Thursday, March 21, 2013
Thomas B. Repas, DO, FACP, FACE, CDE
Patient 2 is a 43-year-old-man with hypogonadism due to Klinefelter’s syndrome treated with transdermal testosterone gel. He had done well without adverse drug reactions or side effects of therapy. He had been on the same dose for years; thus, we had decreased the frequency of routine lab testing to annually.
He transitioned over to new insurance. Before agreeing to cover the testosterone therapy, they demanded that I provide copies of his pre-treatment testosterone levels proving that they were below the normal range.
Tuesday, December 11, 2012
Thomas B. Repas, DO, FACP, FACE, CDE
A young man was referred to me for evaluation of low testosterone and gynecomastia. The initial total testosterone was 57 ng/dL; results of a repeat testosterone assessment were even lower. Prolactin was normal, but follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were both undetectable. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were previously normal but were now both over 200. His total and LDL cholesterol levels were high; his HDL was low.
He was muscular, physically fit and an avid weight lifter. I questioned him about the use of anabolic steroids. He had not knowingly used any product that was marketed as an anabolic steroid for a few years. He seemed sincere and I believed him.
Friday, September 4, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
This week I saw two young women, a 31-year-old and a 21-year-old with galactorrhea. They were sent to me from two different gynecologist’s offices. Both had analysis of the breast discharge which confirmed breast milk. Both had normal prolactin on repeat testing. One had pituitary MRI which showed “physiologic hypertrophy” but no pituitary adenoma. The other was to have an MRI but was sent to me first.
Wednesday, May 13, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
Bilateral oophorectomy at the time of hysterectomy is common. According to the CDC, of women aged 40-44 years undergoing hysterectomy, 50% have ovaries removed; of those aged 45-64 years, 78% have ovaries removed. One reason is to reduce risk for future ovarian cancer. In the United States, 14,700 women die from ovarian cancer every year.
Friday, February 20, 2009
Thomas B. Repas, DO, FACP, FACE, CDE
A 19-year-old gentleman came to see me for unilateral gynecomastia. He has had it since age 13, and there were no signs that it is going to regress. Besides the cosmetic concerns, it has been painful, limiting his ability to perform his physically active job. He has already seen a surgeon and is planning to have this surgically corrected. He was sent to me to be certain there were no other factors that should be addressed first.