I have been approached by a consultant colleague who is setting up an Andrology
Clinic (yes, Viagra has reached the East Midlands!).
He has come across a subset of male patients with a variety of symptoms
including impotence and in one case a combination of breast enlargement and
apparent reduction in penile size. These patients also have a variety of other
medical problems, commonly diabetes.
However in addition the subset in question also have a slightly low serum
testosterone in the range 6-8nmol/L (our quoted reference range is
9.7-37nmol/L). In some where SHBG (sex hormone binding globulin) has been
measured this is also low. Gonadotrophins have been normal.
My understanding is that such modest abnormalities in biochemistry are unlikely
to be the cause of symptoms but I would be grateful for input from any one with
expertise in this area.
Because my colleague feels he is the final arbiter in these cases he is anxious
not to miss a treatable cause.
Questions
1. Is there anything else the lab should be offering?
2. Is there ever any indication for doing an LHrH (luteinising hormone releasing
hormone) test in male patients with this combination of finding?
3. Are reference ranges for serum testosterone for 50 and 60 year old males the
same as for younger patients and if not are there other ranges out there?
4 Is anyone aware of any established medical andrology clinics in the UK (or I
guess anywhere prepared to communicate by email) that have expertise in these
sorts of problems.
Either reply to the mailbase or directly to me ([log in to unmask]) as you feel is
appropriate.
Many thanks in advance as usual!
James Falconer Smith
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