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Brain-injury impotence lies undiagnosed

A friend's son committed suicide last year, apparently as he could no longer cope with relationship problems due to impotence. It seems that a childhood head injury had caused pituitary dysfunction resulting in impotence and depression.

After initial scepticism, as neither my GP colleagues nor myself were aware of this association, I Googled ‘traumatic brain injury and hypopituitarism'. I was surprised to find that this complication is far more common than previously thought and most cases are undiagnosed – tragically, as they can be treated.

GPs in particular are well placed to pick this up by asking whether patients with impotence or depression have ever had a head injury, and if so, checking pituitary function (FSH, LH, prolactin, GH, TFTs, ACTH/cortisol, testosterone/ oestrogen as appropriate). Treatment of hypopituitarism by appropriate hormone replacement can greatly improve quality of life.

Perhaps if my friend's son had been to his GP and had his testosterone tested and replaced, he might still be alive today.

From Dr Graham Brodie, Chapel-en-le-Frith, Derbyshire

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