Sexual Medicine and Medical Collaboration · Endocrine Screening

The Invisible Contributors

Eight symptom clusters, four endocrine axes. In every one of them the sexual symptom is the reason the client came in and the systemic symptoms are the reason you refer.

What this exercise practises

Reading a cluster rather than a complaint, naming the axis you would ask about, and distinguishing presentations that have an obvious psychological narrative already attached to them.

The bins are axes rather than diagnoses, because the axis is what belongs in a referral and the diagnosis is what the receiving clinician establishes. Two clusters belong to each axis.

Estimated time to complete this exercise: 20 minutes

1The clusters
2The case
3Close

Before you begin

How this one works

Eight symptom clusters, four endocrine axes. Sort each cluster to the axis you would be asking about.
The bins are axes rather than diagnoses. The axis is what you refer for. The diagnosis is what the receiving clinician establishes, and in some cases cannot establish on a single reading.
After the sort there is one case, and the question is what you do in the first session rather than what she has.
Nothing is graded and nothing is recorded. Reloading starts it again.

Endocrine disorders are common, frequently subclinical in presentation, and significantly underidentified as contributors to sexual dysfunction in mental health settings. Subclinical is the operative word. These presentations do not announce themselves, and in every cluster below the systemic symptoms are the ones the client has stopped mentioning because nobody has ever connected them to anything.

References

  1. Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. https://doi.org/10.1210/jc.2018-00229
  2. Carani, C., Isidori, A. M., Granata, A., Carosa, E., Maggi, M., Lenzi, A., & Jannini, E. A. (2005). Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. The Journal of Clinical Endocrinology & Metabolism, 90(12), 6472–6479. https://doi.org/10.1210/jc.2005-1135
  3. Elsenbruch, S., Hahn, S., Kowalsky, D., Offner, A. H., Schedlowski, M., Mann, K., & Janssen, O. E. (2003). Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 88(12), 5801–5807. https://doi.org/10.1210/jc.2003-030562
  4. Melmed, S., Casanueva, F. F., Hoffman, A. R., Kleinberg, D. L., Montori, V. M., Schlechte, J. A., & Wass, J. A. H. (2011). Diagnosis and treatment of hyperprolactinemia: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 96(2), 273–288. https://doi.org/10.1210/jc.2010-1692
  5. Shifren, J. L., & Gass, M. L. S. (2014). The North American Menopause Society recommendations for clinical care of midlife women. Menopause, 21(10), 1038–1062. https://doi.org/10.1097/GME.0000000000000319
  6. Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., & Norman, R. J. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, 33(9), 1602–1618. https://doi.org/10.1093/humrep/dey256