52-year-old man comes to the office due to decreased libido and inability to achieve and maintain erections for
the past several months. He has also had fatigue, anorexia, and a 5-kg (11-lb) weight loss over the same
duration. The patient is married and has one child. He drinks alcohol but does not use tobacco or illicit drugs.
Blood pressure is 110/70 mm Hg and pulse is 82/min. Physical examination shows bilateral gynecomastia and firm
and small testes. Laboratory testing shows normal TSH with decreased levels of total triiodothyronine (T3) and
thyroxine (T4). Which of the following is the most likely diagnosis?
- 0 A. Adrenal insufficiency
- 0 B. Chronic liver disease
- 0 C. Exogenous thyroxine intake
- 0 D. Hashimoto thyroiditis
- 0 E. Penile vascular occlusion
- 0 F. Testosterone insensitivity
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