IMPAIRED LIBIDO IN HOCKEY PLAYER

Abstract

HISTORY A 24 year old male hockey player presented to the physician's office with an initial complaint of injured forefinger but it became clear that his main concern was inability to have an erection. This was ongoing for 2 years. Past medical history revealed some vague problems with his liver and patient had declined a liver biopsy. No current medications. Pt admitted to 6 years of anabolic steroid use (since age 16) stopping 2 years ago. Pt. denies problems with hypertension, cardiovascular disease, peripheral vessel disease, diabetes, wt change or trauma to the groin; he reveals recent treatment for a chlamydia infection. PHYSICAL EXAMINATION VITAL SIGNS: BP 120/84 HR 76 wt 188.9 pounds ht 5 feet, 10.5 inches RR 16. GENERAL: Well developed well nourished male with muscular physique. GENITAL: shaven genital area, circumsized, descended testicles, measuring 2.2 to 2.5 cm, soft, large grapelike appearance in size; no hernia; RECTAL: boggy prostate with tenderness. DIFFERENTIAL DIAGNOSIS Impotence related to anabolic steroid use (hypogonadatropic hypogonadism) or trauma, neurologic, vascular or drug etiologies; persistent exogenous steroid use; liver dysfunction; prostatitis. LAB TESTS Urinalysis 3–8 White Blood Cells per high power field; Urine culture no growth; LIVER FUNCTION TESTS: Albumin 4.8 g/dL [3.5–5.0], Prothrombin Time 13.8 sec [11.7–13.5], Alk Phosphatase 107 U/L [38–126], AST (SGOT) 45 U/L [14–41], ALT (SGPT) 46 U/L [17–63]; HEPATITIS SCREEN: negative for HEP B,C, and A; DHEA 619 ng/ml [140–1250], Luteinizing Hormone < 0.5 MIU/ml [2.0–12.0], Prolaction 9.6 ng/ml [1.6–18.8], Total Testosterone 189 ng/dL [270–1194]; Prostate Specific Antigen 1.1 ng/ml [0.0–4.0]. DIAGNOSIS HYPOGONADATROPIC HYPOGONADISM TREATMENT:Chorionic Gonadatropin 2,500 U SQ biweekly with 4 month taper