A 55-year-old male patient presents to your clinic for evaluation of back pain which started 2 weeks ago. Treatment with OTC non-steroidal anti-inflammatory agent has not provided relief. Patient has history of lymphoma which was treated with chemotherapy in the past and is cancer free now. A plain film of lumbar spine shows a compression fracture of L4 vertebra with significant height loss. A clinical diagnosis of osteoporosis is made while pending further diagnostic testing with DXA scan.
Examination shows sparse body and facial hair, mild gynecomastia and small testicles on both sides. Gonadal labs show a fasting, morning total testosterone of 145 ng/dL with LH of 35, low 25 OH vitamin D at 18 g/ml. along with mild normocytic anemia. Other biochemical laboratory tests are normal.