Diving Deep for a Man’s Health

Hemochromatosis & Male Infertility
The beauty of the ocean runs deep (Courtesy: Unsplash.com)

As a surfer, I find spending time on the ocean wonderfully intoxicating. The power and pitch of the waves, the size of swells, the shimmer of the sea, all magnificent to behold. But, what’s beneath the water’s surface is truly a whole other world; one even more marvelous than floating on top. And so it goes with men’s health.

Scratching the Surface

He came to see me because his vasectomy reversal had failed and he was wondering whether I could help him have kids. He had had a vasectomy and then a vasectomy reversal a decade or so later. The reversal had worked initially but over the last several years, while he was trying to conceive, his sperm count fell to zero. Not a single swimmer.

I think about several things when I see this: surgical failure of the reversal procedure with scar tissue causing re-blockage, changes in health (cancer, diabetes, obesity), testicular failure from illness or exposure (fevers, hot baths, solvents) and medications, to name a few. And since I have a habit of asking “why?” we now break the water’s surface and head into that deeper place where answers lie.

He was a picture of health. His reversal was done by a highly competent colleague and so I ruled out reversal failure. He was medication-free and had no bad health-related habits. I was really coming up empty handed…except for one thing: he mentioned that he was feeling more tired lately and has been having trouble with erections and a lower sex drive. His primary care physician measured his testosterone and it was low…really low. Low testosterone could explain the erection and sex drive issues and also poor sperm production.

His doctor suggested that he start on testosterone replacement. But the patient knew better: this might help his symptoms, but it would “turn off” sperm production. He didn’t follow that advice but asked for my help instead.

Deep Dive

It is medically satisfying and usually correct when a set of symptoms can be ascribed to a single overarching diagnosis. But this didn’t happen until I reviewed the ream of laboratory data that he handed me during the visit.

Then I saw it. His blood counts have always been really high. For years. Thick blood. Hemochromatosis! A genetic condition that causes blood to sludge in the pituitary and reduce the signal strength for the testicle to make testosterone and sperm. We confirmed it with iron studies. He started donating blood, and I kickstarted his pituitary with medication, and, low and behold, both his sex life and sperm returned.

Being able to find and cure disease relies not only on powers of observation, but also the ability to listen (and trust) that what patients tell you is real and relevant. Only then, when the truth is laid bare on the table, does the hidden become obvious.

 

6 thoughts on “Diving Deep for a Man’s Health

  1. Dear Sir,
    I have been married since last 3.5 years and my wife was not able to convince since i am suffering from Azoospermia.
    I have consult a senior Urologist and observed a cyst in prostate gland.
    Doctor suspect that it may be due to cyst in prostate , sperm are getting blocked.
    So, therefore, i have gone minor operation of prostatic cyst to deroof it but still my sperm count is showing NIL when i have done my test last week.
    My hormone level like LH , FSH and testosterone are normal in range. My testes size are also showing normal.
    I am totally devastated now sir..
    I am not getting what is the root cause of my problem..

    Could you please assist me and guide me about the next step should i take..?

    Awaiting for your valuable feedback sir..

    Thanks,
    Shakir
    +91 – 9748664945

    1. Dear Md Shakir, Sounds like you were treated for ejaculatory duct obstruction due to a prostatic cyst. The key finding with this diagnosis is LOW VOLUME (<1.5mL) azoospermia. It can often be confused with congenital absence of the vas deferent (CAVD), but the physical exam with CAVD shows no vas. Maybe you do have EDO but the procedure wasn't as thorough as it should have been? Before you lose hope, consider a Second Opinion with us!

  2. Dr. Turek. Nick Drobocky here. With your help we now have two healthy children. I am so grateful.
    I look forward to your emails.

    1. Nicholas! So great to hear that you have 2 kids! Two by the hand of God and man, with a little more man than usual!

  3. HELLO DR TUREK. I ALWAYS FOLLOW YOUR PUBLICATIONS AND YOUR WORK. YOU ARE SUCH AN AMAZING DOC. I HAVE AN “EXCESSIVE” AZOOSPERMIA CONDITION THOUGH I DO NOT KNOW THE UNDERLINING CONDITION BEHIND IT.
    DUE TO HIGH COSTS INVOLVING TO VISIT YOU FROM MY COUNTRY, I THINK I MAY NEVER MAKE IT. I WOULD HAVE LOVED TO CONSULT WITH YOU. HOWEVER, I WILL CONTINUE TO READ YOUR PUBLICATIONS JUST TO HAVE HOPE AND TO SEE MYSELF OUT OF THIS WORLD. THANK

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