Erectile dysfunction with diabetes — SCE Endocrinology MCQ

Correct answer: D — Repeat morning testosterone with SHBG and gonadotropins

The best answer is “Repeat morning testosterone with SHBG and gonadotropins”. Testosterone has diurnal and biological variation and can be lowered by obesity and acute illness; diagnosis requires compatible symptoms and consistently low properly timed measurements, then gonadotropins to classify the cause. “Start testosterone from the single afternoon value” is less appropriate because a single poorly timed result does not establish persistent deficiency “Diagnose primary testicular failure without measuring gonadotropins” is less appropriate because LH and FSH are required to distinguish primary from secondary disease “Arrange adrenal CT before confirming biochemical hypogonadism” is less appropriate because adrenal imaging is not part of initial confirmation “Start cabergoline without measuring prolactin or confirming testosterone” is less appropriate because dopamine-agonist treatment requires a demonstrated prolactin disorder and does not substitute for diagnostic testing

Reference: Society for Endocrinology: Male hypogonadism and testosterone replacement. https://www.endocrinology.org/endocrinologist/143-spring-22/features/male-hypogonadism-and-testosterone-replacement/