Q&A: teens & social media; BMI as bible; testosterone levels, hormonal mood swings

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In this week’s reader submitted Q&A, we’re tackling these questions:

1. What are the harms of social media on teen mental health?

2. Is the BMI an accurate predictor of health?

3. Could testosterone treatment help with a lower sex drive?

4. For a few days in my cycle, I am depressed - do I need antidepressants?

Click here to submit your questions (about anything) for future Q&A posts!

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

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Photo by dole777 on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: TEENS AND SOCIAL MEDIA

What are the harms of social media on teen mental health? To me the fears seem overblown.

- Jane

Dear Jane,

The U.S. Surgeon General, Dr. Vivek Murthy, issued a warning about the effects of social media on youth mental health for good reason. In it, he said:

“We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.”

Social media use in young people is almost universal. There are data to show its directly harmful effects on mood, body image, and social relationships, among other things. We also know that social media use can be addicting—and that it can take kids away from other healthy activities like playing sports, being outside in nature, and connecting in person with their peers. Dr. Murthy came on my podcast to discuss these very issues.

Whether or not social media is the cause of the adolescent mental health crisis on a population level is an open question. In his new book, The Anxious Generation, social psychologist Jonathan Haidt makes a compelling argument for causality. His critics disagree, arguing that social media is merely correlated with—not the cause of—emotional distress in teens. Indeed, young people are dealing with so much these days—from political unrest to gun violence to pandemic-accelerated learning loss—that it’s difficult to tease out the role of social media on teen despair. What we do know is that social media can do harm—and that some kids are more susceptible than others. 

My advice: Take an honest look at the amount of time you and your kids are spending online. Take stock of the cost of spending that time—emotionally, physically, and mentally. For example, after spending 15 minutes on your favorite platform, ask yourself: How do I feel? Is it better or worse than I would have if I had been resting my brain, reading a book, or talking to a friend instead? What am I avoiding by scrolling online? What meaningful activities have been replaced by screen use? Ex. Would I exercise/sleep/social more if I wasn’t so regularly online?

Whether it’s alcohol and sugar or Instagram and TikTok, the question isn’t just: how much? It’s: What is my relationship with the thing I’m consuming? Maintaining digital hygiene takes work. A healthy relationship with technology requires the same self-awareness that we should apply to everything we feed our eyeballs and brains.

My podcast episode called “What Are You Feeding Your Brain?” is here. 

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QUESTION #2: BMI AS BIBLE

BMI—is it an accurate depiction of health? I recently had a doctor tell me I was "borderline obese" based on my BMI, despite being incredibly active and healthy, strength training 3+ times a week, doing cardio 5-7 times a week, and eating a diet mostly consisting of unprocessed fruits, veggies, etc., I have an amazingly low cholesterol and LDL levels, and lots of muscle... I was shocked and hurt with this assessment. Of course I understand she wants me to be healthy, but what gives?

- Riley

Hi Riley,