RESUMEN
Many male patients are discovered on screening to suffer from hypogonadism and age related hypogonadism is being increasingly recognized. However, secondary causes of hypogonadism should not be overlooked, especially in patients who may have concomitant morbidity as highlighted in this case. Our patient with vascular hypogonadism was treated with testosterone and clomiphene citrate in cycles; with a hope of improving not only androgen levels but overall pituitary function as there were co-existing endocrine pathologies of albeit primary hypothyroidism and low IGF-1 levels. Treatment with exogenous testosterone is fairly well established; but there is also increasing evidence of the effectiveness and short-term safety of clomiphene citrate in restoring not only biological levels but functional states in males as well. As such, we report an unusual case of a patient seen at our Men's Health & Andrology clinic in which both the cause of some otherwise unremarkable symptoms and the treatment, using a combination of clomiphene citrate and testosterone, were remarkable.
Asunto(s)
Clomifeno/uso terapéutico , Hipogonadismo/tratamiento farmacológico , Testosterona/uso terapéutico , Adulto , Terapia de Reemplazo de Hormonas , Humanos , Hipopituitarismo/tratamiento farmacológico , Lipoproteínas LDL/sangre , Masculino , Testosterona/sangre , Tirotropina/sangre , Tiroxina/uso terapéuticoRESUMEN
We investigated whether a preference by patients regarding the gender of a health care provider to manage erectile dysfunction (ED) may be a factor in the diagnosis and care of this condition, whose broader medical significance is an area of increasing interest. A brief questionnaire was completed by 1087 adult males in a primary care setting. The questionnaire explored provider gender preference and other possible biases. The prevalence of ED in the 40-69 age group in our population was 68.8%. The prevalence was 81% in the age group of 70 and more. Of those who reported having experienced ED, 51.5% had discussed it with a provider, and 28.1% had been treated. Approximately, 57% expressed no provider gender preference, regardless of history of ED. Of those who stated a preference, approximately 75% prefer male providers. However, also among those who state a preference, Hispanics are not as likely as non-Hispanics to prefer a male provider (P=0.03). Most believe that males and females are equally qualified to manage ED, but among those who have a different opinion, the gender perceived more favorably is male. The issue of privacy during the discussion of ED was also very important to the respondents in this study.
Asunto(s)
Disfunción Eréctil/psicología , Personal de Salud , Satisfacción del Paciente , Relaciones Profesional-Paciente , Adulto , Anciano , Disfunción Eréctil/epidemiología , Disfunción Eréctil/terapia , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/etnología , Factores Sexuales , Texas/epidemiologíaRESUMEN
Genetic variation at the apolipoprotein (apo) A-I/C-III/A-IV gene cluster on chromosome 11 has been associated with differences in occurrence of atherosclerosis and with variability in lipid levels among hypercholesterolemic-hypertriglyceridemic individuals. The functional cause of the association is not known, but polymorphisms of the apo A-IV gene are of interest because apo A-IV is involved in both triglyceride and cholesterol metabolism. Two mutations in the apo A-IV gene, 347T->S and 360Q->H, are known to cause amino acid substitutions in the mature protein. These polymorphisms were typed in a sample of 119 subjects with high cholesterol and high triglycerides in whom carotid artery wall thickness was previously shown to be strongly associated with silent polymorphic variation in the A-I/C-III/A-IV gene cluster. The relative allele frequencies were 0.83 and 0.17 for codon 347T->, and 0.95 and 0.05 for codon 360Q-> H. These polymorphisms did not show a statistically significant relationship with prevalent hypertension, diabetes, or cardiovascular disease or with plasma lipid levels. Most importantly, these amino acids substitutions in apo A-IV were not associated with carotid artery wall thickness. Therefore, the genetic cause of disease variability in a sample of mixed hyperlipidemics is not amino acid substitutions in codons 347 or 360 of the apoliproteins A-IV gene.