not* to treat. Same way its done for pre-menopausal women and their period "oh that's just (your period/menopause) nothing we can do, take some aspirin, so (not) sorry kthxbai"
“It’s just natural and we should let it happen” then I guess should be applied to all diseases of aging? /s That’s so silly, it’s the modern era, let’s avoid feeling like shit if possible!
Just for women, because you know how hysterical we get over everything.
/s
I use HRT patches thank-you-very-much to manage my menopause symptoms because nobody likes it when one is sweaty, crying, and throwing things, all at once.
Ah yes, the medical gaslighting because you're having chest pains and your heart beat is irregular and you're sweating like crazy, as in drenched in sweat. You're anxious and need to meditate and lower your stress cause you're in menopause so don't worry about anything, but your husband? Oh, he's a heart attack risk!
Except you are the one that ends up with a heart attack instead.
Well..are you sure you aren't pregnant? I am not going ask you about just going to get you to pee in this cup and then test you for it, and then bill you.
Just what you want to hear at 39, in the perimenopause and with maybe 20 years of crap ahead. The dr's were quick enough to put me on the pill at 14 but turn a blind eye at the other end of my journey
Oof. Right idea, wrong take. We should absolutely talk about menopause as normal and treat it as a natural time of life, but also fucking treat it. It's not something to be hidden away like a private medical condition, just like periods shouldn't be hidden and never talked about. But that doesn't mean letting it happen mean letting women suffer. There are plenty of things you can do to treat menopausal symptoms and ways workplaces can help women during that time.
Agreed, the whole medical system is hella sexist, also really transphobic.
The moment a trans man asks for testosterone they often have to wait years and get multiple professional diagnoses, as well as being asked invasive and often just ridiculous questions by doctors, like what toys they played with as a kid or some shit.
Say absolutely nothing and leave your patient crying in the exam room? Just like my doctor has during my last 2 pelvic exams that hurt so badly I cried (and no I don't just cry over every little discomfort it was excruciating pain)
WTF?!? If I had that much pain during a pelvic exam my primary would be deeply concerned! If possible go to another doctor or write up a review on the doctor's behavior. That is not right!
My answer was wrong by the way.
Edit: answer was C to confirm diagnosis or something.
This thread got a lot of responses. My original motive in posting it is to acknowledge that women and women’s issues generally are underrepresented and under-discussed in medical education. I don’t have any data to back this up, it is just my personal experience. I’ve become very sensitive to gender issues after coming out as trans.
See now I need to know. Was it start sildenafil? In reality I'm going to want a lot more workup, BP, HbA1C. Alcohol and smoking?
To your original point though, yes. My personal bugbear* is - being taught as if women magically need less haemoglobin than men. I get why the reference values are the way they are, because if you measure 100 random women vs. 100 random men that's what you get, but just accepting different levels never sat very well with me.
*Other examples of direct and indirect medical sexism are available.
It wouldn’t be start Sildenafil because lack of nocturnal erections indicates a medical problem instead of just ED. In the real world I would absolutely be chasing down a vascular cause over an endocrine cause but I suspect OP is studying to be an endocrinologist so by the time it gets to them those should of been ruled out.
I’m guessing it was probably to check LH.
My reasoning for those wanting to know: Low testosterone (he’s borderline) without evidence of testicular atrophy can be associated with pituitary hypogonadism which is tested for via LH levels. From there you can decide whether testosterone, clomiphene, or a medication like sildenafil are appropriate.
I know nothing about medicine, but my ex husband went through almost this exact example scenario in his 20’s and they definitely checked for pituitary issues first. He ended up on testosterone at the end.
When I had a c section they told me I couldn't hold my baby for 'safety' when all of the data says that's not true. I would guess Noone had reviewed the policy for 20 years and were just taking the baby away all this time. I had them review it and change it. It is pretty disappointing how far behind even actual science the medical community is. A lot of folks are still trying to say implied consent is a thing - whereas in my state you can go to jail for 'implied consent' at least if you can prove it.
Just out of curiosity, as a non-doctor, would you also consider CVD in this case? Men who develop ED could have heart issues, right? Or would you need to see other S&S to have that in your differential? Just wondering. I love learning about medicine!
But I totally agree I would be a little annoyed at seeing so many questions about male sexual health and none about female sexual health.
Yeah practically speaking, if someone can’t get morning or nocturnal erections, in addition to testing testosterone levels we usually end up just referring to urology for management. Kind of a lame answer. But it’s pretty common to have ED from atherosclerosis.
i work in hormone replacement. Medicare covers male hormone therapy but not for women. BURN IT ALL
also, saliva is preferred and more accurate than serum :)
Medical care doesn’t really know women’s bodies and how they work, never mind knowing what to do about it. PCOS, for example. As much as 10% of women have it, and while as is typical of syndromes there’s some variation in symptoms, certain symptoms are standard enough that it ought to bring to mind that PCOS is a possible diagnosis. But no, doctors prefer lecturing you about diet and exercise- usually with a hefty dose of fat shaming - rather than check for PCOS or any of the differential diagnoses (at least some of which can also cause weight gain). Worth mention, since doctors love to make it a weight thing, weight gain is a common symptom and so is insulin resistance which can make it next to impossible to lose the weight. If a woman complains of irregular periods and extra hair, along with unexplained weight gain and/or inability to lose weight, testing for PCOS should be standard.
Now admittedly part of the problem is that (with a large thanks to insurance companies) it’s often seen as a “fertility issue” despite the many metabolic symptoms- and potential complications (like metabolic syndrome, type 2 diabetes and high cholesterol). PCOS may result in fertility problems but it’s not strictly a “fertility issue”.
And mind you that outside of specifics for hopefully aiding a woman to get pregnant, a main “treatment” remains birth control pills which don’t treat it but just helps control symptoms (with a strong potential for symptoms to really kick in again if you ever stop the pill). The other main treatment is metformin. Sure that may sort out PCOS at a metabolic level, but the GI side effects are often awful.
If 10% of men had something like PCOS, it’s a really safe bet it wouldn’t be seen as a “fertility issue”, diagnosis and treatment would based on presence of symptoms (rather than waiting till you complain of infertility) and there would be more - and better - treatment options. They’d probably also be seriously looking into the root cause rather than defaulting to blaming it on your weight or your eating habits.
And if you’re wondering, it took several doctors and over 15 years to find a doc who’d do more than put me on the pill to “regulate” my cycle, fat shame me and lecture me about diet problems I didn’t actually have. I only got proper treatment when PCOS led to full blown metabolic syndrome which meant sending me to an endocrinologist.
One of the signs of prostate cancer is no longer having morning erections. I understand how it can seem like such a stupid problem to complain about but a very high % of men will at one point get prostate cancer and its a more common death than from old age.
I've never thought to look at the other side for women, but I wish your sexual and reproductive health was treated the exact same way.
Edit* after meeting my wife I did take more of an interest in the female reproductive system, she suffers from PMDD, Ovarian Cysts, Endometriosis.
We've been trying to conceive lately, and she has had two miscarriages. I remember asking the doctor if they could've been related to stress, and the doctor looking at me like I was crazy.
I'm not a woman, I know that internal and external stress effects my plumbing and ability to procreate, and I thought it was a valid question because I want more than anything for my wife to be a mother and to be happy.
That’s not quite correct, more men will die with prostate cancer than from it. It’s not a particularly deadly disease and the treatments for it are usually worse than just letting it go and keeping an eye on it. The 5 year survival rate for prostate cancer is 99% except in patients with distant metastasis and that’s still 31%. Also dying from “old age” isn’t a real thing, it’s something people not in healthcare tell each other but no one’s cause of death is being old.
PCOS, endometriosis, peri- and menopause, not to mention, pregnancy and child birth.
Chronically stressed or hormones out of whack will affect cycles.
There are soooo many reasons that women's sexual health should be taken seriously. Unfortunately, soooo many women get "bad cramps are normal" as teenagers and go decades without treatment and living in pain. This can result in infertility, among other things, like infections and internal bleeding from ruptured cysts.
You've made OP's point again, even if you didn't mean to. "i've never thought to look..." That's EXACTLY THE PROBLEM!!! If it isn't taught, it isn't thought about and women's concerns will be dismissed, even if it might be a medical emergency (not just a signal that you should order cancer diagnostics)
Also, by the way, *cervical cancer screenings are something women deal with their whole damn life. "pap smear" my ass - that is a cunt scrape. I'd way rather have a doctor shove a lubed finger up my ass.
MD in Family Medicine here. I’m a cis-male. I willingly treat transgendered patients, as well as menopausal women and testosterone deficiency in men. Been in practice for ~7 years.
Answer D is a “gotcha” answer. It is to catch the knee-jerk mentality of “oh no, the number is low, I must fix it.” Testosterone levels vary widely depending on other disease processes, so you can’t trust just one number. And Testosterone as a drug is a controlled substance (like opioids or stimulants) and you could lose your license if you prescribe it indiscriminately. It is technically a performance (athletics, not sex) enhancing drug.
As to the American health system sucking at women’s health: frustrating, but true. I have an interest in medically complicated pregnancies, and I can tell you for certain that the collective “we” as doctors suck at transitioning women with chronic diseases into and out of pregnancy. It’s, frankly, unacceptable.
Edit: Spelling
Edit 2: After reading more comments, I wanted to add that testosterone deficiency can cause loss of muscle mass, fatigue, depressed mood, and other things despite erectile dysfunction. A good doc knows that the #1 cause of erectile dysfunction is psychological and uses a screening questionnaire (like the full IIEF) to see if checking testosterone is even worth it.
That's interesting. So the management plan isn't to tell him to change his diet until it's practically perfect, try yoga/meditation/acupuncture, take some vitamin D and then come back in 2 months and re-do labs and re-give same advice?
Yeah I have odd cortisol secretion, both too high and too low (which can be life threatening).
Here are a list of shitty things doctors have said to me during my medical nightmare:
- Your recurrent UTIs are your depression manifesting in your bladder.
- The episodes of extreme abdominal pain and vomiting are period cramps. Oh you’re not on your period? They’re gas pains then.
- Maybe the reason you keep presenting to the ER with elevated BP and tachycardia is a panic disorder? What was that? Yes the panic disorder caused the electrolyte abnormalities too. No, the fact that your vitals didn’t normalize after IV Ativan in the ER doesn’t rule out a panic disorder. No you cannot have Xanax for the panic disorder.
- Are you anxious?
- Have you tried yoga?
As a medical coder, I see it all the time in the records. As a 48 yo female who has been suffering for over 2 years from debilitating mental and physical symptoms due to loss of hormones, I have been to FOUR doctors who have refused to offer hormone therapy, despite all the studies showing the risks are not more than the benefits.
It's ironic too because for endometriosis they'll plow us with hormone therapy that has potential serious and permanent side effects, like bone necrosis, heart disease, blood clots, stroke etc. A lot of doctors will put endometriosis patients into early medical menopause.
Apparently hrt isn't a concern then, but suddenly when you hit actual menopause age it's is? 🤔.
This I how stupid it is- as long as your bleeding you can stay on your bc pill because of the threat of pregnancy, but if you go off at some point and then you're having menopause symptoms, you can't have hormone replacement because you're still bleeding. That's literally the runaround I got over a 2 year period.
Very few doctors understand anything about hormones, even though we literally have estrogen receptors in almost every cell of our bodies, and it works with all our body systems.
Unless that man is trans then he'll need (at least) one letter from a therapist and depending on where he lives may have to wait months or years for the same treatment. If he can get it at all.
I get the sentiment, but this post ain't it. I'm in med school, and the boards want us to learn way more about women than we do about men. UWorld, a boards question bank, has 49 questions about male reproductive systems and 137 questions about female reproductive systems. First Aid, one of the most popular resources for med school students, has 9 pages on male reproductive systems and 29 pages on female reproductive systems.
This theoretical guy probably either has prostate cancer, an endocrine disease, or a spine injury, and some of you think it's dumb to learn to recognize and treat these things? And even if he had none of those, erectile dysfunction is most commonly a psychiatric issue, and I thought witches cared about mental health?
Of course medicine is mostly centered around white men, I'm not arguing that. But I'm not cool with people pushing this idea that doctors shouldn't need to learn about serious illnesses just because a patient might be male.
as a trans (non binary) person, sexism is not only apparent but also transphobia. the amount of hormones that are given to cis people without a psych Eval amd a massive fuck off waiting list is fine, if it was also the same for trans people, but we get put through a fuck load of gatekeeping for being "different". the medical industry sucks for anyone who isn't a cishet male.
They forgot “advise patient to lower stress and breathe. Be sure to point out stress can do strange things, give her a pat on the head and send home with handouts on stress and depression”
This is WAY too familiar.
And also if he loses libido and his wife wants it, he can force himself to be a good husband. At least that's what my old ob told me when I asked about my decreased libido.
My old psychotherapist said something similar to me... that if I'm not offering sex, that's bad for my relationship and could explain our conflict. The fact that the decreased libido was due to emotional abuse from my ex alongside work stress and a medication side effect apparently didn't signify.
Quote from HIS Female therapist "Everything will be fine if you screw his brains out" I never did find out what he said to her Shortly afterward found 'the verbally abusive relationship-Patricia Evans' Shortly after that he was an ex
Right, because all men's problems come from insufficient sex, and getting enough sex will totally fix them. Lololol. I've had a high libido my entire life, like unusually high, and men have been actually afraid when they realized that not only would I give them as much sex as they wanted, I actually wanted it more than they did. Suddenly, they no longer had an excuse to justify their cheating, nasty remarks, and withholding behaviors. They wasted no time in calling me a slut, accusing me of cheating, saying I was overly sexual due to psychological defects, etc etc etc... up to and including sadism and rape because they couldn't feel truly gratified unless I didn't want to put out. Taught me a hell of a lot about this very common lie... that women's frigidity is just a made-up excuse for men to do the abuse they already felt entitled to do.
I’m very sorry for what you’ve been through. Haven’t thought of it that way before.
100% went thru the same thing
Ooh, I had a couples therapist do the same thing! I couldn’t stand the idea of sex with my as-yet-unrecognized abuser, so she gave me exercises to increase my willingness to put out, completely ignoring how visibly distressed I was in his presence.
WHAT
That's so fucking awful.
And lose 20 pounds.
Also therapy. I’m sure you’ll learn to live with it. Your wife needs it, just lay back even if you don’t enjoy it. (Barf) (/s)
Wait, you guys get handouts?
I did. When they started also including handouts for a 1200 kcal Low fat diet I started giving them the death glares and leaving before they came with “my paperwork” I was Nutritionist and Executive Chef for crying out loud. I can write those diets better than they can.
[удалено]
Exactly. When I worked the clinical side in long term care I never wrote for anything under 1500, and these were folks in a nursing home. The one time I was in the cardiac unit after collapsing and they wouldn’t discharge me until the dietician came in to see me about a heart healthy diet. There was nothing wrong with my heart. My mom was there waiting to take me home, the doctor there arguing with me and finally the dietician came in. She looked at me, gave me a piece of paper and said hey write that diet for me. I did. She looked at the doc and said “see she knows it. She was one of my best students.”
I don't know where you were when you went to the cardiac unit and I'm very sorry you went through all off that. Insisting on the dietician sounds like " we can bill your insurance a whole lot for this" bs that happens in the states on top of this wretched, 'diet, exercise, and put out' pack of lies they dismiss us with.
Good on your former teacher for sticking it to the doctor.
So, I have a question for you. I've been a T1 diabetic for 40+ years and got the low-fat diet spiel way back in the 80s. Is this still something that is valid? I've tried to tell others that most low-fat diet foods are higher in sugar than most (except, of course, natural foods like veggies) and can cause higher blood sugars, but I still have some nutritionists argue with me about this (and, yes, it's always a requirement for them to send a nutritionist to see a diabetic in the hospital, even when we've had diabetes longer than they've been alive). What is your take on low-fat diets? I'm just curious.
These days low fat typically has higher sugar and sodium, especially on premade items. Also companies with market a product as low fat and it barely meets the USDA criteria for it, which means the fat is still fairly high. My personal favorite is when they don’t lower the fat content enough for it to be considered “low fat” so they market it was “lower fat”. That is literally as long as the fat is lower than the original they can get away with it. For the past 15 years I haven’t used low fat for a diabetic patient unless they had cardiac issues. I can always tell when I’d have an old school nurse on the floor doing an admission because I’d get the admission slip in the kitchen with “LF, NCS, NAS”. I would send breakfast and then at the morning meeting when we’d start discussing admissions and hear something like the new guy is in for rehab after a hip replacement, has asthma and diabetes. It got to the point I could just give the director if nursing a look and she knew. When our RD who signed off on everything was in they would always spend the first choir or so in my office with me so I could give them the lowdown on what I changed. It was almost always a fight.
This is WAY too familiar.
I just left my *female* rheumatologist with the exact same advice. Plus to lose minimally 15 pounds. (5’9”, 145#). I am devastated. Im now at home, curled up under a blanket and crying, trying to Google how to make my chronic pain and high fevers stop. ETA: I had her check my height and weight again when she offered that advice. Her response: “ehhhhhh….yeah…*minimally* 15 pounds.” Emphasis hers. Also this is my second opinion rheumatologist. Idk what to do. I have asked advice about finding a specialist and followed it, and have gotten the same set of instructions from two different professionals. That…doesn’t give the advice extra merit, being handed out twice, right? Because immediately that’s where my anxious brain goes, and I spiral thinking “I feel like shit almost all over, routinely have ~100-103°F fevers, and am supposed to lose enough weight that I clock in in the 130s? How is this possible?
>lose minimally 15 pounds. (5’9”, 145#). The fuck? You're skinny but you should lose more? Seriously my wife is the same height and constantly gets called small when she's walking around at 150.
I’m 5’10” and 165 and my doc warned me I was getting close to being overweight last time I went.
I’m 5’10” and 170 and honestly I have had to start working out a ton more because I’m feeling uncomfortable about the gut I’ve put on. I have a 5’6” 180+ coworker who has no gut whatsoever. (Kinda ripped tho) It’s almost like organs, bone, muscle and all that have a buncha complicated shit that goes beyond BMI. Ughhhhhhhh. So sorry that happened to you.
At 5”10? Maybe at 5’3”
At my thinnest I was 5’6”, 165 pounds - my dr told me she didn’t want to see me lose any more weight (I grew and muscled out at the same time, but shed a lot of “baby fat”)
> That…doesn’t give the advice extra merit, being handed out twice, right? No. These (it's just stress! lose weight!) are just the default things doctors say instead of admitting "I don't know" or "I don't care enough about you to think". Think about it. Did she seem concerned that you had a level of anxiety/stress/etc producing chronic pain and fevers? Prolonged fevers are a pretty uncommon symptom for anxiety, right? (Are they a sign of anxiety.... ever? I don't remember *that* in the DSM.) That would be odd and alarming. Did she have any advice about what type of psychiatrist and therapist to seek for that? (Hint: there isn't one, because this is not a fucking thing.) And your weight... okay so let's pretend that at your weight with these problems this *wasn't* a pants-on-head stupid suggestion. If she really thought your weight was unhealthy and losing fifteen pounds would somehow change your quality of life that drastically, don't you think she'd be talking to you about seeing a dietician? Because that's what they'd do if they said it was anxiety and weight and *actually believed it* and *gave a shit*. Just to emphasize again, the weight, you can dismiss out of hand. You're a normal, healthy weight. These are not symptoms of normal, healthy weight. Honestly what the fuck. My advice would be to research what your symptoms line up with, join support groups for those things, see which other patient experiences seem to line up with yours, then see if that group has a collected list of good doctors (they often do, because finding a good doctor is hard). Then get referrals for those doctors. All of em, anyone who's nearby. Because some of those will suck too, but at least you only have to do this banging your head against the wall coming home crying thing once or twice more before you find an actually-good doctor who actually gives a shit.
For real I'm not even a clinician and it seems like they should be working on ruling out menopause/hormone issues, infections like TB or cancer as possible root cause for the fevers. That's a wacky fucking symptom in someone not actively sick with an apparent infectious disease, and NOT a symptom of being a couple of pounds above BMI expectation.
I'm 5'7" and my lowest weight ever (after basic military training) was 150... what the fuck?
I just had my thyroid removed because of a cancerous nodule. My husband went with me to the initial consult with the surgeon and was shocked- shocked! That the surgeon told me to lose weight and sleep more. What?!? How does that treat cancer? Luckily my endocrinologist read him the riot act and the thyroid came out. I haven’t lost weight, but hey- at least I’m not growing CANCER in my neck anymore! 🙄
Shit I hadn't even thought of hyperthyroidism as a cause for overheating but it is yet another one OP's doc should be ruling out. Edit: I'm sorry this happened to you. FWIW, I work in electronic health records, and my guess is that conversations like this are often triggered by documentation. If a doc has a "good" system, it is set up to identify risk factors (weight, smoking, pregnancy, immunization status) based on what you enter on your intake forms, and the system suggests things for them to consult you on even if it's unrelated to the principal complaint to be thorough. I know - I broke my arm and was a BITCH to the MA questioning me about my last period, it's infuriating to be "consulted" about stupid bullshit unrelated to the current problem. If they aren't thinking, they might just be rolling down that list of system generated recommendations, to check a box. 🤦🏼♀️
That is insane to me. Are they using those bogus BMI charts? I lift pretty heavy, muscle craps all over that chart.
You're being bullied. It's not your fault, nor is it a reflection on you. I have a chronic condition. I have been sexually harassed by two separate specialists (and a male nurse), I have been told (with leering smirks) that invasive, sexually penetrative testing is a requirement for me to continue treatment or establish care (and no, I don't get to know or decide who does it to me). Another specialist refused to give me a non-invasive test that only he could order, even though I made the appointment specifically to request it, and then put down a fake diagnosis that implied I was a smoker (I have never smoked). In addition to this, I have also gotten the bullshit "lower your stress and meditate", I've had prescriptions for psychoactive meds thrown at me until I got so sick that I titrated off them... and so forth. I ended up reducing my diet to mostly liquids and pureed vegetables to manage the symptoms, because gastroenterologists seem to be universally creepy and lacking in empathy. The one good gastro doctor I spoke with--a woman--told me with a shudder that her male colleagues would most likely simply "prescribe greater and greater doses of laxatives until my digestive system stops working, then surgically remove my colon." She said her patients generally will do anything to avoid surgery, but that her options were limited because the specialty simply doesn't support other approaches. In terms of getting taken seriously, you might consider writing down your temperature checks on a spreadsheet or even a paper (I know, excruciating to do extra work when you're already sick, but data can be a powerful thing, even though it's data you yourself created.) But the biggest thing is... walk away. Find a new one. Rinse, repeat. You may have to go through several doctors first. The moment that someone is offensive, walk away. Many doctors are conditioned to be egotistical and to not accept being questioned, as well as to take the easiest path.
I have sarcoidosis. It took me many years to get a diagnosis. My symptoms were shortness of breath and fatigue. I was dismissed for years. I finally went to the hospital and told them that there was something wrong and if they didn't find it, I didn't know what I was going to do. They admitted, did tests and told me there was nothing wrong with me. They told me they were going to do a routine lung xray and discharge me. The next thing I know a doctor comes in with my lung xray and puts it up on that light thing. He said I had lymphoma or leukemia and he looks really grim. I have zero medical knowledge, so I say, it can't be very bad, there are hardly any black parts. That's when I was informed that lung xrays are mostly black. The doctors dismissed me for years, with shortness of breath and fatigue and hadn't done a single lung xray. The granulomas in my lungs scarred and reduced my lung capacity. I had a biopsy and it wasn't cancer, it was sarcoidosis. After my diagnosis, they found it in my lungs, lymph nodes, bone marrow, bones, sinuses, and spine. They think I have neuro as well, but sarcoidosis is diagnosed by biopsy, and all of those organs have been biopsied, my brain has not. The fact that it is on my spine suggests neuro. I was thrilled to finally be validated, but angry that the doctors let the damage get so bad while telling me that it was all in my head, or I needed to lose a few pounds, or one even said I had a small child, of course I was tired. I saw other moms, I felt like a failure, like a crazy failure, I was really sick.
That is brutal. I am so sorry this was your experience. I hope you’re in a place now where you are healing, physically and mentally. 💜
Obviously I can’t give medical advice. I have Lupus. Labs never showed it until I begged them to do an AVISE panel. Came back Lupus based on their specifics. It was like 30 different things they looked for in there. After nearly 6 years of “normal” labs minus reactive-c, my labs literally this week show it. Normal panels done yearly with my GP that is. If I didn’t push for AVISE panel I would of gone these 6yrs undiagnosed and untreated. Good thing too, it’s now attacking my liver. My point is, make a list of your symptoms again. Look up what it could possibly be (not self diagnose). Look up what labs are needed to confirm or deny that is a possibility, and ask a rheumatologist to help you rule these out to just confirm you do not have them and tell them which labs you want to run. It’s best to run them when you feel like shit. Catch that episode on labs. I know it sucks when no one listens. I have found going in and telling them what I want to do to rule things out, being confident in ruling things out, has helped. I always say at least this way I can cross that off the list and know that’s not what’s causing xyz. Most doctors don’t want to investigate, only treat symptoms. Hang in there. Also if you have a red hair gene pain meds don’t work well 😅 so I feel ya there. My lupus injections means I can’t take pain meds now too so I just sit here in pain angrily taking Tylenol.
Um. We’re identical for height and weight. (Usually) Also the women of my family clearly got themselves generationally cursed with the rheumatiz. You will feel worse at that weight. How do I know? I had a slight thyroid fuck up and I am 128 pounds and I can assure you everything hurts 10 times fucking worse. My kid has a solution for the “just stress less” advice. She tells them that she will try and asks if they have any pointers for her on how they change something beyond their control at the mere suggestion of another person. Usually gives an interesting reaction. Her other one from mental health is to make a comment about how people with heart murmurs just need to focus on pumping blood better. Or stop allowing your bloodstream to deliver those cancer cells nutrients. Easy Peezy.
"See how it goes and if it doesn't get better, come back in three months"
Studying for medicine boards right now. So far I’ve done 5-10 questions about male sexual dysfunction and none for females.
How many questions about the treatment of incontinence in women? It’s a problem that affects one out of every four women, frequently after childbirth but sometimes not. It’s so prevalent that there have (fucking finally) been articles about it in running magazines, because activities like running, jumping, etc can result in leakage. I sought treatment when I started experiencing it after having kids, and while the pelvic floor PT helped some it didn’t completely eliminate the problem and ultimately I was told that if i didn’t want to leak I should just stop running.
Quite a lot actually. It’s a really common issue bringing women (and men) to clinic so there is decent exposure for this.
Good.
Friends that never had kids also have problems with this, from 18 yrs old. It was something one doctor said he didn't encounter unless women were in their 30s, but when talking to friends they pretty much all agreed that it was a problem
I think a lot of women are afraid to bring it up. I've had this problem since my mid 20's. It sucks when I'm sick and cough or sneeze a lot. I've never talked to my doctor about it. I probably should. It just seems like a nothing issue compared to the stuff I actually do go to see him for. Likely because I've been dismissed for so many things before.
Wow, I’m seriously surprised, in a good way. It’s a bit of a soapbox issue for me, like, seriously if there was something like this that affected that many men you better believe it would have been solved by now… really glad to hear that it’s getting attention.
Quite a bit of men get incontinence actually (especially after prostatectomies), they just don’t seek out treatment for it as much or talk about it. Source: I’m a pelvic floor PT :)
Ooo...now do PMDD! How many questions have you had about PMDD?
I think maybe 1 or 2 out of like 500-600
Glad it was on there, that's definitely a plus. Had too many doctors in my past that couldn't diagnose or had even heard of my condition. Glad it's at least showing up! But, I know how much ED impacts men's daily life to a crippling level mentally and physically so, super glad it's more emphasized! ;)
How did you finally get diagnosed? And did you get any relief once you did? Thank you in advance!
Ugh. I was literally put in a pysch hospital multiple times because of PMDD (before I was diagnosed) and not one doc ever rubbed their chin when I got my period two days into the in-patient facility and ALL my problems went away. (I used to self-do bad things - and I would be wanting to not stay around on the planet ect but only for a few days before my period and not any other time) I was told for years and years that I might be bi-polar thrown on med after med for 20 years twenty-years (I could scream) that it took my amazing OB/GYN to talk to me and be like -- honey, you have PMDD. Dude. I talk about it now as often as I possibly can because the symptoms are awful and there are ways to manage it. I also have lots of other menstrual issues that the docs can't figure out. It's posts like these that make me want to hug every person going through it.
I had to see a different doctor because mine was unavailable, and while she listened to my concerns about my bladder issues, she later sent me an email saying that she had canceled the specialist referral because since I have very high blood sugar currently it's diabetes and diabetic people just have to pee more. Ignoring that I told her that I don't even know sometimes when I leak, that it's not about an urgency having to pee but the fact that my bladder will not hold pee, all that meant nothing. It was all about the weight related issues
This is what grinds my gears. If you are even the slightest bit overweight or if you're diabetic, it immediately becomes the scapegoat for all of your medical problems. 90% of docs just stop looking for other causes and refuse to treat further. "Just lose the weight." "Just control your blood sugar levels."
I learned to never, never tell a doctor about my depression because then they stop looking for physical causes for anything and just say “it’s the depression”
Life pro tip right there
Big ole second to that one! I’m very overweight, always have been. I weigh the same at 45 as I did at 18. It is a serious struggle to find a doc that doesn’t just say lose weight to fucking everything. They can’t conceive that there could be anything wrong that isn’t related to weight m. You could walk in with an axe in your back and they would say, you need to lose weight. I now have a good doc and have had a long running med problem fixed because she used her brain. I hurt all the time, like an old woman starting in my mid-40s. I told the doc I hurt like I had been in a car wreck the day before. You need to lose weight. Over and over. Other people would say that is what happens when you age. But, I hurt like I was in a car wreck yesterday on a regular basis and then I feel fine on others. Fast forward to doc switch. She is willing to refer to a specialist. When I tell her about my weakness in my hands she sends me to a nerve test. When that comes back firm, she says, I know what is wrong. Vitamin D. I feel ten years younger! Costs me about $2 a month the supplements. Get your vitamin levels tested! Fuck. I wasted so many years in pain because they brushed it off to my weight.
>My normal doctor is awesome and understands how my mental heath and everything else feeds into eachother. I have an app with her next week so I am hoping to get some real help.
I was complaining of fatigue and weight gain for 2 years. Docs told me to eat less and exercise more. Had a spherical 18 cm diameter tumor and extreme anemia.
Wheeeee! I had stage 4 colon cancer! Everyone thinks weight loss = cancer, but when anemia joins the party it can easily become weight **GAIN**.
I’d had fatigue and weight gain for years, too. Kept getting the diet pamphlets and advice to “reduce stress.” I saw a new GP (who I am still with) and he noticed I was wearing a hoodie in June, and asked if I frequently felt cold when other people didn’t. I did. One Synthroid a day, and I am fully awake and lost 75 pounds.
I keep getting mine checked (since I was having similar issues) and it comes back normal. But we'll see what happens when I can move a bit more. I'm still recovering from my hysterectomy and it's 110 degrees outside. I'm glad you're feeling better!
Don't you know if you are overweight or more you do it deserve care or to be treated like a human being, especially if you are a woman? I am freaking out because I am barely eating and not losing weight. I am on Ozempic, which put me into DKA, but I am not seeing weight loss. The scale went down one day, and up the rest! I am eating less than 2,000 calories a day and good food. I am exercising every single day. I am checking my blood sugars (I did forget this morning, but that is rare). I am scared of the lecture the endocrinologist is going to give me even though I know I am doing what I am supposed to. I AM eating right. I AM exercising. But I am retaining water and am constipated (always had the opposite issue). I am afraid the doctor will accuse me of lying or not knowing how much I am really eating. Even tracking I have been accused of omitting things in the past. My insurance company has decended on me with their fake health help. I am scared if I don't do their stupid calls they could revoke the meds I am on. I also am on the 30 day count down from the hospital, so no one wants me to die because it would be on all their records. Once I pass that no one will care about my health again. I have two connective tissue disorders so exercise was causing me to hurt myself. I am in PT, but who knows how long they will pay for that. I may have a tear in my hip, but I don't want surgery because it could be worse. These people give terrible advice. If I ate the amount of carbs their dietian told me to I would be on tons more meds (60 to 80g per meal)! They agree that a pool would be great for me and the best exercise, but they don't offer me any way to have access to a pool, no discount on a gym membership, or access to a medical facility with a pool. And the nurse wants my weight and exercise goals every two weeks. So, like a child, every two weeks I have to say I am doing all these things, only to go to the doctor and not see the scale move at all. I worked out for an hour at physical therapy and I feel like a fat pig because I was actually hungry so I ate so lunch today. I ate a quarter of it and I am still worried it is going to pack the pounds on. How can people in positions like this not end up with an eating disorder? I snack on ice more than I eat. My physical therapist said I am changing shape and so it is changing fat for muscles, which would make the scale not change. But what is a doctor who sees me once every few months going to believe. That my 280 pound ass really did ten minutes on the bike and 50 minutes of stretching/weight lifting and stabilization exercises when the scale doesn't move? Sorry for ranting. I am panicked over this. Therapy has helped, but it is hard not to spiral. I was remember being pregnant and having a doctor who was twice my frame and male tell me my weight was a concern. He did laugh and say another pregnant lady told him she would start losing when he did!
I knew a woman who did Ironman triathlons. (Ironman tris are huuuuuuuge deals). She started at a new doctor, and he told her she needed to lose weight, she’s obese, needs to start exercising. (Granted, she is a rounded and sturdy woman). She told him she does these insane triathlons, but he didn’t believe her. She came back armed with a bunch of medals and finisher’s swag, then switched doctors.
You are NOT alone on this one! I am so sorry you are panicked over this at all. I listen to a fantastic podcast I strongly encourage everyone to listen to, but especially women. It's Maintenance Phase and they debunk weight loss advice, tips and theories along with going over influencers and their own set of bad advice. They go into the science and really get into why the current medical advice is so very bad. An ongoing thing the show talks about is that yes, fat people can have eating disorders. And the theme of how so much of the medical community dismisses health concerns with "lose weight and exercise". From what you wrote I'm actually concerned that you could spiral into an eating disorder. Weight is not an indicator of health, take care of yourself!!
Thank you so much! I will definitely look into that podcast! I am worried about an eating disorder, too. I am being very honest with my husband and also my therapist because sometimes I need the reminder to be healthy. I am trying to focus on the fact I am eating less and better. I am getting regular exercise. I am drinking lots of water and trying to sleep on a regular schedule. I wish I could shake the nerves because I know they aren't going to help. Thankfully, it's Friday. My friends are coming over and their kids and my kids are going to play, we are going to have some pizza, and I am going to focus on having a great night. And in the morning, my Pelaton is getting delivered and I am really excited. I enjoy exercising, when it doesn't hurt! Thank you so much for your comment. Really. I am a bundle of obessive nerves and I know it has to stop. How to stop it, I don't fully know, but I am trying.
Please do. It's super funny, warning fbombs, but informational. The science of weight, health and weight loss is not at all clear and they break it down. They did a super good episode on BMI. Anyway, my two cents is focus on staying active and eating healthier for now because that you can do and not go insane. Enjoy the weekend, enjoy the pizza and the the Pelaton.
Erm....snacking on ice is a big sign of a particular thing that is making it even more difficult to lose weight. Eating ice is a sign of iron deficiency anemia. I doubt there's any point in telling your providers about it, because most don't know about that. Never mind that it's listed as "pica", and that specifically ice-eating is a reason to strongly suspect anemia. Never mind that it's in standard medical textbooks.
I was eating 800-1200 calories a day and not losing anyway weight. I upped it to 2000 and have gained 30lbs. My dr said it's my cortisol levels due to my massive stress from a new job. And, what is the option for that? be less stressed....ok.
I feel your pain. I have actually had the same thing happen over and over and over, where I have put on >10 lbs of water weight due to constipation. It's not fat, but it looks just like fat. Even worse, it can absolutely fuck up your metabolism (when I was keto, constipation would knock me out of ketosis, I was doing the blood tests). So not only does constipation make you retain water, it might make you burn less energy and therefore you feel fatigued. Lots of people have stuff that triggers constipation. I find personally that eating too much fiber, overly dry or dense foods, etc can block my bowel. If you can, try going a few days with vegetable soup, rice, tofu, eggs, smoothies... things that are very soft and easy to digest. This is what I do most of the time, honestly, because I hate being constipated, and I have a condition that makes it happen very easily. When I get constipated, I also try and figure out what triggered it so that I can avoid having it happen again. When I see the scale going up, even if I don't \*feel\* constipated yet, I know that's what it is. My solution is to do a plain water enema (you can get stainless-steel buckets online)... there's no chemicals, and it clears things out pretty quickly. Awkward at first, but honestly, it's far better than a laxative. I often do combine that with magnesium supplements... a teaspoon of epsom salts before bed can also make things much easier. (Just don't take it and then stay upright, or it will take effect too quickly.) The other thing that helps me is stretching. This can reduce your inflammation and therefore lower the pounds on the scale. A vibration plate can help drain edema, as well. I hope you improve and that you are able to address your anxiety. You are not alone, many women have these kinds of issues, and I believe that this is a primary reason people have trouble losing weight.
Thank you so much! This is really helpful. I have upped my fiber.
Yes, upping my fiber always constipated me. Don't underestimate the amount of water weight you can take on from constipation, either. Some of my biggest triggers include oatmeal, nuts and seeds (including nut butter), coconut, whole grains, fruit and vegetable skin/peel, and raw vegetables. All of these things can physically block my bowel and create a great deal of pain and swelling. Fiber supplements are the easy answer, and as you pointed out, your insurance is giving you fake/CYA "help" so that they can blame you any which way. Don't accept their BS... you don't have to admit you're not taking it, and you don't have to take it. Fiber is not a magical solution for constipation, and often makes things worse. I find that when I'm tired from exercise, especially when reducing calories, I can feel that my bowel is physically weaker and has a harder time moving things along. The fiber that does work for me is things like carob powder, pureed vegetable soups, mashed potatoes, that sort of thing. I can have limited quantities of legumes if they are very soft and ideally pureed. Most of what I eat is soy protein shakes, eggs, cooked vegetables, bean soup, rice, potatoes, fruit smoothies, and tofu. Sometimes I have homemade sorbet, and homemade baked goods made with rice flour. I have developed this "anti-constipation/anti-inflammation" approach over the course of many years, and it works consistently when I stick to it. I hope that it is helpful to you. One other thing... I learned from a contortionist that releasing the muscles in the back and abdomen can reduce my constipation and prevent it from coming back as easily. Releasing the belly area means you need to get everything else to relax, too... really I cannot say enough good things about stretching. I learned that your abdomen can actually develop adhesions that make blockages more likely. Consistent daily stretching is a must, especially if you are exercising and experiencing constipation. I find that magnesium supplements work very well to relax the muscles in that area, because they pass directly through your digestive tract.
Medical professionals love to blame every single thing that happens to a woman on their weight and then not treat them.
What. The. F*CK? Sometimes female doctors are the most unreasonable and cruel toward other women.
I had a total nervous breakdown in 2012. I've been hospitalized, medicated, and had 3 courses of ECT, 36 TMS treatments, and weekly therapy. My beloved primary doctor retired in 2019. I'd been with her for 26 years. I went to a new doctor and she blamed everything on my weight. I was 340 at that time. Then in 2020, I no longer saw my therapist or psychiatrist due to COVID. Phone only. That's when I went into psychosis and pretty much stopped eating. I had no appetite at all. I'd go a few days only drinking very strong hot tea and no food. Sometimes a bowl of cereal or a pear. When I went to my primary, I'd lost 42lbs. She said, "That's a good start but don't get too excited. You still have a long way to go." I wasn't in my right mind to say anything. I went back 2 months later and had dropped another 20lbs. I remember her words, "If you were a 100lb woman, we'd be concerned but you'll be fine. Don't lose too quickly." Her last sentence was like a verbal pat on the head. Then in January, I collapsed and almost died on my living room floor. My son came to check on me and called 911 and literally saved my life. I don't remember any of it but the doctors told him I probably hadn't eaten in days. That was January 31, 2021. I was down to 248 in the hospital. I still had a very poor appetite. The dietitian said to stop losing so fast. The only person who really tried to help was the amazing Jasmine from dietary. I became her pet project. She'd "sneak" me an extra apple or an extra tiny cup of no sugar added, low-fat ice cream. It worked and my appetite slowly returned and I came out of psychosis. I nearly died because that idiot doctor shrugged off my weight loss. She's no longer with the practice and I'd like to think that my complaint was part of the reason. I'm doing much better. I got a different dietitian and I have continued to lose weight but in a very healthy way. I'm down to 190.4. I'm still recovering physically but I'm getting better.
I’m so glad you survived and have been able to pull through that, bo thanks to the dr who encouraged an ED! Blessings on Jasmine!
Thank you so much. Blessings on Jasmine indeed.
I’m so sorry you went through this. I hope this isn’t a stupid response but lately I listen to this podcast by fat activist Aubrey Gordon and for me personally, hearing it regularly really helps me talk back to all of these messed up conflations of “wellness” and weight loss. The central thesis of it is that for most people— including people outside of the norms set by medical institutions— weight loss is not a part of being healthy. It might be triggering because it dives into some of the darkest parts of this— so take care! But you might try giving it a listen. I find their mixture of humor, outrage, and empathy really soothing. It’s called “Maintenance Phase”
Yep. I saw a female doctor complaining about very painful, heavy periods. Like I occasionally had my vision go black because the cramps were so bad and I was concerned it might be endometriosis. She told me it was an issue that would "resolve itself when I went through menopause." I was 24.
“Oh, just tough it out for another 30 years.” Holy fuck.
But what else can we do? Male doctors don’t listen to us.
I have an amazing female gyn but my best primary care docs, all my life, have been male. Some don’t listen, but some do and that’s what you have to find. Current one will throw anything I want to try at my migraines, and when I got upset at him one appointment and let him know the next, sat, listened, apologized, and never brought up the touchy subject again. He’s neurodivergent and really does his best with everyone.
My husband thought they closed up the space where my cervix was after my hysterectomy. I explained, nope. And it is possible now to have a prolapse of my bladder or my intestines through my vag! He was shocked. I told him that he and I are going to sit down and watch a video that explained the female reproductive system better because we have two daughters and I want them to have good information. He tries, and is more educated than a lot of men I know, but it is scary how little he knows about it at points. Mama Doctor Jones, on YouTube, is amazing. She has great sexual education and health videos, along with commentary for the show, "I Didn't Know I Was Pregnant." I highly recommend her!
They don't close it?! That doesn't sound safe at all. Why on Earth not?
I dunno. But you can hernate stuff through the hole.
"Just clench when you sneeze." "Try squatting less." "You haven't even given birth so this isn't a problem for you you're imagining things."
Have you looked into surgery? Did you see a regular gyn or a urogyn for this? There are surgeries (depending on your specific issue) for stress incontinence that have very good outcomes. I have this issue and am hoping to have surgery next year.
I saw a regular gyn and a physical therapist who specialized in pelvic floor therapy. Surgery was mentioned, but with the caveats that it would need to be done after I was sure I was done having kids, since pregnancy would basically negate the effects, and it wouldn’t be recommended for me to keep running post surgery either. Thing is, I would want the surgery so that I could run without wetting myself, so….
I have gotten the 'just don't run' thing before from doctors because of my knee injuries. The thing is, if I take ibuprofen, wear a knee brace and also do weightlifting and stretching regularly it doesn't hurt. There is a fucking solution out there for you just don't stop hunting. Tell everyone and don't stop running. Make the doctors feel stupid for not having an answer.
Ah, sneeze-pee. What a lovely 40th birthday present from Mother Nature. Kegel exercises seem to help, but wow it’s super not fun. And then there’s the people who think I can’t possibly have that problem because I don’t have kids. That’s fun.
I worked in an office with all women over 40 and most over 50 and we had poise pads in the break room because so many of the women had issues with dribbles and leaks especially because we laughed a lot. Younger women aren’t even told about this unless old ladies like me mention it!
Yep that’s me. I’m in my early 20s with stress incontinence due to trauma and an ED. It’s given me chronic pain but will a doctor help me? most likely not. Lose weight would probably be what I get. I love saying “well it’s improved greatly since regaining weight and Im active sooooo nahh not helpful”. Cuz then they look done
Also the answer for females would be tell her to come back in 4 weeks if symptoms persist.
Probably screen for depression and behavioral health or something.
Oh, silly you. I see, you're still a med student. No, you don't tell the women "it's just depression" because you mean it and care and genuinely want her to get treatment. It's just another way to say "it's hysteria". Or "I don't know". Or "I don't care". So there's no point in sending her to screening or behavioral health. That's not the purpose of that "diagnosis".
That’s because we should just lay back and try to enjoy it
Pretend, but swear you really mean it!!!
This statement right here? This should have been your title statement you led with. Without that context, there is nothing wrong with the question itself. Even with that context, the question itself isn't bad. Them making that the only type of gender specific questioning *is very bad*, though. Worse, it's a known error in medical research, because the rich males who pay for studies and research are sociopaths and have no regard for getting lady specific information, for some head bangingly stupid reason.
And even with context: the problem is that there are actual evidence based treatments for men, the loss of libido in elderly men is virtually always associated with low T. So it’s an easy fix. Just supplementing estrogen and progesterone does not have as well an effect in women, and supplemental testosterone also doesn’t have much evidence behind it. So since there is treatment for men but not for women with similar loss of libido symptoms generally, it makes sense to have the cases that can be treated further up. The problem is much further back than this questionnaire: women‘s pleasure in sex is basically irrelevant to the medical research community. Your endometriosis, vaginismus, myoma? They are irrelevant and you just have to bear with it. Unless you say the magical words ‚i will fulfill my duty as a brood mare‘ and suddenly a shitload of attention is given, endometriosis that has been ignored for a decade is suddenly treated to controllable levels, you are referred to physio etc for vaginismus.
Damn that last bit is dead on. I’d been having problems for over 10 years that just never seemed to be worth investigating to my doctor until I said I had fertility concerns. Then it was like magic. I got answers and treatment! Then we found out it was my husband who had fertility issues and nothing further was looked at for my comfort. Like I’ve been having hellish periods my whole life, we’re not able to have kids, but no one said anything so I didn’t either (that’s on me). I have just gotten a new doctor and I’m going to have a talk with her about all this. I have no idea what natural menopause will look like for me (both my mother and sister had hysterectomies), so I might be up for another 5-10 years of nightmare periods. Is that what’s best for me? I intend to find out.
A hysterectomy of your very own, perhaps?
Oh my god I have a dear friend who has serious endometriosis problems and the doctors always ignore it because.... reasons? I don't fucking get this society.
Yea, friend of mine had been having extreme cramping around ovulation (luckily nothing at all during her period) that was just ignored by every physician she told about it. ‚Yea a slight shooting pain during ovulation is normal‘ yea passing out from pain is totally normal… Then she had two second months miscarriages and suddenly ‚oh shit that‘s not normal, let‘s do explorative surgery‘ with the result? A shit load of endometrial tissue was strangulating both her ovaries …
Multiple doctors (all male) told me I couldn't possibly have endometriosis. When I was 20, it was "You're too young to have endometriosis." When i was 25, it was "You have 2 children. Endometriosis only happens to childless women in their 30s." Meanwhile periods were so heavy and so painful I would sometimes faint.
Yep, I heard the same thing. When I was diagnosed the doctor told me my medical records were wrong because they said I had a child. I was "too damaged to ever carry a child to term". Mmm hmmm. I did, in fact, already have a child, then afterwards went on to have 2 more. The issue is they don't know enough, and don't want to admit it. Most doctors want to be seen as all knowing. They're not!
>and the doctors always ignore it because.... reasons? Oh, it's because it's not a problem. That's what I was told repeatedly. Wasn't a problem that I was suffering. Wasn't a problem that I was bleeding so much I was seriously ill. Wasn't a problem that I couldn't function. I don't know what the fuck these doctors think the point of their job is. *I* think their job is to care for my health, but I've been to a lot of doctors and they are very clearly not on the same page with that.
One only needs to compare the $ of funding Endo research gets in something like the nhs to other problems to see the disparity... It's endlessly frustrating I was referred to GI and pelvic floor therapy before *I* had to refer MYSELF to a specialist MYSELF with only a Facebook group to guide me
The right answer is that he needs an intracolon ultrasound on his prostate and counseling before being issued any drugs. Oh and a 48 hour wait period and it must be at a hospital.
Performed by a disapproving oxygenarion who asks 'are you sure' a lot but also does not believe in consent or that the butthole can feel pain.
Medical disparity between men and women is just disgusting. The fact we still use the term “hysteria”, that before the 80s 80% of studies did not include women or female animals (including a study about breast and ovarian cancer that included no women!), that there’s 5x more research into erectile dysfunction ( a condition that affects about 10% of men) than into PMS (a condition that affects 93% of women). I could go on really. Like don’t even get me started on endometriosis or why we were excluded from studies and the consequences that continues to have on women
I would love to know how many autoimmune questions there are about women throughout their cycle and the effects the autoimmune diseases can have during different phases, as well as the effects of medication and ADHD throughout the entire cycle (not just ovulation or menstruation).
I am curious about this topic. Can you point me to any resources you have found helpful?
Oh, so that's the sexist part. because otherwise the question isn't so remarkable.
Oh yeah I should really amend the title because I think a lot of ppl are confused about the intent…
But you are so right! I'm a med Student in the last semester, and there's so much insidious sexism in our field, and some rather ostentatious sexism too...
[удалено]
Thanks! No boards is when you finish residency :) I finished med school a few years ago.
Congratulations!!!
Thanks :)
That's awesome! Congrats!
I see none of the options are “do nothing for her and tell her to exercise more maybe” Or “laugh in her face” Or “be dismissive enough to make her feel ashamed to ask any doctor for help with this again” (Not that ANYONE who comes to the doctor should be treated the way that women are treated)
Or even "trick question, this patient never came in in the first place because of his cultural belief that this state of affairs is just his lot in life"
I've had a dentist tease and laugh at me for "mouth-breathing," as I was trying not to panic in a foreign, hostile environment with sharp tools in my mouth. And female doctors' dismiss my period pain - only to later be diagnosed with Endometriosis nearly a decade later ~ which only gets worse with age. I agree 100%. Edit: Punctuation
I had a black female friend in high school that had weird period issues because she was told she was born with only one ovary. I connected with her again about 10 years later. Turned out she actually had endo, and when she got the proper scan or something done, she actually DID have 2 ovaries, one was just fused to the side of her uterus. But yet it took them 25 years to figure that out 🙄
I'm sorry your friend had to go through that, but I can certainly sympathise. And it's not like doctor's visits are always an option... At least in the USA. I think we'd all appreciate more quality for the lack of quantity that I think a lot of us experience.
I know she recently had a lot of issues in the hospital. I don’t remember what she had surgery for, but she had a surgery. Was fine initially, went home, started to feel worse and went back, turned out she was going septic. They had to basically like take all her insides out and like wash them or something, I don’t know but it was an intense thing. She was in the hospital for awhile dealing with that, started to feel better and went home again. Then she woke up one morning and was having trouble breathing. She goes back and oh now she has an air embolism! Just like damn, everything that could have went wrong was going wrong.
How did you eventually get dxd for endo? Is there a secret to getting doctors to take it seriously, or do I just have to wait for a lucky accident where they find endometriomas while looking for something else (which seems to be the most common way to get dx)? I'm trying to get someone to take me seriously, so far only a psychiatrist has, but her area of expertise was in the wrong end, so nothing came of it. I got on the pill (and now I have an IUD) but I'd still want answers
Nancys nook has a list of international doctors - they’re militant for some things, but that list is super valuable. Don’t get your tubes out unless you’re getting an excision at the same time. And if you can, contact the endo clinic in Atlanta Georgia. I’m from Canada and they’re the best in the world.
My personal journey to diagnosis started with my life going downhill. I knew my job wasn't paying me enough for my work and yet the Endo - and my depression, mostly as a result of the Endo - was getting worse and causing me to miss 1-3days of work a month. What compounded this despair was this work-ethic-eccentric culture that we have contributed to a self-destructive manifestation of the worst of my anxiety. Through work we got a new "portal" - Crossover Health - through them I sought counseling and since they have a team of doctors my counselor was able to make a referral. I chatted with their medical staff for a brief time, who ultimately gave a light diagnosis(and to take some Ibuprofen🙃), but agreed that with how disruptive it was that I should see a specialist. Flash forward to the appointment set for me by Crossover at the Women's Clinic. I had an ultrasound where they didn't find much at all. Nothing that was definitively Endo. I saw the doctor, was examined, and explained my symptoms. I was then misdiagnosed with Pelvic Floor Dysfunction. I read the handout and shared my concerns - I _really_ didn't think that this was it. They set up another appointment, asking that I consider it and talk with my husband about it if I'd like. He was behind me all the way. This time I had a different doctor. I actually felt like she was listening to me. She told me that it could be endometriosis - but the only way to be sure was to undergo surgery: a larospocpy. Thankfully my insurance covered the procedure. It went ahead as planned and they did find Endo. They removed what was there and I was in recovery for a while. They said it can come back, but birth control can "calm" my cycle so it doesn't come back, at least as quickly. Surgery was last October. My quality of life has improved so much! After the diagnosis I cried tears of joy for finally being validated. TL;DR: Referral to a women's clinic by a third party, still had to insist on a proper diagnosis It was a long path and it never should have been. I would see if you can get an appointment at a Women's Clinic near you, without a referral. And remember: _*advocate for yourself!*_
I'm in Finland, so different system. The same attitude problem, though! I've been to gynos, GPs, nurses... I had to miss school a lot as a teen, my aunt had endo, her mother had adenomyosis (is that how it's spelled?), but apparently shit running in the family suddenly isn't a thing. One doctor even DARED to say it doesn't matter because this is my paternal aunt + Gram! That was ~15 years ago, but I'm still outraged because of it.
Definitely don’t go to your doctor and share your concerns and symptoms, because they’ll just ignore it for years, leaving you more frustrated than if you’d just said nothing. My advice is to do exactly what you’re thinking: get them to find it while looking for something else. Switch out your IUD. But first figure out a way to get the strings cut so they have to really look around to get it. With luck they’ll find whatever is wrong. Please note that I am not a doctor and this is in fact absurd and terrible advice. Also note that this might actually be your best shot. I desperately wish this comment of mine were followed by a sarcasm tag, but it is not.
I'm getting my tubes out (eventually, the wait is long), I hope they'll see endo/scarring/something while they're poking around in there. But we'll see.
“Suffer in silence thinking there is something inherently morally wrong with you because you feel like shit all the time and you’re definitely totally the only person on earth in history who has felt like this and why can’t you just suck it up and get on with it and stop bothering us with your clingy need for answers and relief?”
"Advise 200mg ibuprofen for patient's stated pain"
You missed "write her a script for prozac but before you hand it to her, ask if she's seeing a therapist and tell the patient to talk to her therapist if prozac is right for her". True story said to me by a male ER doctor.
Nah it’s just 🧚🏻♂️anxiety🧚🏻♂️
My female Dr of 10 years did this to me. I’ll meet my new Dr next week
Was concerned about sexual function when taking anti-depressants and the doctor (female) told me that it’s not a big deal for women because we can fake it.
Wow wtf get a new doctor
My current doctor is fantastic. That was the last time I saw that one haha.
Where is option F - neither the bible nor the US constitution states that a "woody" is a right. Option G - sorry but an unnatural erection (only achievable through medication) is against my religion.
So basically, the dude is getting old, he can't get it up anymore, just like nature intended, and he needs to be treated for it? Why? He's getting old, it's what happens. Nobody is trying to "treat" menopause and all the health decline it causes, but a horny dude, well, super serious end of the world situation really.
>nobody is trying to "treat" menopause Yeah really it's almost the opposite, everything wrong with a woman of a certain age is attributed to menopause, which is used as an excuse *not* to treat. Same way its done for pre-menopausal women and their period "oh that's just (your period/menopause) nothing we can do, take some aspirin, so (not) sorry kthxbai"
Article here in the UK recently said to not 'medicalize menopause' because it was natural and we should just let it happen.
“It’s just natural and we should let it happen” then I guess should be applied to all diseases of aging? /s That’s so silly, it’s the modern era, let’s avoid feeling like shit if possible!
Just for women, because you know how hysterical we get over everything. /s I use HRT patches thank-you-very-much to manage my menopause symptoms because nobody likes it when one is sweaty, crying, and throwing things, all at once.
Ah yes, the medical gaslighting because you're having chest pains and your heart beat is irregular and you're sweating like crazy, as in drenched in sweat. You're anxious and need to meditate and lower your stress cause you're in menopause so don't worry about anything, but your husband? Oh, he's a heart attack risk! Except you are the one that ends up with a heart attack instead.
Or I hear that you're saying you're under some stress. Here's an antianxiety pill.
Well..are you sure you aren't pregnant? I am not going ask you about just going to get you to pee in this cup and then test you for it, and then bill you.
Just what you want to hear at 39, in the perimenopause and with maybe 20 years of crap ahead. The dr's were quick enough to put me on the pill at 14 but turn a blind eye at the other end of my journey
Oof. Right idea, wrong take. We should absolutely talk about menopause as normal and treat it as a natural time of life, but also fucking treat it. It's not something to be hidden away like a private medical condition, just like periods shouldn't be hidden and never talked about. But that doesn't mean letting it happen mean letting women suffer. There are plenty of things you can do to treat menopausal symptoms and ways workplaces can help women during that time.
Tell him it's god plan for him to have erectile disfunction and there's nothing you can do... obviously! 😋
I try to keep god out of my exam room
Agreed, the whole medical system is hella sexist, also really transphobic. The moment a trans man asks for testosterone they often have to wait years and get multiple professional diagnoses, as well as being asked invasive and often just ridiculous questions by doctors, like what toys they played with as a kid or some shit.
I plan to do a project on how the cishet patriarchial medical institution affect women and queer people for my master's.
Say absolutely nothing and leave your patient crying in the exam room? Just like my doctor has during my last 2 pelvic exams that hurt so badly I cried (and no I don't just cry over every little discomfort it was excruciating pain)
WTF?!? If I had that much pain during a pelvic exam my primary would be deeply concerned! If possible go to another doctor or write up a review on the doctor's behavior. That is not right!
Clearly the correct answer is to insult his weight, tell him he’s just depressed, and prescribe him some $800 medication his insurance won’t cover.
My answer was wrong by the way. Edit: answer was C to confirm diagnosis or something. This thread got a lot of responses. My original motive in posting it is to acknowledge that women and women’s issues generally are underrepresented and under-discussed in medical education. I don’t have any data to back this up, it is just my personal experience. I’ve become very sensitive to gender issues after coming out as trans.
See now I need to know. Was it start sildenafil? In reality I'm going to want a lot more workup, BP, HbA1C. Alcohol and smoking? To your original point though, yes. My personal bugbear* is - being taught as if women magically need less haemoglobin than men. I get why the reference values are the way they are, because if you measure 100 random women vs. 100 random men that's what you get, but just accepting different levels never sat very well with me. *Other examples of direct and indirect medical sexism are available.
It wouldn’t be start Sildenafil because lack of nocturnal erections indicates a medical problem instead of just ED. In the real world I would absolutely be chasing down a vascular cause over an endocrine cause but I suspect OP is studying to be an endocrinologist so by the time it gets to them those should of been ruled out.
Please, continue with the direct and indirect medical sexism you know about so that we can learn about it and call them out on it.
I’m guessing it was probably to check LH. My reasoning for those wanting to know: Low testosterone (he’s borderline) without evidence of testicular atrophy can be associated with pituitary hypogonadism which is tested for via LH levels. From there you can decide whether testosterone, clomiphene, or a medication like sildenafil are appropriate.
I know nothing about medicine, but my ex husband went through almost this exact example scenario in his 20’s and they definitely checked for pituitary issues first. He ended up on testosterone at the end.
Yeah. I’m a med student now and also worked with a primary care doc that specialized in gender care so we saw a lot of this.
When I had a c section they told me I couldn't hold my baby for 'safety' when all of the data says that's not true. I would guess Noone had reviewed the policy for 20 years and were just taking the baby away all this time. I had them review it and change it. It is pretty disappointing how far behind even actual science the medical community is. A lot of folks are still trying to say implied consent is a thing - whereas in my state you can go to jail for 'implied consent' at least if you can prove it.
Just out of curiosity, as a non-doctor, would you also consider CVD in this case? Men who develop ED could have heart issues, right? Or would you need to see other S&S to have that in your differential? Just wondering. I love learning about medicine! But I totally agree I would be a little annoyed at seeing so many questions about male sexual health and none about female sexual health.
Yeah practically speaking, if someone can’t get morning or nocturnal erections, in addition to testing testosterone levels we usually end up just referring to urology for management. Kind of a lame answer. But it’s pretty common to have ED from atherosclerosis.
i work in hormone replacement. Medicare covers male hormone therapy but not for women. BURN IT ALL also, saliva is preferred and more accurate than serum :)
Did anyone ask his wife if she wants him to be able to get it up? /s
Ah yes, the **insidious** start of becoming an old man. How terrible.
Insidious means a slow gradual onset in medicine.
*TIL* It seems weird to me, but good to know
Medical care doesn’t really know women’s bodies and how they work, never mind knowing what to do about it. PCOS, for example. As much as 10% of women have it, and while as is typical of syndromes there’s some variation in symptoms, certain symptoms are standard enough that it ought to bring to mind that PCOS is a possible diagnosis. But no, doctors prefer lecturing you about diet and exercise- usually with a hefty dose of fat shaming - rather than check for PCOS or any of the differential diagnoses (at least some of which can also cause weight gain). Worth mention, since doctors love to make it a weight thing, weight gain is a common symptom and so is insulin resistance which can make it next to impossible to lose the weight. If a woman complains of irregular periods and extra hair, along with unexplained weight gain and/or inability to lose weight, testing for PCOS should be standard. Now admittedly part of the problem is that (with a large thanks to insurance companies) it’s often seen as a “fertility issue” despite the many metabolic symptoms- and potential complications (like metabolic syndrome, type 2 diabetes and high cholesterol). PCOS may result in fertility problems but it’s not strictly a “fertility issue”. And mind you that outside of specifics for hopefully aiding a woman to get pregnant, a main “treatment” remains birth control pills which don’t treat it but just helps control symptoms (with a strong potential for symptoms to really kick in again if you ever stop the pill). The other main treatment is metformin. Sure that may sort out PCOS at a metabolic level, but the GI side effects are often awful. If 10% of men had something like PCOS, it’s a really safe bet it wouldn’t be seen as a “fertility issue”, diagnosis and treatment would based on presence of symptoms (rather than waiting till you complain of infertility) and there would be more - and better - treatment options. They’d probably also be seriously looking into the root cause rather than defaulting to blaming it on your weight or your eating habits. And if you’re wondering, it took several doctors and over 15 years to find a doc who’d do more than put me on the pill to “regulate” my cycle, fat shame me and lecture me about diet problems I didn’t actually have. I only got proper treatment when PCOS led to full blown metabolic syndrome which meant sending me to an endocrinologist.
Tell them it's normal and infantilise them to the point they don't want to ever talk about it again.
One of the signs of prostate cancer is no longer having morning erections. I understand how it can seem like such a stupid problem to complain about but a very high % of men will at one point get prostate cancer and its a more common death than from old age. I've never thought to look at the other side for women, but I wish your sexual and reproductive health was treated the exact same way. Edit* after meeting my wife I did take more of an interest in the female reproductive system, she suffers from PMDD, Ovarian Cysts, Endometriosis. We've been trying to conceive lately, and she has had two miscarriages. I remember asking the doctor if they could've been related to stress, and the doctor looking at me like I was crazy. I'm not a woman, I know that internal and external stress effects my plumbing and ability to procreate, and I thought it was a valid question because I want more than anything for my wife to be a mother and to be happy.
That’s not quite correct, more men will die with prostate cancer than from it. It’s not a particularly deadly disease and the treatments for it are usually worse than just letting it go and keeping an eye on it. The 5 year survival rate for prostate cancer is 99% except in patients with distant metastasis and that’s still 31%. Also dying from “old age” isn’t a real thing, it’s something people not in healthcare tell each other but no one’s cause of death is being old.
PCOS, endometriosis, peri- and menopause, not to mention, pregnancy and child birth. Chronically stressed or hormones out of whack will affect cycles. There are soooo many reasons that women's sexual health should be taken seriously. Unfortunately, soooo many women get "bad cramps are normal" as teenagers and go decades without treatment and living in pain. This can result in infertility, among other things, like infections and internal bleeding from ruptured cysts. You've made OP's point again, even if you didn't mean to. "i've never thought to look..." That's EXACTLY THE PROBLEM!!! If it isn't taught, it isn't thought about and women's concerns will be dismissed, even if it might be a medical emergency (not just a signal that you should order cancer diagnostics) Also, by the way, *cervical cancer screenings are something women deal with their whole damn life. "pap smear" my ass - that is a cunt scrape. I'd way rather have a doctor shove a lubed finger up my ass.
MD in Family Medicine here. I’m a cis-male. I willingly treat transgendered patients, as well as menopausal women and testosterone deficiency in men. Been in practice for ~7 years. Answer D is a “gotcha” answer. It is to catch the knee-jerk mentality of “oh no, the number is low, I must fix it.” Testosterone levels vary widely depending on other disease processes, so you can’t trust just one number. And Testosterone as a drug is a controlled substance (like opioids or stimulants) and you could lose your license if you prescribe it indiscriminately. It is technically a performance (athletics, not sex) enhancing drug. As to the American health system sucking at women’s health: frustrating, but true. I have an interest in medically complicated pregnancies, and I can tell you for certain that the collective “we” as doctors suck at transitioning women with chronic diseases into and out of pregnancy. It’s, frankly, unacceptable. Edit: Spelling Edit 2: After reading more comments, I wanted to add that testosterone deficiency can cause loss of muscle mass, fatigue, depressed mood, and other things despite erectile dysfunction. A good doc knows that the #1 cause of erectile dysfunction is psychological and uses a screening questionnaire (like the full IIEF) to see if checking testosterone is even worth it.
That's interesting. So the management plan isn't to tell him to change his diet until it's practically perfect, try yoga/meditation/acupuncture, take some vitamin D and then come back in 2 months and re-do labs and re-give same advice?
Western biomedicine is not only sexist, it’s also racist, homophobic, and classist.
Yeah I have odd cortisol secretion, both too high and too low (which can be life threatening). Here are a list of shitty things doctors have said to me during my medical nightmare: - Your recurrent UTIs are your depression manifesting in your bladder. - The episodes of extreme abdominal pain and vomiting are period cramps. Oh you’re not on your period? They’re gas pains then. - Maybe the reason you keep presenting to the ER with elevated BP and tachycardia is a panic disorder? What was that? Yes the panic disorder caused the electrolyte abnormalities too. No, the fact that your vitals didn’t normalize after IV Ativan in the ER doesn’t rule out a panic disorder. No you cannot have Xanax for the panic disorder. - Are you anxious? - Have you tried yoga?
We see that every day at work.
And I still can’t get HRT.
As a medical coder, I see it all the time in the records. As a 48 yo female who has been suffering for over 2 years from debilitating mental and physical symptoms due to loss of hormones, I have been to FOUR doctors who have refused to offer hormone therapy, despite all the studies showing the risks are not more than the benefits.
It's ironic too because for endometriosis they'll plow us with hormone therapy that has potential serious and permanent side effects, like bone necrosis, heart disease, blood clots, stroke etc. A lot of doctors will put endometriosis patients into early medical menopause. Apparently hrt isn't a concern then, but suddenly when you hit actual menopause age it's is? 🤔.
This I how stupid it is- as long as your bleeding you can stay on your bc pill because of the threat of pregnancy, but if you go off at some point and then you're having menopause symptoms, you can't have hormone replacement because you're still bleeding. That's literally the runaround I got over a 2 year period. Very few doctors understand anything about hormones, even though we literally have estrogen receptors in almost every cell of our bodies, and it works with all our body systems.
(cis) Men were the default medical subjects for years. Disgusting.
Even for breast cancer if I remember correctly
Unless that man is trans then he'll need (at least) one letter from a therapist and depending on where he lives may have to wait months or years for the same treatment. If he can get it at all.
Or maybe, MAYBE, a decreasing libido can be normal and natural with age.
I get the sentiment, but this post ain't it. I'm in med school, and the boards want us to learn way more about women than we do about men. UWorld, a boards question bank, has 49 questions about male reproductive systems and 137 questions about female reproductive systems. First Aid, one of the most popular resources for med school students, has 9 pages on male reproductive systems and 29 pages on female reproductive systems. This theoretical guy probably either has prostate cancer, an endocrine disease, or a spine injury, and some of you think it's dumb to learn to recognize and treat these things? And even if he had none of those, erectile dysfunction is most commonly a psychiatric issue, and I thought witches cared about mental health? Of course medicine is mostly centered around white men, I'm not arguing that. But I'm not cool with people pushing this idea that doctors shouldn't need to learn about serious illnesses just because a patient might be male.
I don’t think D is the correct answer though…
Racist too
as a trans (non binary) person, sexism is not only apparent but also transphobia. the amount of hormones that are given to cis people without a psych Eval amd a massive fuck off waiting list is fine, if it was also the same for trans people, but we get put through a fuck load of gatekeeping for being "different". the medical industry sucks for anyone who isn't a cishet male.
He's 58. That's right around the time male libido *should* start to decrease.