Endocrine Abstracts

Introduction: Functional Hypogonadism (FH) is a condition with low circulating serum testosterone and an intact Hypothalmo-pituitary-gonadal axis. The use of testosterone replacement therapy (TRT) use in FH is controversial based on the risk-benefit ratio. This report highlights the benefits of managing FH with TRT.

Case Presentation: 47-year-old man presented to the endocrine clinic on account of poor erection, reduction in libido and quick ejaculation of 3 years duration. There was associated infrequent and unsatisfying sexual activities with marital strain. He was diagnosed with diabetes mellitus seven years earlier; glycaemic control has been poor due to non-drug adherence. He takes no steroids or opioids. He has four children in a monogamous family setting, with no other sexual partners. On physical examination, BMI was 30kg/m2. BP-112/78mmhg. Other systemic examinations were unremarkable. He has normal male-pattern hair distribution. Penile length was normal and both testes were descended in the scrotum, with testicular size 20ml bilaterally. He has no gynaecomastia. Investigations revealed elevated FBS(8mmol/l). Fasting Serum Testosterone was low at 2.18ng/ml (2.6-10), SHBG, LH and FSH were normal. Liver and Thyroid function, Prolactin, FLP and PSA were all essentially normal. A diagnosis of Functional Hypogonadism with poor glycaemic control was made and he was commenced on Testosterone gel 50mg daily, anti-diabetic medications, along with lifestyle modifications. Subsequent follow-up visits showed improvement in sexual functions and better glycaemic control with moderate weight loss. After one year of TRT, serum testosterone had normalized: 6.97ng/ml (2.6-10), with restored sexual function, then TRT was discontinued.

Conclusion: This report highlights that TRT is useful in non-reversible FH as it improves sexual functions and cardiometabolic profiles, normalizes testosterone levels with no documented adverse effects. Adequate monitoring of cardiovascular safety and adverse effects is paramount when used in men with FH.