Does It Really Have to Be This Hard?

The case of the month is an actual patient of The Turek Clinic.
He came into the office the day before I left town to lecture to endocrinologists from around the country about novel ways to increase testosterone in men at their annual meeting in Nashville.

The T Patient

“Doc, I’m kinda down about things at this point,” he begins. “I wasn’t feeling right so I got checked out and my T (testosterone) was low. I was started on T shots every other week, a couple of months ago and it has not been fun. I think it’s helping but it’s such a damn hassle to get the shots in the office all of the time. Not only that, that shot in the butt doesn’t get any easier and, well… it’s not the most pleasant reminder of my T-problem. There MUST be a better way to do this. Not sure that I can live with this for the next 50 years!”

The T Interview

“I hear you,” I said. “Can I ask you some questions?”
“Sure. Ask away.”
“Did you know that you can be taught to do self-injections? That would keep you out of the doctor’s office.”
“They told me that too. I refused. Not into stabbing myself all the time.”
“Okay. Have you been offered one of the several gel formulations that are applied daily just like suntan lotion?”
“Yup. Not covered by insurance and that stuff cost BUCKS!
“How about T pellets? I can place them painlessly under your skin in your bottom and they last 4 months.”
“Doc, you guys love to hurt us, don’t you…”
“Ok. One more question: Do you know why your T is low?”
“Uh… no. No one explained this. They just started the T shots.”

The T Evaluation

I later learned that he had stopped going for the injections a month ago and asked him to get some baseline blood tests right after his visit. No diabetes, no hemochromatosis, no pituitary tumors. An otherwise healthy, but stressed guy.
Only one finding struck me: the hormone that serves as gasoline to drive the testicle (engine) to make testosterone was low. So, I called him up a couple of days later.

The New T Solution

“Sir, your LH is low.”
“Doc, is that good news or bad news?”
“It’s good. It means that your testicles are just fine, but need more signal to make more testosterone. Stress is the most common cause.”
“Sure I’m stressed! Two jobs, not much sleep and just about paying the bills.”
“So, here’s my plan: You work on taking better care of yourself by getting some sleep and exercising and I will give you a pill called clomiphene that will increase your own T levels. No injections, no gels. Let your testicles do the work.”
“Sounds too good to be true. What’s the catch? Expensive, I bet.”
“Well it’s what we call an ‘off-label’ use for men as it’s designed for women’s fertility. But, it’s nowhere near as pricey as T-gels. And who can argue with a pill.”
“Doc, I’m in.”
And so it goes. A case of secondary hypogonadism likely due to life stress and treatable with a pill that raises native testosterone levels just where you want them. And with some attention to stress reduction and a healthier lifestyle, the pill can probably be stopped over time, just like landing a plane after the storm is over. Not only that, a similar drug called enclomiphene citrate is up for FDA approval…and it’s for men! The endocrinologists must have loved the lecture as they lined up afterward to ask me piles of “how to” questions. Warmed my heart to no end. What a great way to start Men’s Health Month!