Monday, November 23, 2015

A Hypogonadism Consult

I had an interesting consult the other  day. Again, one of the many, hordes in fact, of men coming in for a testosterone prescription. And I admit I'm jaded and I've begun the stereotype. This was the classical young man, meathead type with biceps bigger than a treetrunk. He could have been a body double for the incredible hulk. Proud that he bench presses 200 lbs.
And yet, feels that he needs to be on testosterone. Admits he 'juices' up frequently too (a word I learnt not too long ago) with crazy shit he was getting from his gym- androgens, to which they often add aromatase inhibitors to prevent gynecomastia, and HCG to prevent the resultant testicular shrinkage. What a crazy world.
Anyway, like many before him, this chap refuses to accept that his blood test showed his testosterone to be normal. And so he was here for  some 'medical testosterone'.
"I'm young. I should be on the higher range of normal!".
They all say that. Never mind that the total T was in the 600s already.
And he was most convinced of this for two reasons. That he has peaked with his weightlifting. And that he has 'erectile dysfunction'.
As an endocrinologist, I do go into a bit of detail when taking a history of ED. So I asked him what that meant to him. He was very concerned because a few years ago he could have sex about 5 times. And now it's only about twice.

Talk about feeling inferior. This chap's definition of normal was having sexual intercourse 5 times a day. And he is concerned that he is now only interested or able to do it 2 times a day.

I wasn't sure if I should laugh, cry, hit my head on the wall, or go on my knees and kowtow to him. 5 times a day??? Teach this padawan, O Master.

I was professional and held my composure. And did all I could to explain to him the normal endocrine physiology of the reproductive system, the risks of unnecessary testosterone use and the medical guidelines. I'm pretty sure he left unconvinced.

In the meantime, I feel like I need to go to the gym more.