Endocrine Abstracts

This is a case of 23 year-old male who presented with 2 months history of significant lethargy, erectile dysfunction and lack of libido. He has obesity with BMI of 43, and fatty liver disease. His sense of smell is intact. His random testosterone level was low at 5.8 nmol/l, and repeat 9 am fasting testosterone was 8.4 nmol/l (8.3–13.2), with normal gonadotrophins. SHBG was 15.2 nmol/l (14-71), which is at the lower end of normal. The rest of pituitary profile were unremarkable. Low testosterone was likely secondary to obesity, however in view of patient’s age and significant symptoms, how would we approach this case?

Points for discussion:: 1. Is pituitary imaging required? 2. Should testosterone therapy be considered for his symptoms? 3. Fertility considerations with testosterone therapy 4. Weight loss approach, should we consider bariatric surgery?