A 37-year-old man presented to the primary care clinic with fatigue, subjective muscle weakness, erectile dysfunction, and decreased libido of several months’ duration. These symptoms had progressively worsened over several months. He also reported poor morning erections, decreased motivation, loss of interest in activities he previously found enjoyable, depression, anxiety, sleep disturbance, and snoring.
He reported no weight changes, headaches, or vision changes. His medical history was notable for generalized anxiety, gastroesophageal reflux disease, and long-standing obesity.
On physical examination, his blood pressure was 133/86 mm Hg, heart rate was 73 beats/min, and body mass index was 39 kg/m2. His weight had increased 7 kg over 2 years but had been stable for 6 months.
Cardiovascular, respiratory, abdominal, and neurologic (including cranial nerve, strength, and sensory) examination results were unremarkable. Neck circumference was 45 cm,
and the oropharynx was rated as Mallampati class II. The thyroid gland was nonenlarged, nontender, and had no palpable nodules. The testicles were nontender with normal firmness and size and measured 20 cc bilaterally,
with no testicular masses or inguinal hernias noted. The patient’s prostate gland was normal in size and morphology. His score on the Patient Health Questionnaire-9 depression screen was 11, indicating moderate depression.
