Diving Deep for a Man’s Health
As a surfer, I find spending time on the ocean wonderfully intoxicating. The power and pitch of the waves, the size of swells, the shimmer of the sea, all magnificent to behold. But, what’s beneath the water’s surface is truly a whole other world; one even more marvelous than floating on top. And so it goes with men’s health.
Scratching the Surface
He came to see me because his vasectomy reversal had failed and he was wondering whether I could help him have kids. He had had a vasectomy and then a vasectomy reversal a decade or so later. The reversal had worked initially but over the last several years, while he was trying to conceive, his sperm count fell to zero. Not a single swimmer.
I think about several things when I see this: surgical failure of the reversal procedure with scar tissue causing re-blockage, changes in health (cancer, diabetes, obesity), testicular failure from illness or exposure (fevers, hot baths, solvents) and medications, to name a few. And since I have a habit of asking “why?” we now break the water’s surface and head into that deeper place where answers lie.
He was a picture of health. His reversal was done by a highly competent colleague and so I ruled out reversal failure. He was medication-free and had no bad health-related habits. I was really coming up empty handed…except for one thing: he mentioned that he was feeling more tired lately and has been having trouble with erections and a lower sex drive. His primary care physician measured his testosterone and it was low…really low. Low testosterone could explain the erection and sex drive issues and also poor sperm production.
His doctor suggested that he start on testosterone replacement. But the patient knew better: this might help his symptoms, but it would “turn off” sperm production. He didn’t follow that advice but asked for my help instead.
Deep Dive
It is medically satisfying and usually correct when a set of symptoms can be ascribed to a single overarching diagnosis. But this didn’t happen until I reviewed the ream of laboratory data that he handed me during the visit.
Then I saw it. His blood counts have always been really high. For years. Thick blood. Hemochromatosis! A genetic condition that causes blood to sludge in the pituitary and reduce the signal strength for the testicle to make testosterone and sperm. We confirmed it with iron studies. He started donating blood, and I kickstarted his pituitary with medication, and, low and behold, both his sex life and sperm returned.
Being able to find and cure disease relies not only on powers of observation, but also the ability to listen (and trust) that what patients tell you is real and relevant. Only then, when the truth is laid bare on the table, does the hidden become obvious.
