Recently, a doctor treated his patient for erectile dysfunction and decreased sexual drive. The patient had multiple reasons explaining these two conditions. He was on a SSRI. He had a history of alcohol abuse. And several other medical issues. What was also clear was that he had low free testosterone levels for his age cohort; and he had clinical hypogonadism.


The doctor discussed treatment with exogenous testosterone. They discussed the risks, benefits, and options – including low sperm count and fertility issues. The patient said he understood and gave his blessing to proceed.

His symptoms improved.


And he was happy.


And he was appreciative.


One little minor detail. The patient never told his wife. She had her heart set on another baby. And they were unable to conceive.


His wife went to see a fertility specialist. One thing led to another and the wife understood she might need several rounds of IVF treatment. Not an inexpensive endeavor.


Well, the wife eventually learned about the testosterone treatment. She was livid. Not with her husband. But with the doctor.


She barked that the testosterone treatment caused the low sperm count. Had that treatment not been initiated, she’d be pregnant and never would have needed fertility treatment. Yes, I know, there are several details the wife seemed to be missing. Regardless, the husband demanded he be reimbursed by the testosterone prescriber for his wife’s impending treatments – or he’d alert any number of authorities.




Let’s deconstruct this. Who’s the doctor’s patient? The husband or the wife? The doctor never saw the wife. To the extent the doctor was even aware there were fertility concerns, the doctor explained in detail the risks, benefits, and options for the testosterone treatment. With full informed consent, his patient elected to proceed. The doctor’s duty was to HIS patient.


Next, most fertility evaluations involve both the woman and the sperm donor (often, but not always, the wife and her husband). If the patient had a low sperm count, this should have been addressed early in the fertility evaluation. And, a history would have identified that the husband was on testosterone replacement. An important detail. If the husband chose to withhold this fact, then the husband is culpable for the outcome. Even so, it’s not clear that the exogenous testosterone was the cause of the low sperm count; that the low sperm count was the cause of the infertility; or that even fully “fixed”, whether the patient’s wife would have conceived and brought a baby to term.


What is clear, though, is that the demand to make payment or a complaint will be filed sounds like extortion, a criminal offense.


Whenever your treatment affects a third party, there is a chance that third party will spew venom on you. But, unless your patient brings that third party into the discussion, you generally do not owe that third party a duty of care. I say generally because this rule has occasional exceptions. In some states, doctors have been held liable for prescribing medication to their patients that caused their car to crash into another. The injured third party successfully sued the doctor. And, in some states, psychiatrists may be liable if they fail to warn third parties of an imminent and detailed threat by their patient. Again these are exceptions and not the rule. Your primary duty is to your patient.


It’s unfortunate the patient in this vignette wasn’t candid with his wife. That is also probably not an exceedingly rare occurrence.