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DEAR DR. ROACH: We are very fond of our family doctor. I was in to see him the other day, and it came up in conversation that he was going to be getting married.

We would like to acknowledge this event in his life with either a lovely card or a small gift. I know the old-school way of thinking is to never do things that are so personal when it comes to your physician. Do you think that still holds true today? N.W.

ANSWER: Physicians are human beings, and a thoughtful card is always appreciated. Gifts can sometimes be OK, but the American Medical Association has some guidelines for physicians on accepting gifts. I agree with them and you might find them helpful:

Be sensitive to the size of the gift: Inappropriately large gifts should not be accepted. Do not let a gift influence patient care.

Decline a gift that would present an emotional or financial hardship to the patients family.

Consider suggesting a charitable contribution in lieu of a gift.

I would add that sometimes rejecting a gift can be hurtful, and if accepting a gift conforms to the guidelines, I generally accept it with thanks.

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DEAR DR. ROACH: Hi. Im a very healthy, 68-year-old male. My only issue is almost nonexistent testosterone. What type of doctor should I see? It seems to be a problem for many senior men. A.

ANSWER: Low testosterone is a concern for many men as they get older. In some cases, the concern is justified. Some men may have a problem making testosterone due to a condition in the brain (the hypothalamus and pituitary gland both need to be working properly for testosterone production) or in the testes, where testosterone is actually made. In these cases, testosterone replacement therapy is clearly indicated.

What is still controversial is whether to treat healthy older men who have a low testosterone level and no symptoms. Its not clear that treatment of low testosterone will prevent problems in the future.

Its possible thats the case, but I am very cautious about prescribing a drug with potential harms for someone without symptoms, when it has not been proven to be of benefit.

However, men with symptoms of low testosterone, such as low sex drive, depressed mood and loss of body hair, and who have clearly low testosterone levels may benefit from treatment, and a trial of testosterone treatment is appropriate.

Men should learn about potential risk (prostate cancer remains a concern, despite reassuring early studies) and have regular laboratory evaluation. Low energy by itself is not clearly a symptom of low testosterone and may not improve with testosterone treatment.

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DR. ROACH WRITES: A recent column on easy bruising in older adults prompted several readers to recommend specialized makeup products to cover the discolored areas. That is not something I had considered, and I appreciate the recommendation. Another reader recommended dry skin brushing, but I could not find good evidence that this helps with skin discoloration.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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Can they give a gift to their doctor? - Gulf Breeze News