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Hypospadias , gynecomastia, low testosterone - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Men's Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
Doctor :   hi
Doctor :   Dr. XXXXXXXX here
Doctor :   please proceed with your health query
Doctor :   how can I help you?
User :   Hello I am 23 year old male ,i have got some tests done in which my dheas-187,testesterone-258 and prolactin-19 and esr -45,got gynecomastia surgery done and currently having problem of distal hypospadias -have short penis-i suppose under developed,erection for small time and sperm volume on ejaculation very low and does not come the second time,less hair on my body,less secondary sexual characters such as less hair on body-chest and face ,high pitch voice and no muscle mass ,less bone density,get fatigued easily.Suffer from low blood pressure and high pulse rate-114 to 120.Pls suggest some treatments to get me fit.
User :   my reports are sent from WWW.WWWW.WW at doctor and customercare email
Doctor :   let me read what you have typed
Doctor :   let me go through your reports
Doctor :   your DHEA and testosterone levels are fine
Doctor :   the estrogen levels are on the higher side. it should come back to normal in due time.
Doctor :   coming to addressing your problems, let me do it one by one
Doctor :   the distal hypospadias, needs to be examined to see if there is any correction surgery required.
Doctor :   what is the penis size when in flaccid state and in erect state?
User :   yes i went to doctor,he asked for urethroplasty
User :   in erect it is 13cms and flaccid is very small
Doctor :   ok, then I would advise you to go ahead with the urethroplasty
Doctor :   it will improve the erection time to some extent and also the ejaculation
Doctor :   coming to the ejaculation problem, there is lag time needed in between two ejaculations, before you can have a proper erection and ejaculation
User :   but it is usually done for infants,does it has any compliacations at age of 23 years
Doctor :   normal semen ejaculate can vary from 1ml to 6.5 ml in men
Doctor :   no it should not have complications
User :   so how to get this test done for semen count and what other tets to get done?
Doctor :   the lag period can vary from 15 minutes to 2 hours in men
Doctor :   the semen test or analysis is for seeing the quality, quantity and morphology of sperms
Doctor :   it will be done on the semen sample you will give
User :   what about low testerone levels which are below normal
Doctor :   the testosterone being low can be supplemented externally in form of tablets or injectables, but first the hypospadias should be corrected, else the supplementation will be of no use.
Doctor :   was a doppler scan done for scrotum?
User :   as per my conditio what you need to say what treatments i need to take and what medicines,surgery is very expensive and at the moment after gynecomastia i do not have sufficient funds for another surgery ,by what age i can get it done and how many days it take to recover?
User :   no doppler scan done but doctor told testes size is small but balls are ok
Doctor :   ok. in that case I would suggest you to take a second opinion for your condition from a urologist, you can do it either by meeting a urologist personally or by e-mail or phone from our panel specialist
Doctor :   right now what can be done is to supplement testosterone for sometime and get the surgery done to correct hypospadias as soon as possible
User :   can you guide me or i need to have specialist opinion only
Doctor :   in the meantime have a well balanced diet and have plenty of fluids to try and correct hypotension.
Doctor :   I am a general practitioner, you will need specialist guidance for your problem.
User :   can you elaborate -like name of testerone supplement and what diet i take and what fluids
Doctor :   if you decide to consult our panel specialists, here is the link for it
Doctor :   WWW.WWWW.WW
Doctor :   the testosterone supplement dose should be given based on your examination findings, since I am not examining you personally, It would be unethical to prescribe you
User :   doctor i asked about medications and supplements
Doctor :   WWW.WWWW.WW
Doctor :   this link is for you find list of urologists in XXX , for getting an repeat examination done if needed
User :   what about high pulse rate,low B.P.,i am always stressed,confused and unhappy,do not have enough energy as boys of my age have ,why ?
Doctor :   your treating doctor should prescribe you, discuss about getting the prescription in your next visit to your doctor.
Doctor :   these symptoms could indicate depression due to your preset condition. and also be a part due to higher estrogen levels
User :   i have oily skin and have acne problem,can you help in that
Doctor :   having a well balanced diet will solve a few of them
User :   what is well balanced diet,i need details
Doctor :   the oily skin and acne may be due to estrogen levels being on higher side
User :   ok
Doctor :   your diet should comprise of the right amount of carbohydrates, protiens, fats, vegetables, and fruits
User :   so i need to see a urologist,can you name some good ones in XXX ,i am from XXX XXX
Doctor :   you should take 3 servings of vegetables and 2 servings of fruit per day.
Doctor :   i have given you the link to find urologist in delhi, you can select your nearest area of location and find one there.
Doctor :   coming back to diet advise: incorporate protines in form of beans, meat (if you take non veg food), milk and pulses
User :   ok,so is there any need to visit endocrinologist as told by my doctor after gynecomastia
User :   i am a vegetarian
Doctor :   you already ahd the surgery for gynecomastia, now you need to visit endocrinologist to get the estrogen levels under control, to avoid recurrence
User :   so can you give me a link for them and which is imp. first urologist or endocrinologist?
Doctor :   first is urologist and then endocrinologist. i will send teh links again
User :   how ths condition happnd to me ?
Doctor :   WWW.WWWW.WW
Doctor :   WWW.WWWW.WW User :   so in my case email or telephone call will help or a visit ,i lack funds ,so need to know how much ths all costs
Doctor :   the hypospadias could have resulted as a birth defect
User :   and my overall condition is result of high estrogen-that is birth defect or defect in pituitary gland
Doctor :   for second opinion from our panel specialist, phone call might help in better way in which you can ask all your queries.
Doctor :   hypospadias could have resulted as birth defect
User :   what can i ask them to solve my problem
Doctor :   and the high estrogen may be due to the pituitary problem
User :   as you told first i need urethroplasty and then testesterone supplentation
Doctor :   you first need a detailed investigations to look for further causes why you are having higher estrogen level, if a pituitary cause is suspected
Doctor :   then a brain MRI to see if pituitary ia enlarged
Doctor :   the low testosterone levels also need evaluation further with a urethroplasty to correct the hypospadias.
User :   so which more tests,also in mu cbc there was problem in rbc -like i read about it rbcmw was more ,larged size cell and esr was 45
Doctor :   the approach to problems depends on what is most urgent to you now
Doctor :   the another cause for all your problems could be genetic cause, a karyotyping test will help to find out if there is any such problem
User :   oh my god ,what kind of defect i am,i need so many tests ,what do you suggest at the moment to me ,how to go about,its been a week after my surgery has completed
Doctor :   the most common cause for hypospadias and gynecomastia is chromosomal abnormality which results in such birth defects
Doctor :   so in such cases the facial and other body hair distribution is affected with testoterone levels being low
User :   so can i become normal now or have to struggle like this
Doctor :   if we put all your symptoms and recent investigations together, then the possibility of a chromosomal abnormaility being present increases
Doctor :   I would in this light advise you to take these steps
Doctor :   1) get a karyotyping done, to look for abnormality, get counseling done based on the results
Doctor :   2) meet endocrinologist to get estrogen levels adjusted (since you cannot go for surgery at present for hypospadias)
Doctor :   3) meet urologist and get re-examination done to see if the hypospadias can be fixed totaly
Doctor :   4) discuss about getting testosterone supplemented after getting a semen analysis done.
User :   hw much karyotyping cost and where in XXXX is it done?
Doctor :   5) if the sperm production is found less or nil, then further test should be done to see if the precursor cells in testes are normal or not, it will require testicular biopsy.
Doctor :   In XXXX , XXX will be the best to get the karyotyping done, and the results interpreted, as it will have Genetic Department associated with it
Doctor :   Karyotyping is also done in XXXX in the Karyotyping center
User :   what are other options and pls tell me avg cost,as i am not doing any job at present and all this due to shyness to face the world with confidence and my parents arre not so well off and i dont want relatives to make fun of me as they laughed out when i went for gynecomastia treatemnt ,they say most men have but i can't be open to them about my problem you told me.
User :   where in XXX ?
Doctor :   let me search, and get back to you, give me sometime
Doctor :   this is the address in XXX
Doctor :   XXX
Doctor :   is there anything else I can help you with?
Doctor :   focus on finding the exact cause for your problems such that definite treatment can be started
Doctor :   are you there?
User :   yes,i have my sister,she is 26 ,she had gullen barre syndrome when she was 12,gradually she has recovered so an extent that she was able to walk by taking suppport of stick or something to hold on ,but she fell down on 31,march and underwent ORIF,then she is not able to stand on her own as earlier ,she is not standing straight but bending and moving short distances with walker with wheels now after 3 months,any doctor or treatment for her.she is been taking physiotherapy for many yeras and now too.
User :   hello
Doctor :   yes i am here, i am reading what you have typed
Doctor :   for her I would suggest combined orthopedic and neurologic approach
Doctor :   when was her recent followup?
User :   very recently
Doctor :   ok
User :   neurologic approach was taken for years when she got this gullen barre ,they told nerve weakness caused musle weakness and then se stuck to physiotherapy
Doctor :   ok
User :   now what ?
Doctor :   if there is not much improvement in her condition, then get a second opinion
User :   she has become obese these 3 months,gained a lot while on bed
Doctor :   from another neurologist and an orthopedician
User :   can u name a few or refer
Doctor :   WWW.WWWW.WW
Doctor :   WWW.WWWW.WW
Doctor :   visit these links to locate neurologist and orthopediacian. since I am from Bangalore I do not have any personal reference.
User :   ok bye take care,i will continue later
Doctor :   sure, you can get back to us if you have further queries after getting the tests done
Doctor :   thanks for consulting me , bye for now
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