Endocrine Abstracts

A 27 year old was referred to endocrine clinic for investigation of longstanding gynaecomastia. He had noticed loss of early morning erections. He never fully grew a beard and had no children. This was associated with temporal hair recession and intermittent headaches. On examination he appeared to be of asthenic built and youthful. He was tall with his upper body being longer than lower. He had widely spaced breasts and long arms. His testicular volume on examination was 1–2 ml bilaterally. His visual fields were full on confrontation. His bloods showed an FSH of 44.0 μ/l (1–12) and LH of 22.4 μ/l Testosterone levels of 3.7 nmol/l (8.64–29), sex hormone binding globulin levels of 41 nmol/L (18.3–54.1) and a Free Androgen Index of 9.0 (42–200). He was investigated for hyper-gonadotrophic hypogonadism and consented for genetic testing for Karyotyping. His genetic testing confirmed a diagnosis of Klinefelters and he was commenced on testosterone replacement therapy. As he was unable to make testosterone, replacement was required to alleviate the symptoms that he had long suffered with including mood problems, lethargy and sexual dysfunction plus the long term benefit on bone and cardiovascular health, also reducing the risk of developing type 2 diabetes. Review a few months later showed a noticeable improvement in energy levels, mood elevation, and hair growth on arms and increased sex drive. His repeat blood tests showed Testosterone levels of 45.2 nmol/l (8.64–29). He generally felt much better and was terrified of any deviation from this relief and asked for the IM equivalent after being told that Testogel supplies were extremely scant. It was therefore agreed to start him on IM Nebido (Testosterone Undecanoate 250 mg/ml) 1gm every 12 weeks. Dosing will be varied on the basis of trough levels and regular full blood count monitoring during the course of treatment.