Case Report: Illness Inflicting Low Testosterone: Look and You Shall Discover

Male Fertility Specialist Los Angeles, CA
Your empty tank might be refilled but it surely’s good to ask why it emptied (Courtesy: Unsplash)

He got here to my workplace out of types, searching for solutions to his medical points. As a 30-year-old, he had been experiencing fatigue, despair, low intercourse drive and erectile dysfunction for 8 years! Realizing that the common younger male thinks about intercourse each 10 minutes throughout waking hours and ever so not often fails to have an erection, I used to be very involved for him and took his signs very significantly. He had seen his main care supplier, an endocrinologist and a neurologist earlier than me. He was given antidepressants, psychotherapy and different therapies to no avail. This led to a analysis of low testosterone and subsequent remedy with testosterone injections. Like a recharged Energizer® bunny, testosterone substitute revived him fully, making him really feel “completely higher in each approach.” All good. But, he sat in entrance of me questioning whether or not or not he must take testosterone for the remainder of his life, possibly 60+ years! He was extra anxious about how he would keep fertile when he realized that testosterone remedy acts as a contraceptive.

The Backside of Issues

I’m a “root-cause” man. By determining why issues occur, you have got the perfect probability for remedy. The straightforward query right here is: What was the reason for the testosterone drain on this younger man, and will it’s reversed? So, I went to work.

His medical historical past was a clean slate for threat, together with no pot or different drug use, no premature stress, and no sleep apnea or weight problems. His bodily examination was additionally unremarkable with regular testicle measurement and no varicoceles. The discovering of regular sized testicles advised me that no matter occurred to his testosterone occurred after puberty and was not a lifelong downside of testicular failure. His blood work confirmed no diabetes, anemia, prolactin or thyroid points, all of which might be related to low testosterone.

However then I noticed it, deep inside his bundle of laboratory research: his blood counts have been excessive. He was polycythemic. However why? Properly, simply being on testosterone might do that, however he wasn’t taking excessive sufficient, anabolic doses of testosterone. Then, I stumbled on blood assessments taken earlier than he began testosterone and, lo and behold, he was polycythemic then too. Bingo! The analysis: hemochromatosis.

A Bloody Illness

Hereditary hemochromatosis is attributable to a mutation in a gene that controls the quantity of iron your physique absorbs from meals. It happens in 1 of each 200-300 folks and is discovered much more typically in males than ladies. Due to this gene defect, extra iron is absorbed after which will get saved in physique organs just like the liver, pancreas and spleen. Over time, the saved iron causes scarring and organ harm that will result in liver illness, diabetes and coronary heart failure. Infertility, erectile dysfunction and low testosterone are additionally penalties of hemochromatosis. And, left untreated, it may be deadly.

You’ll by no means guess the way it’s handled: Bloodletting (now often called therapeutic phlebotomy). Bloodletting, or draining of a affected person’s blood to stop or remedy illness, was the most typical medical process carried out by surgeons from antiquity till the late nineteenth century, a span of over 2,000 years. And it nonetheless has software right this moment. Does it remedy hemochromatosis? No, but it surely prevents harm to organs by maintaining iron from accumulating in them and ends in an primarily regular lifespan.

So, this root trigger evaluation paid off handsomely. I requested this younger man to think about donating blood repeatedly. I additionally took him off of the testosterone injections and began him on clomiphene citrate tablets to push his “lazy” pituitary more durable to make extra of his personal testosterone ranges. On this approach, we maintained his regular (excessive) high quality of life that he loved whereas on testosterone with out utilizing testosterone; he now additionally enjoys good sexual well being and is fertile, and we added a couple of extra years to his life.  We’ve got executed what Hippocrates, the Father of Medication, ordered us to do: “Declare the previous, diagnose the current, foretell the longer term.” And that, my associates, is the hat trick of nice drugs!

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