Research Evaluation & Methodology
Rev. Dr. Christopher L. Clemmer
June 30,1998
Assignment
Claire, Paul. (1997). Men: The Moodier Sex? American Health for Women. v.16, n.10, pp. 31).
The Questionnaire: Is His Testosterone Low?
If a man in your life always seems to be in a bad mood, he may have a testosterone deficiency. To find out, have him take the following quiz, developed by John E. Morley, M.D., director of geriatric medicine at St. Louis University School of Medicine.
1. Do you have a decreased sex drive? Yes [ ] No [ ]
2. Have your erections gotten weaker in the last few years? Yes [ ] No [ ]
3. Do you lack energy? Yes [ ] No [ ]
4. Has your strength or endurance decreased? Yes [ ] No [ ]
5. Have you gotten shorter in the last few years? Yes [ ] No [ ]
6. Have you lost interest in things you once enjoyed? Yes [ ] No [ ]
7. Are you often sad and/or grumpy? Yes [ ] No [ ]
8. Has your sports performance suffered recently, even though you’re not injured? Yes [ ] No
9. Do you fall asleep after dining? Yes [ ] No [ ]
10. Have you been performing poorly at work? Yes [ ] No [ ]
SCORING: A “yes” to the first or second question, along with at least two other affirmatives, suggests your partner may have a testosterone deficiency and should consult his doctor.
Writer Paul Claire specializes in men’s health issues. Copyright: 1997 RD Publications Inc.
Claire, Paul. (1997). Men: The Moodier Sex? American Health for Women, v.16, n.10, pp.31(2)
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My Questionnaire Critique: Is His Testosterone Low?
1. Originator of questionnaire
According to Paul Claire (1997), the questionnaire was developed by John E. Morley MD, director of Geriatric Medicine at St. Louis University School of Medicine. (See attached article and questionnaire).
2. Expressed purpose of questionnaire
To assess for male testosterone deficiency at home.
3. What type of questions does it use?
The questions are closed, with forced choice, yes or no responses required.
4. What type of format does it use?
The format is a relatively simple list of ten questions aimed at finding symptoms of testosterone deficiency. The format does not follow a typical slow warm up to start, then the sensitive questions, and then a cool down with easier questions. It starts right out asking about the person’s sex drive and erection strength. It’s designed to be used in the home by a wife who judges that their husband, “always seems to be in a bad mood.” If a wife finds that her spouse does seem to have bad moods, it then suggests that she have him take the questionnaire.
5. What is the best question?
I’m resistive to identifying a best question because I find the questionnaire troubling. If I must, I suppose the best question would be the first, “Do you have a decreased sex drive?” It stands to rule out whether a man fits the stereotypical norm of always being interested in sex and if he’s not there must be something wrong with him. It’s also most tied to testosterone deficiency in our minds, whether it’s true or not. It certainly gets right to the vulnerable part of male ego. When placed with the next question, “Have your erections gotten weaker …? it gets at a dreaded fear a man might have, making him fair game to want to grab a pill that offers an easy cure that will bring back their ability to live up to their proscribed stereotypical role. It’s not the best question for identifying a medical problem of making a diagnosis at home. It’s actually the best marketing question for those who seek to sell their product … which is testosterone. I’m curious whether Dr. Morley has a connection with the manufacturers of testosterone.
6. What is the worst question?
Do you lack energy? This is so obscure. There could be a myriad of reasons why a man might lack energy, many of them certainly might not necessarily having anything to do with their testosterone level. Lacking energy can range from normal variations, low thyroid hormone, cancer, slow undiagnosed internal bleeding, depression, grief, or from a sense of feeling inadequate about not living up to societal norms of masculinity itself.
7. Do you find any problems with the questionnaire?
Yes, I have many problems with this questionnaire. First of all, I have a problem with it being in a magazine for the average person to use because the questions are so general and could have so many complex ramifications. It’s frightening to think that a woman might actually use this questionnaire to evaluate her husband’s symptoms and send him off a doctor seeking a prescription. So many of the questions could relate to so many other problems other than a low testosterone level. In the state of cost cutting in health care it would certainly be cheap for a doctor to address a patient’s symptoms with a prescription in response to a wife’s urging after utilizing this questionnaire.
A man’s depression could be missed, an undiagnosed silent disease could go on and maybe even be made worse by taking testosterone because he failed this questionnaire. As a nurse for over thirty years, I know that doctors do attempt to meet public demands for the latest fads in treatment and to solve complex problems simply and effortlessly with a pill – it looks like an easy fix that holds the potential to cause serious harm to men.
Secondly, “bad moods” are very subjective initial criteria to start a wife out looking for a testosterone deficiency. Thirdly, attaching these symptoms with sexuality places them with sex role stereotypes and then connects them to a simple medical cure in a pill. If a man answered these questions positively the results could be seen as a prescription to fulfill the stereotype of real men. According to this questionnaire real men:
1. Have a high sex drive and perform well sexually
2. Have strong erections
3. Have lots of energy
4. Have strength and endurance
5. Are tall
6. Have high interest in sex and sports
7. Are happy, and not crabby
8. Perform well in sports
9. Stay awake after dinner
10. Perform well at work
The questions seem to be powerful marketing tools that offer hope of curing this apparent deficiency, while at the same time, offering profit to drug manufacturers. Because testosterone is a prescription medication it also means men must visit their doctor’s, thus keeping the doctor’s bank account filled too. Many in the general public believe whatever doctors say simply because they’re doctors. Since this questionnaire was written by a doctor, the questionnaire itself has the potential to plant seeds in people’s minds that if they have these symptoms, they must have a testosterone deficiency.
Instructions for scoring the questionnaire claim that a “yes” to the first or second question along with two other “yes” answers suggests testosterone deficiency. If I go back and answer these questions for my ex-husband during the early nineteen eighties it would look like this:
He had a decreased sex drive, he started falling asleep after dinner, and he was extremely worried about his performance at work. According to the quiz he was a candidate to receive testosterone. For the previous ten years, my husband had a very high sex interest, never fell asleep after meals, and felt confident about his performance at work. In the early eighties he worked for Illinois Bell which went through a divestiture that threatened most workers jobs. He couldn’t sleep worrying about losing his job, so he was tired after eating. It’s hard for a man who cares about his family’s economic well-being to remain focused on sex, not matter how interested he might be. This was the cause of his symptoms, not a lack of testosterone, not his sexuality, his manhood, or any disease pathology.
8. What could you do to make it better?
Not have it at all or not have it in a magazine for the average person’s use. It might be more appropriate in The Journal of the American Medical Association or The New England Journal of Medicine to offer the possibility of testosterone deficiency to doctors attempting to diagnosis a patient with these types of complaints. With the possibility of testosterone deficiency in the back of their minds, doctors can then look at the man and his symptoms holistically within the context of the medical history, physical exam, and present life situation – not just a list of symptoms alone.
This questionnaire puts the symptoms in a framework that connects male hormone deficiency and sexuality, which can be misleading. I’m concerned about this questionnaire offering flimsy hope and easy solutions to complex medical, psychological and societal problems.
9. Would you trust the conclusions of this questionnaire?
Absolutely not. I’m concerned about the ramifications of this questionnaire because it could be used as a list defining and focusing on how a male should be. As if sexual performance and energy level are valid measures of who a man is. Stereotypical sports and sexual behaviors are not what make a man a man. The worst part with this questionnaire is that it connects male sexuality and sports performance with an easy fix – just take this pill. In a culture in which some men are willing to risk their lives by taking steroids to build their bodies and enhance their sports performance, this is a dangerous questionnaire.
Estrogen replacements first came out in the early nineteen sixties. I remember their being touted as a way for women to regain their sexual potential. To keep their appearance youthful and beautiful, to maintain their energy, and to maintain or increase their libido. These hormone replacements were used on women before adequate research was done to learn about any possible negative effects. That research has only recently begun to be done – it’s still a controversial issue whether women should use estrogen replacements.
I hope this same thing doesn’t happen to men. I hope our cultural focus on staying young and sexually potent doesn’t lead men to an untested pill that may have serious adverse effects on their health. Adequate research on potential physical side effects, along with public and private discourse, and reflection on what drug will mean in men’s lives should be our priority.
Feminists are critical of how women have been sexualized in our culture. This new societal focus on male sexuality is doing the same thing to men which I find sad and worrisome. Neither sex should be sexualized in this manner. It’s just as morally wrong to set up standards for male performance as it has been to place expectations on women to focus on making themselves beautiful, sexually attractive and responsive to males. I believe that just as women are much more than their sexuality, men are much more than their erectile ability or disability. These questions set up a list of criteria for how males should be. It fails to consider so many other complex and often invisible aspects of life that may lead to these symptoms. What the questions may do is send men and their wives to doctor’s offices looking for magic potions to fix male physicality without also looking at the psychology, spirituality and humanness of the men.
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Are Men Actually: The Moodier Sex?
Claire, Paul. (1997). Men: The Moodier Sex? American Health for Women. v.16, n.10, pp. 31).
Most men will deny it, but new research shows they are every bit as moody as women. Experts tell you how to handle six common male dispositions. Although society often assumes that moodiness is a “woman thing,” science is slowly confirming what we’ve long suspected: His mood swings can be just as frequent and diverse as yours. The male hormone testosterone is chiefly responsible, says San Diego psychiatrist Theresa L. Crenshaw, M.D., a pioneer in this developing area of study. The hormone fluctuates throughout his life, gradually declining after age 40; it also has daily highs and lows.
Since a man’s testosterone level can make him feel not only sexual but also depressed, aggressive, lonely, happy or irritable, its ebb and flow can significantly sharpen or dull these moods, says Dr. Crenshaw, author of The Alchemy of Love and Lust, “Almost all hormones, male or female, have rhythms,” she explains.
“Monumental changes in these rhythms can occur over brief periods. Since testosterone is a complex hormone, we don’t fully understand how it works. But all men experience these shifts in hormone levels.”
The shifts are especially noticeable during stressful times, because as tension increases, testosterone decreases. Although many people associate high testosterone levels with aggression and irritability, low levels cause these symptoms too, says Ted Quigley, M.D., a reproductive endocrinologist in San Diego. In a 1996 Swedish study, the testosterone levels of 50 men were measured on each of the two days before the potentially stressful situation of participating in clinical research. Between measurements, the mean testosterone level of the group fell nearly 50%.
“The trouble is, men aren’t focused on their changing moods,” explains Dr. Quigley. “To make matters worse, it’s often difficult to get them to discuss with friends and family what they’re feeling.” Such blindness and denial can cause many problems in a relationship, because one of the keys to a successful and happy partnership is being able to understand and adjust to a mate’s changing temperaments.
Experts warn that the stress of the holidays often makes men and women more temperamental, so we’ve compiled this guide to the six most common mood shifts your man Is likely to exhibit, along with advice on how to get through each one. Consider it your small role in maintaining peace on Earth this holiday season.
ANXIETY The cause: This mood is typically triggered by apprehension–the gnawing fear that he’ll never fulfill work or home responsibilities, says James Levine, Ed.D., director of the Fatherhood Project at the Families and Work Institute in New York City and author of Working Fathers: New Strategies for Balancing Work and Family. “Men have redefined what it means to be a success,” Dr. Levine says. “They’re still concerned about doing well at work, but they also want to build strong relationships at home. As a result, men have more to worry about.”<p> The effects: Some men become irritable, withdrawn or compulsive (drinking too much, working overtime), says Ronald Podell, M.D., an assistant clinical professor of psychiatry at UCLA.
Others may experience physical symptoms such as headaches and stomach upset. Still others may simply vent by yelling and cursing when things get tense. What he can do: Commiserate with his friends. Once he realizes he’s not the only guy on the planet with these concerns, he’ll feel better and be able to brainstorm solutions to ease the stress in his life, says Dr. Levine.
What you can do: Don’t let his bad mood infect you. Resist obsessing about his maddening actions or words and instead say, “Your behavior has changed, your way of speaking to me has changed, and I’m having trouble with that. What’s it all about?” Once he begins to discuss the problem with you, don’t interrupt him with a solution, advises Dr. Levine. Wait until you’ve given him time to talk.
MILD DEPRESSION The cause: The blues often stem from what Dr. Podell calls a “misery gap,” the perception of what a person had hoped life would be like vs. the reality of what it is. While the anxious man has yet to realize he can’t meet all the expectations, the depressed guy sees the difference between what he can and can’t do and is saddened by it.
The effects: Mild depression normally creates reclusiveness and/or irritability in men. He wants to be alone, and when you ask him why, he snaps at you.
What he can do: Exercise and eat right. Negative moods such as depression are often compounded by stress and fatigue, typically brought on by a lack of sleep, a poor diet, too much alcohol and inactivity, explains Robert E. Thayer, Ph.D., a professor of psychology at California State University in Long Beach and author of The Origin of Everyday Moods.
What you can do: Make sure you both eat healthful food. And after dinner, suggest going for a brisk walk or a bike ride. Such simple things should help lift his mood (and yours). If the depression persists for more than two weeks, it may signal a more severe problem, so consider professional help. For a referral to a psychiatrist who specializes in depression, contact the American Psychiatric Association in Washington at 202-6000.
LONELINESS The cause: Loneliness is more common during the holiday season because it’s often triggered by memories of festivities with a now deceased parent or other loved ones.
The effects: This mood can be similar to depression but generally comes and goes.
What he can do: Make an effort to think positively during low-energy periods. A man’s natural energy level tends to be low when he awakens, then rises slowly to its high point in the late morning or early afternoon, says Dr. Thayer. Male energy declines again in mid to late afternoon, briefly rebounds a bit in the early evening, and drops to its lowest level toward bedtime.
What you can do: Don’t bring up troubling matters or try to handle stressful situations at low-energy times. Any loneliness that creeps in won’t be as bothersome to him if you can steer, him away from dwelling on it when he’s naturally down.
ANGER The cause: Men are brought up to become angry and resentful when they feel sad or depressed. It’s their way of protecting themselves from their own feelings, says Dr. Podell.
The effects: He blows up over small things such as a flat tire or a Lakers loss.
What he can do: Examine the roots of his feelings. Once he addresses the real issue, his angry outbursts should diminish.
What you can do: Don’t get drawn into an argument or tell him it’s silly to be upset; that will only fuel the anger. In a calmer moment, help him address the real problem.
EUPHORIA The cause: This extremely upbeat mood is usually prompted by celebrating with friends and relatives, getting that annual bonus check, and, of course, watching kids experience the excitement of the holidays.
The effects: The signs are obvious, but one that isn’t so easy to recognize (at least until it’s too late) is overspending. Impulsiveness can also spill over into your social life; for instance your partner may say yes to three cocktail parties in one night.
What he can do: Enjoy this seasonal high, but resist making major decisions on the spur of the moment.
What you can do: No matter how Scrooge-like it may seem, set a holiday budget (including ceilings on gifts for each other), and review your social calendar at the end of each week. Cut back where necessary. Other than that, you can let this mood infect you.
ROMANCE The cause: That twinkle in his eye may be a result of all those good smells emanating from your kitchen. Alan R. Hirsch, M.D., neurological director of the Smell and Taste Treatment and Research Foundation in Chicago, found that the scent of baking cinnamon buns makes men more amorous. He speculates that the odor triggers warm, nostalgic feelings, and that other homey aromas might do the same.
The effects. You get flowers, chocolates and lots of romance.
What he can do: Have another bun. What you can do: Keep baking.