A 52-Year-Old Man Comes to the Office Due to Progressive

A 52-year-old man comes to the office due to progressive erectile dysfunction and loss of libido for the last 8 months.  He is unable to obtain an erection and also has malaise and poor energy.  The patient has no history of headaches, visual loss, anabolic steroid use, daytime sleepiness, or prior testicular injury.  His other medical problems include type 2 diabetes mellitus, hypertension, and hyperlipidemia.  Medications include metformin, atorvastatin, and ramipril.  The patient is married and has 2 children.
Blood pressure is 120/80 mm Hg and pulse is 66/min.  BMI is 31 kg/m².  The patient has normal secondary sexual characteristics without gynecomastia.  Peripheral vision is intact on confrontation testing.  The testes are normal in size with a soft consistency.  The remainder of the physical examination is normal.
Laboratory results are as follows:
Repeat serum testosterone is 136 ng/dL, with serum FSH of 5 mU/mL, LH of 4 mU/mL, and prolactin of 10 ng/mL.  Which of the following is the most appropriate next step in addressing this patient's current condition?

A) Intensify diabetes treatment
B) Measure nocturnal penile tumescence
C) Obtain MRI of the pituitary
D) Perform nerve conduction studies
E) Start testosterone replacement therapy

Correct Answer:

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