Male Patient Case Studies

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• Case studies on male patients:

Case #1

• 64-year-old male presents with chief complaint of falling asleep after dinner.
• Patient's past health history is unremarkable.
• The patient works as an autoworker.
• The patient's mother died of breast cancer at 54, and his father died of Parkinson's disease at 78.
• Current medications: Testosterone 17 mg cream, DHEA 20 mg SR, and Pregnenolone 50 mg SR.
• Current Nutrient Intake: MVI, alpha lipoic acid 100 mg, Ginkgo 120 mg.
• Reports decreased sexual interest, impaired memory, and difficulty building muscle during exercise.
• Physical exam is non-contributory.
• Hormone test results indicate that testosterone is out of range.
• Testosterone level is 90L pg/ml, with the range being 115-3700 pg/ml.
• DHEAS is 6.8 ng/ml, within the age-dependent range of 2-23 ng/ml.
• Cortisol levels vary throughout the day: Morning 6.5 ng/ml, Noon 2.5 ng/ml, Evening 5.4H ng/ml, Night 0.9 ng/ml.
• Ongoing hormone therapies: Topical testosterone 17 mg (8 hours since last use), oral DHEA 20 mg (3 days since last use), and oral pregnenolone 50 mg (3 days since last use).

Case #2

• 17-year-old patient presents with the chief complaint of falling asleep mid-day.
• The patient's past health history is unremarkable.
• Patient is a junior in high school.
• His father is obese; his mother and four sisters are healthy.
• The patient does not take any medications or nutrients.
• The patient has an unremarkable review of systems, staying up late playing video games.
• Physical exam is unremarkable.
• Salivary testosterone levels are: Morning 278 pmol/L, Noon 229 pmol/L, Afternoon 190 pmol/L, Midnight 117 pmol/L.
• Salivary melatonin levels show: 7AM-8AM < 0.50 pg/mL, 3PM-5PM = 14.91 pg/mL, 2:30AM-3:30AM < 0.50 pg/mL
• Lab results note that The Palace Range recommends carving 95% of the afternoon salivary melatonin levels.
• Salivary Cortisol and DHEA: 1 hour after rising = 0.45 mcg/dL, 7AM-9AM = 0.21 mcg/dL, 11AM-1PM = 0.15 mcg/dL, and 10PM-12AM is 0.03 mcg/dl.
• The patient's DHEA at 7am-9am = 334 pg/mL is in the hormone reference range, as is the cortisol ration / 10,000, which = 736.

Case #3

• A 61-year-old male presents with anxiety and stress due to a poor work relationship.
• The patient has a history of hypertension, rotator cuff surgeries, and hypercholesterolemia.
• CT scan shows granulomatous disease of the lungs; rule out sarcoidosis.
• He owns a major corporation, is married with three children, and drinks 1-2 alcoholic beverages daily.
• The patient's father had cardiac stents, and his brother had an acute MI at 45.
• The patient's current medications are Repatha, ASA, and Allegra.
• The patient takes nutrients including MVI, EPA/DHA 2,000 mg, and vitamin D.
• Review of systems reveals seasonal allergies.
• He was referred by PCP to pulmonologist and cardiologist.
• Ordered secondary heart studies since CT scan was positive.
• Follow-up heart studies showed normal results except for elevated ferritin, will repeat the study to see if it is a lab error.
• Blood work was normal except for positive thyroid antibodies, the patient's thyroid function was normal.
• He also had low pregnenolone levels, patient was told to avoid all gluten.
• GI tests were ordered, will start LDN after gut is healthy, iodine test was ordered.
• The patient's pregnenolone was at 26 ng/dL, while the reference range is 33-248 ng/dL.
• Salivary Steroids lab results taken on 08/30/23 indicate: -Estradiol is 1.5 pg/mL -Progesterone is 24 pg/mL -Testosterone is 50 pg/mL -DHEAS is 6.8 ng/mL -Cortisol between 6.8 and 1.0 ng/mL Estrone levels are 3.3 pg/mL
• Hormone Therapy: Aerosol Flonase, Aerosol Glucocorticoids and oral Vitamin D3
• Salivary Steroids levels and Urinary Toxic results taken on 10/02/23 -Urinary iodine is low at 36 L µg/g Cr -Creatinine is 1.16 is in the healthy range -Hormone supplements where still taking Aerosol Flonase, Aerosol Glucocorticoids and oral Vitamin D3
• Salivary Steroids levels and Urinary Toxic results taken on 01/06/24: -Estradiol is 0.7 pg/mL -Estriol is high at 2.2 H pg/mL -Estrone levels are good at 3.6 pg/mL -Progesterone level is low at 19 L pg/mL -Testosterone levels are high at 278 pg/mL -DHEAS 2.9 ng/mL is in the healthy range -Cortisol levels low at 2.2 L ng/mL
• Elevated ferritin; patient advised to donate blood.
• Two reasons for elevated ferritin: inherited or inflammation.
• Inflammation caused by lung disease or GI health possibly causes this
• Physical exam showed the patient's thyroid is enlarged, and a thyroid U/S was ordered.
• Hormones were started: DHEA 7.5 mg E4M, Testosterone 20 mg + chrysin 2 mg + progesterone 1 mg in a gel with a repeat in 3 months, pregnenolone 10 mg E4M
• Mild three-vessel disease was revealed by CTA
• It was recommended that thyroid studies, blood work, and salivary testing, be repeated.
• U/S of the thyroid showed nodules on both sides of the thyroid gland; he was referred to endocrinology.
• Bx revealed a follicular lesion of undetermined significance. Stage III, endocrinology will follow for 6% to 18% chance of developing into cancer; repeat Bx in a few weeks.

Case #4

• This is a 60-year-old male who is without symptoms but would like to remain healthy.
• He has positive seasonal allergies.
• FH: positive for mother and sister with hypothyroidism, father lived until 94, mother is 89 and healthy, and the maternal grandmother lived to 101.
• He works as an electrical engineer.
• Doesn't take medications, instead taking MVI, zinc, vitamin D 2,000 IU, EPA/DHA, and magnesium
• Recent blood work revealed normal levels of PSA, SHBG, and DHT and showed low WBC, RBC, and HCT.
• The recent sickness the patient has recently got over impacts things: Blood testing and SMA done by his PCP was normal except for FBS of 98.
• Pregnenolone level was suboptimal with a vitamin D measurement of 38.
• Thyroid levels are elevated, and this will need to be relooked at
• Urinary toxic Essential elements shows great iodine levels at 177 µg/g Cr
• The patient is recommended to:
• -Repeat thyroid studies to see if they are accurate since the patient has no symptoms. ---If this not normal order gut health test and start Synthroid 100 micrograms daily.
• -Repeat CBC is normal.
• -Order iodine test.
• -Start pregnenolone 10 mg E4M.
• -Start DHEA 7.5 mg E4.
• -start stress reduction techniques.
• -Increase D3 to 4,000 IU daily
• -repeat saliva testing in 3 months.
• The salivary readings from around the first month of 2022 show: --estradiol 1.2 is in the healthy range --Progesterone levels are great at 20 --Testosterone levels are great at 78 --The person also has a great Cortisol and DHEAS reading
• This patient is back again in September for another visit.
• This individual reports to follow a follow up visit to assess his recent health checks.
• This individual lives under a stressful condition and has a +obesity and positive results for metabolic syndrome, hypertension, IBS, and fatty liver This patient has an unknown father history and a positive result of a maternal grandmother and mother with hypertension, CAD, and diabetes type II
• This patient is currently taking all the follow meds and nutes. --Meds - metformin, fenofibrate, losartan, testosterone 30 mg + chrysin 5 mg + progesterone 4 mg, DHEA 60 mg E4M + pregnenolone 20 mg E4M --Nutes - PS, magnesium, vitamin D, EPA/DHA, bitter melon, cinnamon, K2, chromium, vitamin D, resveratrol, MVI, berberine, bergamot
• This patient reports with with several allergies and has + arthritis right knee
• With further assessment this patient has the notes: --Find out if he put on his testosterone the morning of his test before he spit into the first tube. --Increase chrysin to lower his estrogen level. --His pregnenolone level was optimal at current dose. --Patient referred to cardiology for a repeat carotid doppler, stress test, ECG, and calcium score. --Long discussion with the patient on stress. --Long discussion with the patient on his eating habits as well as starting an exercise program.

Case #5

• This is a 59-year-old patient seeing personalized medicine and dermatology doctors concerning hair loss.
• His DHT and testosterone levels are optimal; thyroid labs are optimal on current dose.
• Positive type II diabetes, hypercholesterolemia, hypertriglyceridemia, hypothyroidism.
• No family history of male pattern baldness. Both parents are alive; mother is type I diabetic, and father has type II diabetes.
• Works as the head X-ray technologist; exercises and has 5-6 drinks a year.
• Takes metformin 500 mg BID and Armour thyroid 30 mg daily.
• He takes nutrients including coenzyme Q-10, B complex, MVI, EPA/DHA 3,000 mg, berberine 500 mg BID, bergamot BID, and vitamin D 2,000 IU.
• He has stress since he runs the department.
• The cortisol reading of this individual shows very stressful readings: --5.37 MORENINGI ng/ml --1.20 MOON ng/ml --0.59 BVAMING ng/ml --0.32 NIGHT ng/ml
• Due to the high volumes of cortisol start the patient on stress reduction techniques or counsel.
• Start rhodiola, ginseng and ashwagandha as adaptogenic herbs to help with stress.
• Start nutritional supplement for hair loss.
• Hair loss can be caused by abnormal cortisol levels.
• Return to 3 month check in: If the patient is not improved, consider writing a prescription of compounding hair loss formula.
• This individual will need to take labs again in six weeks: Thyroid studies did not reveal much improvement and compounded thyroid is needed. --Order a gut health test: lodine test was normal.

Case #6

• The 49-year-old male complaints of lack of energy and foggy thinking.
• Past health results show positive feedback for chronic headaches
• He is a pharmacist, has a grown son, has been married twice, and exercises two hours daily.
• Positive recurring sinus infections and allergies
• FH: most of his family died of heart disease, and his mother died of uterine cancer last year.
• No Meds, the person takes nutrients of EPA/DHA, liposomal glutathione, probiotics and MVI
• Hormon supplement: DHEA, Testosterone
• The adrenal lab readings show this data:
  • The cortisol AM30 reading is a bit low at 8.1 nmol/L Cortisol readings for other periods are correct: Noon 5.1 nmol/L, Evening 2.1 nmol/L and at Night 0.69 nmol/L. -The DHEA * levels are healthy 159 pg/mL. --The suboptimal diurnal cortisol pattern is consistent with evolving (Phase 2) HPA axis (adrenal gland) dysfunction.
• Lab study is to review hypothyroidism with normal thyroid antibodies and normal reverse T3 with Iodine testing and nutritional program for regular exercise

Case #7

• A 59-year-old male presents under immense stress for a follow-up visit to improve his health.
• This patient has positive results for obesity and metabolic syndrome. They also have a positive history for. ++hypertension, IBS, fatty liver and CAD. ++Known diabetes type II for the mother and grandmother ++ allergies and arthritis
• I'm unable to give you a synopsis of Lab testing due images being unable to be scanned*
  • The key is for this patient to. +Increase chrysin to lower estrogen and take cardiological to keep an eye for the patients conditions.