Endocrine Abstracts

A 36 year old man was referred to the Endocrine clinic from his GP practice due to an incidental finding of high Testosterone (44.3 nmol/l). He is an actor who has been under a private Trichologist for a number of years, and had been on Finasteride and topical Mixonidil. Under the Trichologist he has had his Testosterone levels periodically monitored, which had been persistently elevated since at least 2018 (39-44 nmol/l). The patient was otherwise well. He has Type 1 Diabetes, Coeliac Disease, and Gilbert’s Syndrome. He had normal puberty, and has normal genitalia, sexual function, arousal and ejaculation. At the time of first presenting in clinic he had stopped Finasteride for at least 3 months, but was still on Minoxidil. He had occasionally been using protein powder shakes, bought from his private members’ club. He has never tried to have children but plans to soon with his wife. On examination he is of medium build, with no increased pigmentation in his creases, and no visual field deficits. Bloods from clinic showed raised total testosterone (39.3 nmol/l) with raised SHBG (91 nmol/l), raised LH (13.7 iu/l) and FSH (21.4 iu/l), with otherwise normal pituitary function and no polycythaemia. Further bloods showed both 17OH Progesterone and Androstenedione within normal range. Mass spectrometry confirmed raised Testosterone. Calculated free Testosterone was 0.443 nmol/l, within the normal range. US testes, MRI adrenals and MRI pituitary were all reassuringly normal. The exact cause of the raised LH, FSH and total Testosterone remain unclear. The possibility of longstanding up-regulation of gonadotropins due to previous persistent reduced negative feedback from suppressed dihydrotestosterone has been considered. Current systemic levels of free testosterone have been normal due to abnormally high SHBG. Aberrations in testicular free testosterone have not been ruled out, and we are currently awaiting seminalysis. The patient has been told that he can start trying for a baby with his wife. He has also been counselled regarding the use of Finasteride and Moxonidil. Given the patient’s strong desire to preserve his hairline for his work and livelihood, he is considering his options.