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Thanks to Ceridwen Dawkins for suggesting this Case. A request from a Family Doctor on a 68 year old man complaining of increasing impotence. Serum results were: LH: 8.3 IU/L (1.6 - 9.6) FSH: 15.1 IU/L ( <6.0) Testosterone: 9.7 nmol/L (9 - 30) This Case attracted 25 participants, and produced a wide divergence of opinion.. One assessor commented 'This was an interesting set of answers because I don't think we know the answer - what the results mean'. He added 'What a horrible question to mark'. Despite this, there was only one large divergence of opinion between assessors. I am awarding myself a bonus mark - last year, I was challenged to find a case for which 'phoning the Doctor would score a negative mark. This is the first such Case! Only 2 participants would call the Family Doctor.(-0.4) 3 participants thought the results were likely to be normal for age;(0.0) 2 participants queried the male menopause.(-0.4) 5 queried mild/ partial/ early/ incipient primary testicular failure;(1.5) 1 each queried secondary gonadal failure;(-0.6*) abnormal tubular function;(-0.4) early hypothyroidism.(-0.8) In addition, 6 queried a drug effect; (-0.2) 2 queried psychological problems; (0.2) 1 each queried galactorrhoea; (0.2) alcohol intake; (0.8) vascular disease; (0.4) autonomic neuropathy; (0.0) stress; (0.2) systemic illness; (0.2) germinal cell dysfunction; (-0.4) testicular lesions. (0.0) 14 would measure Sex Hormone Binding Globulin/ free testosterone; (1.0) 8 would measure glucose; (0.6) 5 would measure prolactin; (0.6) 4 would measure free androgen index; (0.6) 4 would measure LFTs; (0.0) 4 would suggest repeating the tests; (0.6) 3 would suggest looking at sperm count and morphology; (-0.8) 3 would measure urea and electrolytes; (-0.2) 1 each would measure thyroid function tests (0.2) PSA; (-0.4) ferritin. (-0.4) 2 participants would suggest referral to an endocrinologist. (1.2) Perhaps surprisingly, no-one suggested referral to an urologist (or a sexual psychiatrist). Ceridwen commented 'Testosterone unremarkable for age. FSH rather high ?normal LFTs? Perhaps repeat, preferably 8 - 10am' Best wishes Gordon Challand Li Ping %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%