Endocrine Abstracts

A 31-year-old male presented with persistent loss of libido and erectile dysfunction. His symptoms were investigated 3 years prior where his blood results revealed Hb 169 g/l (130-168) HCT 0.544 L/l (0.39 – 0.500) FSH < 0.1 unit/l (1.7-8.0) LH < 0.1 unit/l (2-12) cortisol 247 nmol/l (160-550) prolactin 139 milliunit/l (60-300) TSH 0.98 milliunit/l (0.30-4.20) SHBG 33 nmol/l (15-55) testosterone 14.1 nmol/l (10.0-30.0) oestrodiol 126 pmol/l (<190) and free testosterone 0.292 nmol/l. He had undergone normal puberty, had intact sense of smell, and had a muscular appearance with normal hair distribution His past medical history revealed use of anabolic-androgenic steroids (AAS) including Trenbolone at the age of 18 to enhance body image for a few months. He is currently prescribed Testosterone Enantate 75 mg which was initiated at another clinic. Whilst this normalised his testosterone it did not completely alleviate his symptoms. He reported relationship breakdown and lack of confidence related to persistent symptoms. This case illustrates the diagnostic challenges encountered in AAS use. This patient’s suppressed gonadotrophins were consistent with exogenous testosterone or synthetic derivative administration. However, it is important to recognise that some patients misuse drugs that increase endogenous testosterone production e.g. aromatase inhibitors which can present with raised gonadotrophins. Awareness of these differing biochemical profiles is essential to avoid misinterpretation and ensure accurate diagnosis and management.