What was meant to be a joke landed Jemima in real serious trouble. She had referred to Richard, her husband, as a castrated bull. He got very upset and would not talk to her.
"So how can I help you," I asked, not sure how Jemima's story related to sexual health.
"Let's go back to why I jokingly called Richard a castrated bull," she said and went ahead to narrate how she had noted Richard's body change over time.
They were in their 15th year of marriage and had three children. They were both of the same age, having hit 41 in February.
On the fateful day, the couple had been in their bedroom. It had been a long week together in the house following the Covid-19 control restrictions.
They were both working from home. Richard removed his clothes preparing to have a shower. Jemima was staring at him and without much thought noted how her man had changed.
He had a big tummy and his breasts, too, were prominent. He had accumulated fat over the years.
Having come from a pastoralist community, Richard's body reminded Jemima of what was a common occurrence among her people; they castrated bulls to fatten them and within no time the bull would be bursting with muscles and fat and would fetch huge amounts of money in the livestock market.
"So for me it was an innocent joke when I referred to him as a castrated bull," she explained.
But later during counselling, Richard indicated that in his understanding, he was called a castrated bull because he was suffering erection problems.
This had been going on for three years. Things got worse during the Covid-19 period when they were together in the house all the time.
They attempted sex several times without success. Richard was frustrated and the mere mention of a castrated bull threw him off balance. I asked Jemima to bring Richard along to the clinic the next day.
True to Jemima's description, Richard was obese. He had lost his waistline. He had prominent man boobs. His erections had fizzled out over time and the couple had not had sex for over a year.
I ordered tests and the big finding was testosterone deficiency. Testosterone is the hormone that defines male characteristics. It makes a man hairy, muscular, and aggressive.
It brings the sex desire, causes one to imagine and have sexual thoughts, and makes the sexual process successful.
"So you were both right in your interpretation of a castrated bull," I said trying to explain what testosterone deficiency does to a man.
Most men with low testosterone will not only have sexual difficulties such as low libido and erectile dysfunction; they also suffer body changes that include obesity characterised by increased fat in the abdomen as well as breasts.
Further, the affected person lacks stamina, they are not aggressive and are fatigued most of the time. "That sounds quite familiar," Richard interjected. "In fact, I no longer feel like going to work; my moods are always low."
And yes, low testosterone can cause foul moods, irritability, and anxiety. Loss of self-confidence is also common. Victims can suffer a loss of sleep.
After a full assessment of all his body organs, I put Richard on testosterone hormone replacement. I further advised him on exercise and diet.
It is always interesting that low testosterone will cause obesity and also that weight gain in itself lowers testosterone.
In six months, I projected, Richard would be moving towards the right BMI. With exercise, his weight will be regulated and he will get weak erections.
It's then that I will add him medicine to strengthen the erection. "I will also recommend sex coaching," I explained.
"But doctor, how does that help with testosterone deficiency?" Richard asked.
Well, after many months of not having sex couples do need to be started all over again through structured lessons and intimacy exercises. That is what sex coaching helps to achieve.
Richard will still need to be on the testosterone treatment for quite a while and will need check-ups in the clinic every six months.