MRCP2-1251

MRCP2-1251

A 52-year-old male presents at the diabetic clinic for his annual review. He has been diagnosed with diabetes and mild hypertension for four years and is currently taking gliclazide 160 mg bd, metformin 500 mg bd, rosuvastatin 10 mg od, and bendroflumethiazide 2.5 mg daily. During the consultation, he expresses concern about his deteriorating impotence, which has been ongoing for the past 12 months. Despite trying Viagra, he has not experienced any improvement. His wife is understanding, but he is becoming increasingly distressed about the situation. Upon examination, he has a BMI of 29 kg/m2, a blood pressure of 134/78 mmHg, and a pulse of 90 bpm. There is no evidence of neuropathy or retinopathy, and all pulses are palpable. He reports no history of joint pains.

The patient’s investigations reveal a HbA1c of 63 mmol/mol (20-46), fasting plasma glucose of 9 mmol/L (3.0-6.0), total cholesterol of 4 mmol/L (<2.5), serum testosterone of 6.5 nmol/L (9-35), plasma lutenising hormone of 0.5 mU/L (1-10), plasma follicle stimulating hormone of 0.9 mU/L (1-7), and plasma prolactin of 322 mU/L (<360). What further investigation would you recommend for this patient?