N ,40, was very reluctant to talk about his problems on his first visit. He had been married for 3 years and had tried for a baby for the past one year.
“How often do you have intimacy with your wife?” I asked. “Not often” was his short answer. He did not wish to elaborate further citing tiredness as being the reason.
As we established a closer rapport, he was more relaxed and more willing to open up during his subsequent visits. “Doc, my sexual desire and libido have taken a beating during the last 6 months. I used to be intimate with my wife two to three times a week,” he recalled,” but now, it is down to once a month and sometimes even longer. Erection difficulties have surfaced more often in the past 2 months. This has made the situation worse and I am becoming depressed.
I feel tired most of the time after work. I would even sleep watching television.
I used to play basketball once or twice a week but now my strength is gone. I could not even aim at the hoop properly.
Now, I really appreciate the lyrics in Beatles’ song “Suddenly, I’m not half the man I used to be”...." he sighed.
N was suffering from symptoms of low testosterone, the male hormone in our body. This was confirmed by a blood test. After investigations, I found the low testosterone was due to a tiny growth in his pituitary gland, a small pea-size gland at the base of the brain.
That tiny growth is called a prolactinoma which produces an abnormally high amount of prolactin, the milk producing hormone. It is noncancerous and occurs infrequently. They usually remain small, less than 1 cm in diameter, and are called microadenomas. Very rarely, they may grow bigger and become macroadenomas.
Elevated levels of prolactin reduce testosterone and sperm production. Low testosterone will cause decreased energy, sex drive, erection difficulty, reduced muscle mass and strength, the symptoms manifested in N’s case. If left untreated, low blood count (anaemia) and brittle bone disease (osteoporosis)may result. Breast tenderness and enlargement may also be present.
If the prolactinoma gets bigger, visual impairment may occur and hormones produced by thyroid and adrenal glands may be affected.
Prolactinoma is diagnosed by an elevated blood level of prolactin and the demonstration of the tumour in the pituitary gland by magnetic resonance imaging (MRI)
Most prolactinomas respond well to treatment with medications. Surgery is seldom necessary unless the tumour gets bigger and cause visual disturbances.
N was treated with medication promptly. His blood levels of prolactin returned to normal within a month and the testosterones levels gradually rose. He began to feel more energetic and his sexual drive reverted to normal.
He was beaming with joy when I confirmed that his wife was pregnant 5 months after his treatment. However, I warned him that he should continue with the medication and monitor the prolactin levels as recurrence of prolactinoma occurs frequently.