Cerebral venous sinus thrombosis is a challenging diagnosis due in part to its variable clinical presentation and rarity. The annual incidence ranges from 0.22 to 1.57 per 100,000. The etiology of such disease is related to hypercoagulability states. Although illicit androgen use is a well-known cause of prothrombotic states, its risk of causing cerebral venous sinus thrombosis has been infrequently reported. We present the case of a 33-year-old male with no known past medical history who presented to the emergency department (ED) with persistent seizure activity, neurological deficits, and history of worsening headaches who was found to have an extensive superior sagittal sinus thrombosis on imaging. Radiologic findings demonstrated pathognomonic findings of cord sign and delta sign, the previous being highly specific but of low incidence. An inconclusive hypercoagulability workup prompted further questioning which revealed illicit androgenic anabolic steroid use. Prompt treatment with anticoagulation and anti-seizure medication was pursued with full resolution of his neurologic symptomatology.

Despite the rich vascularization of the penis and its close proximity to other pelvic organs, cutaneous manifestations of metastatic disease to the penis are an uncommon occurrence. Penile lesions suspected for malignancy should alert clinicians to differentiate between primary and secondary tumors. While the majority of metastatic malignancies arise from the genitourinary tract, we present a unique case report of a 51-year-old male with penile metastasis of primary rectal adenocarcinoma. A thorough diagnostic evaluation was performed including imaging studies, colonoscopy, as well as penile biopsies with associated immunohistochemistry panel. The patient was diagnosed with penile metastases secondary to invasive rectal adenocarcinoma. Due to the aggressive nature of the patient’s presentation, systemic chemotherapy was initiated for palliative measures as the patient declined any radical surgical intervention.

Male hypogonadism is a condition in which the body does not produce enough testosterone, resulting in symptoms such as depressed mood, decreased sex drive, decreased skeletal muscle, and increased fat mass. Male hypogonadism can be readily treated with many available treatments when clinically indicated. The advent of readily available testosterone therapy has increased the importance of finding the most efficacious and cost-efficient treatment modality to approach these patients. Testosterone is typically administered through intramuscular or subcutaneous injections, topical gels, and oral tablets. The efficacy of testosterone therapy on hypogonadal men has been widely studied. However, there has been little research done comparing each modality against each other. This paper seeks to compare the various modalities of testosterone replacement therapy using various parameters such as the beneficial effects on bone mineral density, skeletal muscle mass, fat mass, and libido while simultaneously weighing the distinct undesirable side effects of each form of administration. Our investigation analyzes the methodology and results of the existing research within this field. It aims to draw a nuanced conclusion about the current standard of care for testosterone replacement therapy. According to our research and statistical analyses, we have concluded that oral administration has shown to be as advantageous as other modalities for male hypogonadism. Currently, injectables are the modality of choice, but with the right improvements, oral administration can potentially overtake injectables and transdermal testosterone as the treatment of choice.