Endocrine Abstracts

Introduction: Western countries present a gradual decline in male reproductive function. The decline in testosterone levels and sperm production witnessed over the past five decades, has been ascribed to environmental factors and unhealthy behaviors. Substance and drug usage is recognized as a detrimental lifestyle choice, that can interfere with the processes of steroidogenesis and spermatogenesis. Hypogonadism due to substance and drug abuse can be reversible.

Case report: A 40-year-old male patient was admitted to the endocrinology department 7 years ago, for general fatigue, low libido, and erectile dysfunction. He had no known medical history and physical examination revealed no significant findings. The biochemical analysis was normal, and hormonal tests shown hypogonadotropic hypogonadism with slightly low testosterone levels on two measurements, while the other axes - thyroid, somatotropic, corticotropic, lactotropic, and thyroid - were within normal limits. In the first two years after initial presentation, the patient underwent multiple investigations for an organic cause. Hypothalamic-pituitary MRI, testicular ultrasound, and abdominal-pelvic ultrasound were normal. DXA scan reveals decreased bone mineral density with mild vitamin D deficiency, so vitamin D treatment was initiated. During this time, his wife becomes pregnant. Two years after the initial presentation, hormonal evaluation reveals severe hypogonadotropic hypogonadism with very low testosterone, leading to the initiation of injectable testosterone treatment. Two years later, a semen analysis shows azoospermia, and testosterone treatment is discontinued. After stopping testosterone treatment, the patient continues to show hypogonadotropic hypogonadism with slightly low testosterone, and semen analysis reveals asthenozoospermia. His wife becomes pregnant again. Currently, the patient returns to our endocrinology department for reevaluation, where a complete pituitary assessment shows normal results, with no hypogonadotropic hypogonadism, but testosterone levels at the lower limit. In his medical history, the patient admits for the first time to consuming illicit substances (cocaine, codeine, amphetamine, synthetic drugs) and alcohol over the past years, with a reduction in frequency after the onset of the COVID-19 pandemic.

Conclusions: The widespread production and consumption of drugs poses a significant threat to public health. Concurrent abuse of more than one substance can have unpredictable effects, but they are often additive. When assessing a patient for hypogonadism, it is essential to inquire about the use of illegal drugs and other substances like tobacco and alcohol, particularly important in younger men, when no underlying organic causes of hypogonadism can be identified. Substance discontinuation typically results in the resolution of hypogonadism and should be strongly advised.