Geraldo Laurus
Andrology Study Program, Faculty of Medicine, Universitas Airlangga

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How Low is Low Enough to be Given Testosterone Replacement Therapy in Patients with Late Onset Hypogonadism? What Should Be Evaluated? A Case Report Geraldo Laurus; Supardi
Indonesian Andrology and Biomedical Journal Vol. 3 No. 2 (2022): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/iabj.v3i2.40773

Abstract

Abstract Background: Late Onset Hypogonadism (LOH) is a disease associated with advancing age, characterized by symptoms and a deficiency in serum testosterone. It is important to choose which patient suitable for testosterone replacement therapy (TRT), but there is no one consensus that fits for all. After treating patients with testosterone replacement therapy (TRT), several parameters need to be evaluated. Case: A 74-years old male came with chief complaint of difficulty to maintain erection since 2 years ago.. PADAM questionnaire was positive and IIEF-5 score was 6. Physical examination showed an underweight condition. Total testosterone level was 3,65ng/mL, and patient chose to be given TRT instead of evaluating his free testosterone. PDE-5 inhibitor and non-pharmacologic treatment was also given. Follow-up showed that his erection was improved. Discussions: At which level should testosterone be substituted is still debatable. Several consensuses issued by several organization still cannot be used universally. Study in Indonesia showed that symptoms of LOH had been occur when the testosterone level still in normal range. After giving TRT to our patients, routine follow up is needed. Non pharmacologic treatment also needs to be addressed to improve the outcome. Conclusions: Symptoms of LOH had been occurred even though testosterone level is still in normal range. The consideration made by clinician is the most important thing to be evaluated, whether to give TRT or not. Somatic and laboratory parameters mentioned in this study is important to be evaluated.
A Case Report of Psychogenic Erectile Dysfunction with Ego Dystonic Sexual Disorientation: Is Still Relevant to Treat? Geraldo Laurus; Cennikon Pakpahan; William William; Raditya Ibrahim
Indonesian Andrology and Biomedical Journal Vol. 4 No. 1 (2023): June
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/iabj.v4i1.44619

Abstract

Background: Converting Ego-dystonic homosexual to heterosexual is still controversial. homosexuals are encouraged to be accepted and do not require conversion. Currently, many cases of homosexuals are required to accept their identity and do not require conversion. However, there are times when patients want to be heterosexual and experience sexual dysfunction because of this orientation. Then, how a medical professional deal with such a case especially in the era of ease of information and technology? Choose to demand that the patient accept their sexual orientation or help the patient to become heterosexual. Objective: Here we present the case of a man, 44 years old, with a psychogenic erection with ego-dystonic homosexual disorientation, along with a review of the literature related to the case. Method: A case report with literature review Case/Result: We report 44-year-old man who has been married for six years complains of difficulty and decreased erection for 5.5 years. This man had a history of sexual intercourse with men during college but decided to become a heterosexual man and married his current wife. For the first six months, the patient performed oral sex with his wife. Then afterwards, the patient has difficulty getting an erection and even fails. The patient feels guilty toward his wife until their relationship becomes a crisis. The patient wants to commit to being a heterosexual man. So, the patient came to the andrology clinic for therapy. We applied intersystemic assessment approach to the patient. There is progress in the patient’s condition until now. Conclusion: Many experts say that homosexuality should be accepted and should not be converted. But in the end, the choice is returned to the patient, whether to choose to convert or not. Physicians only need to support the patient's therapy and choices so that he does not experience any mental disorders that ultimately endanger his life. Keywords: , , , ,