The BPA and Low-T syndrome story

Hercules, a 39-year-old man have been living in Plasticlandia for 12 years. He is the manager of Happy Plastic Bottles Inc. a company proud of their “BPA-free” products. Hercules is a casual smoker and drinker, married twice with no children from the second marriage. Hercules takes glyburide/metformin for type 2 diabetes mellitus (T2DM, diagnosed 1 year ago). He also takes vicodine for chronic low back pain. Today, Hercules complains of fatigue, weight gain, decreased libido, changes in mood, although he denies erectile dysfunction. He states that his wife is concerned that Hercules may be depressed, given his lack of interest in sex. Hercules has no family history of diabetes.

Physical Examination and Laboratory Findings

Height: 5 ft 11 in (1.80m)
Weight: 223 lb (100kg)
Body mass index (BMI): 31.1 kg/m2
Blood pressure (BP): 138/90 mmHg
Fasting glucose: 104 mg/dL
HbA1c: 6.4%
Total cholesterol (TC): 170 mg/dL
Low-density lipoprotein (LDL): 107 mg/dL
High-density lipoprotein (HDL): 42 mg/dL
Triglyceride (TG): 105 mg/dL

What question would you ask Hercules to guide/help you build a potential diagnosis?

Formulate at least 3 questions

Based on the answers of Hercules to your questions, you decided to measure total testosterone serum levels. What was/were that/those answer/s?

Total plasma testosterone levels were 275 ng/dl

Is this value normal? Why?

You decided to measure free testosterone levels in plasma. Therefore, what was your answer to that question? Why?

Free plasma testosterone levels were higher than reference values

Does Hercules have Low-T syndrome? Yes? No? Why?

1-    Endocrine disruptors and estrogenic effects on male reproductive axis
Suresh C. Sikka, Run Wang
2-    Daily Bisphenol A Excretion and Associations with Sex Hormone Concentrations: Results from the InCHIANTI Adult Population Study
3-    Serum bisphenol-A concentration and sex hormone levels in men
4-    Imbalance of Testosterone Level in Male Offspring of
Rats Perinatally Exposed to Bisphenol A
5-    Low testosterone syndrome protects subjects with high cardiovascular risk burden from major adverse cardiovascular events
6-    Low Testosterone Associated With Obesity and the Metabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk in Men with Type 2 Diabetes
7-    Testosterone Treatment and Mortality in Men with Low Testosterone Levels
8-    Adverse Events Associated with Testosterone Administration