37-Year-Old Man With Fatigue and Erectile Dysfunction

    July 2019 in “ Mayo Clinic proceedings ”
    Terin T. Sytsma, Rozalina G. McCoy
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    TLDR The man's fatigue and erectile dysfunction were improved by treating his obesity-related low testosterone without needing testosterone replacement.
    A 37-year-old man with obesity and other health issues presented with symptoms indicative of hypogonadism, confirmed by low testosterone and gonadotropin levels. Secondary hypogonadism was diagnosed, with obesity and mild obstructive sleep apnea (OSA) as contributing factors. The Endocrine Society guidelines were considered, which suggest that certain conditions are contraindications for testosterone replacement therapy, but the patient's treated OSA and lack of desire for fertility did not preclude this treatment. However, initial treatment focused on addressing reversible causes such as weight loss and OSA management. Clomiphene citrate was used to treat the patient's obesity-associated hypogonadism, leading to improved symptoms and testosterone levels, making testosterone replacement unnecessary. The document also outlines the importance of correct diagnosis, monitoring, and treatment of hypogonadism, including the potential benefits of testosterone therapy and the use of clomiphene citrate as an off-label alternative.
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