Low Testosterone and Blood Disorders

One of the exciting things that happens in my office is when a patient comes in animated with joy because of the success of our treatments. This recently happened in an unusual way when a man came into my waiting room and announced to me in a very loud voice: “You literally saved my life and I want to thank you for it!” At the time, I thought that he was just happy with the results of the testosterone we had replaced for him. Perhaps his sex life had been returned or he and his wife were no longer fighting. Typically, men quickly feel better when they return to a normal (adequate) level of testosterone, so this statement is not unusual. I told him it was my pleasure to help him. But he insisted on telling me and all of the other patients in the waiting room his story. When he first came to me for evaluation, I gave him his first dose of testosterone but told him that he could not continue until he saw his primary care doctor to work up some unusual findings in his blood tests. I knew his particular problem could be anything from minor to life-threatening. His regular doctor saw nothing wrong, and sent him back to me. I still refused to provide him with testosterone replacement because long-term testosterone could worsen some of the possible diagnoses that he might have had. I had made him concerned enough that he went to a specialist in hematology. This specialist, a hematologist/oncologist, found that he had a genetic mutation that made his red blood count very high and never turn off. As a result, his blood was too thick and he needed to periodically donate and destroy a unit of blood to bring him from accumulating too much. This is called a Jak2 mutation and it is rare, but not unusual. The specialist was concerned that his regular doctor had missed it. Once he was treated for it, he sent the man back to me with the message: “Most men your age with this problem have already had strokes or heart attacks. This is potentially fatal and it is good that we caught it.” My patient had gotten a second lease on life, and the initial testosterone had made him feel young and healthy again.