Suggest Treatment For Suicidal Thoughts And Low Self Esteem In A Person With Hypogonadism

Posted on Mon, 3 Aug 2015

Question: Hi my son had undescended testis and had them stitched down when he was around 10 years old he was later diagnosed with hypogonodism and prescribed testosterone gel applied daily, he ceased this a few years ago.The doctor did not give very much information and when he used the gel it gave him urges that he was unaware of and lead to 1 episode where he masturbated in public and was caught he then ceased the gel as he was confused and thought there was something wrong with him we wen back to the doctor to talk with him about this and he was very cruel and unhelpful. He is now depressed and feeling suicidal as he is unable to have a sexual relationship with a women and his penis has not grown since very young maybe 3cm at most.He is also very skinny and tall with long arms and legs which also add to his low self esteem.This has lead him into various drug addictions to try to forget his problems as he was also told he is most likely infertile, children were very important to him. He is embarrassed to go out or make any friendships as he is also ribbed from mates . We have been unable to find a doctor in our area who specializes in this field and would like some help to find one please who can support him to have a health assessment and plan. We live in the Lismore area 2480 northern rivers Thank you YYYY@YYYY

Answered by Dr. Binu Parameswaran Pillai (1 hour later)

Brief Answer:
Hypogonadism

Detailed Answer:
Good day,
Noted your concern. Sorry to hear about his issues.
The description of thin limbs and being tall together with hypogonadism is very convincing. It is important to ascertain the cause of his hypogonadism and undescended testes during childhood. This could be due to a problem in testes itself or a problem in the pituitary area. He need following tests to begin with

1) An examination of his height, weight, smell sensation ( is he able to appreciate the smell of food etc?)
2) Testes volume and penis size.
3) Blood tests: LH, FSH, Testosterone, Semen analysis ( if he is able to produce a sample)
4) MRI pituitary or Karyotyping based on his above tests

Based on this we can decide the treatment.
We can predict his fertility potential based on above tests and treatment can be initiated.
He need to visit an endocrinologist. I must say ( please do not get me wrong), that going to a general physician or a GP or even a urologist would be a waste of time. They will not be able to go to the depth of the problem. Please meet an endocrinologist.

Regards
Binu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar