A 31-year-old man presenting with an 18-month history of sexual dysfunction resulting from severe adult-onset IHH (LH U/L, FSH U/L, T nmol/L). Initial therapy with 50 mg of clomiphene citrate (CC) three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. A 2-month washout period, followed by low-dose maintenance therapy (25-50 mg/d) for 4 months.
MAIN OUTCOME MEASURE(S):Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
RESULT(S):Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. CONCLUSION(S):Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect.
3. Playing It By Ear, As I Go
This last one is a bit of a contradiction -I’ve resigned myself to the fact that I cannot assert my non-binary identity in every and all cases, so, if people are given a heads-up that I’ve changed my name and pronouns, in some situations, that is good enough. Especially at work. Teachers have been great about switching over. And I honestly don’t know how many of them get the nuances I’ve tried to convey. A couple of them for sure, because they asked me questions, and I had some really satisfying conversations. But in addition to this, there’s a larger group of people who are slowly hearing about it (or not) by word of mouth – mainly buildings and grounds workers. Electricians, plumbers, HVAC specialists, people I see now and then, but certainly not every day. If they get that I am a trans-person, and they are respectful, then, that is good enough. There’s this one guy who is over at our school a lot. A few weeks ago, he took me aside, and, obviously nervous about the exchange, he said, “So, I just want to know, because we are friends… It’s Kameron now?” He was just verifying something he wanted to make sure he was getting right, and, in my eyes, I was really psyched about this because he’s a guy that I think other workers look up to. So, the more positivity around it, the better. The less nasty gossip behind my back, the better. And, to that end, I just went to a union meeting two days ago, and the secretary addressed me by my old moniker, “KT.” I almost didn’t correct her, because… I don’t know… the picking your battles thing, I guess. BUT! Someone else corrected her, someone that I didn’t know knew yet! And so, I riffed off of that, asserting, “Yep, it’s Kameron now. I changed my name.” She shrunk into herself at hearing that, but, whatever. Another buildings and grounds guy took it from there, telling me loudly that his “niece” just transitioned recently into his “nephew.” We sat down and continued to converse so that anyone and everyone could hear, if they tuned in. He was just overjoyed to be accepting “Shane,” his middle-school-aged family member. At no point did I try to assert that I was neither male nor female. If he got the gist that I am trans, and he spreads the word with a positive attitude, then that is better than good enough. Acceptance, even if limited in understanding, is still worth it!
The manufacturers of certain testosterone products (., AndroGel and Striant) state that their products are contraindicated in patients with soybean, soy, or soya lecithin hypersensitivity because they are derived partially from soy plants. There is a risk of serious hypersensitivity reactions or anaphylaxis with the use of testosterone undecanoate (Aveed) oil for injection. These allergic reactions can occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose. Observe patients in the healthcare setting for 30 minutes after an Aveed injection in order to provide appropriate medical treatment in the event of serious hypersensitivity reactions or anaphylaxis. The Aveed injection contains benzyl benzoate, the ester of benzyl alcohol and benzoic acid, and refined castor oil. Therefore, testosterone undecanoate use is contraindicated in patients with polyoxyethylated castor oil hypersensitivity, benzoic acid hypersensitivity, or benzyl alcohol hypersensitivity. Patients with suspected hypersensitivity reactions should not be re-treated with testosterone undecanoate injection.