Endocrine Abstracts

Diagnoses: Primary hypogonadism, Gynaecomastia

Case: A 36 year old male presented with bilateral gynaecomastia via his GP. He otherwise felt well in himself and was not significantly affected by this condition. He had initial workup investigations then was lost to follow up and results until 2 years later in my clinic. On review he reported a normal for him libido, normal erections, normal ejaculation. He reported no issues with energy levels, he works in hospitality which involves some long hours but he is generally able to function as usual. He has not had any fractures or features of osteoporosis. He has not noticed any hair pattern changes unusual for him. He was noted to have minimal body hair but felt his hair followed a similar pattern to the rest of the males in his family. His ethnicity is mixed black and Asian. He has no significant medical history and no previous testicular issues that he was aware of. On examination he continues to have bilateral gynaecomastia grade 2-3. He appears overweight with a BMI calculated at 33. His blood pressure was 138/91. Testes as reported on ultrasound, no change as per patient. Socially he vapes, consumes 8units/week alcohol, does not take any recreational drugs or other non-prescribed supplements.

Presenting Investigations: Testosterone 1.9, FSH 32, LH 18, prolactin 133. Repeat showed stable results. Karyotype 46 XY, Semen analysis-Azoospermia. Ultrasound Breasts - both U2. Ultrasound Testes-Both testes appear small without lesions. The right measures 2.5 × 1.1 × 1.6 cm and left measures 2.5 × 0.8 × 1.3 cm. Both epididymis appear normal. The left scrotal sac space has several varices.

Management and Discussion: He hopes to have fertility to father a child. He is in a relationship but they were not currently trying to have a baby. We discussed that if he was to have any success with fertility, whilst unlikely, this should be addressed sooner rather than later. He accepted an offer for specialist referral to consider sperm retrieval and any other options available for his fertility. Apart from gynaecomastia he is currently subjectively asymptomatic and testosterone replacement therapy is unlikely to make a major change to his expected fertility, therefore it may not be indicated at this stage. Thus far he has not been well engaged with his workup and management for this condition so it may not be acceptable to him. In his next appointment we will discuss the options for testosterone.