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Testosterone treatment is controversial for men and even more so for women. Although long-term outcome data are not available, prescriptions for testosterone are becoming more common. Testosterone is used primarily to treat symptoms of sexual dysfunction in men and women and hot flashes in women. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. In individuals with human immunodeficiency virus infection or other chronic diseases, testosterone has been shown to improve mood and energy levels, even in patients with normal testosterone levels. Testosterone can be administered by injection, patch, topical gel, pill, or implant. Side effects in men include polycythemia and acne. Side effects in women include acne, hepatotoxicity, and virilization and usually only occur when testosterone is used in supraphysiologic doses. Long-term studies of the effects of testosterone on prostate cancer, breast cancer, and heart disease have not been completed. Mammograms and monitoring of prostate-specific antigen, hematocrit, and lipid levels are recommended for patients taking testosterone. [ABSTRACT FROM AUTHOR]

Editorial. Criticizes an article on somatization. What to do to help patients with somatization; How to manage to survive hectic days yet keep humanity when treating difficult patients.

The familiar diuretic spironolactone has taken on new life as a treatment for left-sided congestive heart failure. Spironolactone has been shown to decrease mortality in such patients who are New York Heart Association class IV. It can be used in addition to agents such as angiotensin-converting enzyme inhibitors and beta blockers, which also decrease mortality, and diuretics and digoxin, which are useful in treating symptoms. Spironolactone is safe, easy to use and reasonably priced. More research is necessary to determine the order and combinations of these medications in slowing the progression of this disease.

Several antiviral agents are available to treat viral illnesses in healthy children. In some children, treatment with acyclovir is an alternative to vaccination for the treatment and prevention of chickenpox. Acyclovir also can be useful in the treatment or prevention of herpes simplex infections in neonates. Ribavirin, once recommended as routine therapy for high-risk infants with respiratory syncytial virus disease, is now reserved for use in selected children. Amantadine and rimantidine are effective against influenza type A and can be used to protect children from influenza, as well as to lessen the duration and severity of illness in those who are already ill.

Patients with somatization disorder, in the full-blown or subsyndromal form, are high users of health care and often receive expensive, unnecessary tests and treatments. Their multiple somatic complaints do not have a biomedical basis but, instead, reflect underlying emotional conflicts that the patient is unable to face. Treatment of these patients is difficult, with no approach showing a good cure rate. However, if the underlying psychosocial etiology is understood and modest goals are set, much can be done to limit the problem and reduce symptoms. Management includes setting clear limits on the patient's access to the physician, while maintaining an empathetic and supportive doctor-patient relationship. Behavioral cognitive psychotherapy and short-term intensive psychotherapy may help the patient understand the underlying conflicts and thereby reduce the symptoms.

Patients with chronic low back pain can present a treatment dilemma for the family physician. Low back pain is one of the most common symptoms bringing patients to physicians. Despite its high prevalence, low back pain is often difficult to treat. In most patients, the pain cannot be pinpointed at a specific anatomic lesion, and plain radiographs, computed tomographic scans and magnetic resonance imaging studies are not useful. While most people with low back pain improve regardless of the type of intervention, some evidence shows that McKenzie exercises, manipulation and injection therapy are helpful for patients who do not recover spontaneously.