Urology Case Challenge: A Sexually Active Construction Worker Has Erection Concerns

Edward D. Kim, MD

January 30, 2023

Physical Examination and Workup

The examination reveals a virilized male with normal-sized testes. The prostate is moderately enlarged but without evidence of induration or nodules. The penis is normal but is becoming buried in suprapubic fat. No gynecomastia or lower-extremity edema is present. The abdomen is obese but is soft, flat, and nontender.

The patient has a BMI of 32 kg/m², a blood pressure of 145/90 mm Hg, and a heart rate of 80 beats/min. Pedal pulses are present.

Lipid levels are borderline high. The serum total testosterone level is 345 ng/dL (reference range, 300-950 ng/dL). Basic metabolic profile findings are normal. A previous prostate-specific antigen result was 2.1 ng/mL. The hematocrit was 45%. A brief neurologic examination does not reveal any focal sensory or motor deficits.

The patient's erectile function (EF) domain score, as derived from the International Index of Erectile Function (IIEF) questionnaire, is 19.

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