THE ENDOCRINE BLUES

Recently I started very abruptly to experience a mysterious suite of symptoms -- elevated blood pressure, elevated pulse, hand and leg tremors, loss of appetite, aching joints, periods of disorientation and lack of mental focus, alternating chills and hot flashes, the inability to sleep. Since the onset occurred on a weekend, as the symptoms intensified I was forced to choose between going to the ER, or waiting until Monday to see my regular family practitioner. My choice to wait was guided partly by denial ("it has to get better"), but mostly by my having no health insurance coverage (a commentary on the catastrophic state of health care nationwide).

I suffered through the weekend, averaging 1-3 hours of restless sleep per night. By Monday night I was seriously contemplating my own imminent mortality.

The physician's assistant who saw me on Monday morning was clearly at a loss -- such a bizarre variety of symptoms could result from any of a score of sources. My vital signs were in fact elevated, but not to the point of crisis. Opting for a conservative approach ("Physician, first do no harm"), the PA ordered a urine test and a series of blood tests to try to narrow down the field of possible causes. In the meantime .... I had to guts it out. Over the subsequent four days my symptoms very gradually abated. The blood results ultimately revealed no clues. That painful and fearful episode remains a mystery. I dread going through it again, without knowing how to treat it.

Those same blood results, however, did reveal two important ancillary results which warranted further investigation. The first was a low testosterone level. The quintessential male hormone is manufactured in the testicles, and not only plays a key role in male reproductive development, but also influences muscle mass, bone density and hair growth. The low T-level was consistent with my decreased libido in recent months, and a possible result of my having had a vasectomy in 1985. The fix is easy -- I'm now on a simple hormone enhancement therapy, a topical cream.

The second blood result was potentially more troubling -- a slightly elevated PSA reading, indicating a possible disorder in the prostate gland. The prostate is one of three primary contributors to male sexual function. It secretes a milky, slightly alkaline fluid which makes up 25-30 percent of the volume of male semen, accompanied by spermatozoa from the testicles and by seminal vesicle fluid (see diagram below, click to enlarge).

The prostate has another important function -- regulation of the flow of urine. The gland is approximately the size of a walnut. Torus-like, it surrounds the urethra just below the urinary bladder, and may be felt by a physician during the dreaded (because uncomfortable) digital rectal exam.

PSA readings are notorious for giving significant numbers of false positive results (indicating a disorder which is not really present) and false negative results (failing to indicate a disorder which is in fact present). Still, it is a starting point for further investigation. Potential causes for an elevated PSA reading include prostatitis (prostate inflammation), benign prostate hyperplasia (prostate swelling), and (gulp) prostate cancer. You can imagine my trepidation when I visited a urologist yesterday for his diagnosis.

Long story short, he found no evidence to indicate the presence of cancer. He pointed out that PSA levels can, over time, vary in a sine-wave pattern for any individual man, and still be within acceptable limits. My elevated level is low enough to warrant observation, but no intervention is called for just yet. Another PSA reading in three months will give us a more definitive picture of what's going on.

Deep sigh of relief. So why have I burdened the gentle reader with this long and potentially boring narrative? Because if you are a man over age 50, or know a man over age 50, this is information which needs to be just as familiar as any other health issue. For men, regular blood tests, rectal exams, and periodic colonoscopies (I know, ick) are just as important as diet and exercise in taking good care of our health.