As many of you know, I work psych as a medicine person, not a psych person (believe me, you need to differentiate in psych). I have spent a great deal of time hearing that the patient has a somatic disorder in my career.

Somatic symptom disorder involves a significant focus on physical symptoms, such as pain, weakness, or shortness of breath, resulting in considerable distress and/or problems functioning. The individual has excessive thoughts, feelings, and behaviors relating to the physical symptoms.

Blaming problems on psychiatric causes is a common theme with psychiatry, that the psychiatric problems must be masquerading as physical symptoms and not have a physical reason. Not to bag only on the “shrinks” (yeah, I know a good majority don’t like being called that). On the medical side, we tend to lean towards some things being psychiatric (not as much, though, as we tend to do a pretty thorough work up on someone with a physical ailment). We often assume depression is related to the condition. Studies have proven that episodic depression occurs with the worsening of a given malady (listen to me sounding all medical and crap). When something is wrong with your body, it makes you depressed. Shocking medicine right there.

I did a thesis (or feces…no thesis) on that subject in grad school, linking PTSD to pain. There is a positive correlation (more highbrow shit) between increases in pain and/or PTSD and the responding condition (if you hurt more, your PTSD worsens and vice versa). So yes, Karen psych and medicine are often intertwined.

Forgetting any of this, I have been down the psychiatric road for a while. Ya know, PTSD, depressive behavior, etc. A lot of physical symptoms I have attributed to being somatic until recently.

I have been reading a lot on male hormone therapy, which I want to incorporate into my private practice. I started looking at symptoms of low testosterone and the proverbial light when on over my head. Wait, this is fucking me. Now I know that reading symptom lists when studying can cause some folks (yes, me too) to go, wait a minute, is this me? Yet here, it nagged me because I had every symptom. Something I had been contributing to my PTSD and other health issues.

After looking at the far-reaching effects of this hormone, I wonder if most of my problems are related to hormone imbalance. That hypothesis has yet to be proven.

I had the necessary blood work, and low and behold, I have deficient testosterone, like sub-therapeutic…hmm.

So the symptoms of low testosterone are

• Low sex drive
• Fatigue
• Reduced lean muscle mass
• Irritability
• Erectile dysfunction
• Depression
• There are many other possible reasons for these symptoms, such as opioid use, some congenital conditions (medical conditions you are born with), loss of or harm to the testicles, diabetes, and obesity (overweight). See your doctor if you have any of these symptoms

Yes, there are other medical reasons for this, but I thought it was “all in my head.”

So yes, there is a physiological cause, for some of the things I am concerned about are solely psychological. I fell into the trap that often happens on psych; I didn’t eliminate the possibility of a physiological problem causing psych issues.

Having blinders to your specialty is a common practice issue; to dismiss either aspect as a cause. Physiology can be much easier than psych because you can do empirical tests with lab values, imaging, or just plain old physical exam to determine if the problem is physiologically based. I always start here because ruling this out makes it easier to delve into the possibility of psychiatric causes.

I have heard primary care providers say it is “a psych problem, so go see psych” without investigating a physiological cause. It is just plain out sloppy medicine.

As providers, the bottom line is to explore within your area the cause. If you are medical, you should look at a medical reason first.

Old school nurses will tell you that a patient with sudden onset dementia has a urinary tract infection (physiological cause) instead of a neurological problem (dementia). Neuro is not psych, but it’s a snap diagnosis. Psychosis can occur with chronic amphetamine use, so once again, not organic; it has a physiological cause.

Bottom line? First, never try to treat yourself. Even the most brilliant providers have a medical provider that is not them. Second, never assume that the problem lies entirely in your specialty.

Be the kind of person your dog and your mom hope you are.