Exponent of “male menopause” censured by GMC

A London doctor who prescribed male hormones over the internet was last week censured by the General Medical Council for serious professional misconduct. Dr Malcolm Carruthers, aged 64, diagnosed male menopause in a 70 year old patient with Alzheimer's disease without ever seeing him or his records.

The wife of the patient, known as “Mr X,” was on a “constant quest” for treatment for her husband, said Richard Tyson, counsel for the GMC. She contacted the website “e-medicine” in April 2000 looking for help with her husband's dementia.

Dr Carruthers' site contained a questionnaire with which patients could test themselves for possible male menopause (known also as andropause). If their score was 10 or more, the site recommended sending in a blood sample so that hormone levels could be tested. Dr Carruthers could also issue an “androscreen report” and recommend treatment. The minimum fee for the test and report was £210 ($324; €328).

After completing the questionnaire, Mrs X went to her general practitioner, Dr Peter Ewing, to ask for a blood sample to be taken from her husband. A month later she returned with Dr Carruthers' report, which diagnosed longstanding testicular failure and recommended weekly injections of 250 mg testosterone, although testosterone is not licensed for dementia.

Concerned that 250 mg was too much, but under pressure from Mrs X to prescribe testosterone, Dr Ewing agreed to a lower dose. The next week he received a letter from Mrs X saying that Dr Carruthers had emailed her saying that he disagreed with Dr Ewing's advice and asking to discuss the case over the telephone.

When Dr Ewing phoned, Dr Carruthers apologised for the email, which he had written late at night. He also said he was unaware that Mr X had severe dementia. Dr Ewing then visited the “e-medicine” website to test himself and was told he had “probable” testosterone deficiency. He complained to the GMC's professional conduct committee.

Roland Doven, chairman of the committee, said that the test “was constructed in such a way that it produced results that might lead to people with normal hormone levels being advised that they required a hormone profile.”

The committee also found that Dr Carruthers had made an “unnecessary and unsustainable statement” about Dr Ewing's knowledge and skills when he criticised his treatment approach in an email to Mrs X. The recommendation for testosterone was “irresponsible,” said Mr Doven.

Dr Carruthers has been barred from practising medicine through a website for 18 months and ordered to restrict his prescribing to licensed indications and dosages for the same period. He must also attend a teaching hospital or academic department of endocrinology for one year.

He told the BMJ: “I disagree completely with the decision, but I'm treating the whole thing as sub judice because I'm considering an appeal.”

Dr Malcolm Carruthers

(Credit: LINDSEY PARNABY/REX FEATURES)